– He tells me that it is completely harmless. It is October 2020, and the mole that has been on her stomach since she was a child has begun to change. Mari Foseid Tronbøl goes to her GP in Oslo with a wish to have it removed. The doctor takes a look, thinks the stain is a wart, not a mole, and emphasizes again that it looks completely harmless. – We agreed to look into it, Tronbøl tells news. This is what Mari Tronbøl’s stain looked like when she finally had it removed. Then it had begun to change shape and color. Photo: private – Gets bigger and itchy Autumn turns into winter, and the stain has moved. – It gets bigger, deeper and it itches, Tronbøl says. She orders a new appointment with the GP. Again, he says that the stain looks completely harmless, and that she does not have to worry. It will be March 2021 before she decides to go back with some demands. – Now something must happen, you have to take it, I say to him. The doctor does not want to cut it off himself, but refers to Aleris, where Tronbøl only gets an appointment in June. After struggling to get it accelerated, she is assigned an hour in May, two months later. – Not taken seriously – Our impression is that unfortunately it varies too much from GP to GP how much knowledge they have about melanoma. Many members say they have not been taken seriously by the GP, according to the general manager of the Melanoma Association, Mari Sandvold. Photo: Anders Botnmark This is what Mari Sandvold, who is the general manager of the Melanoma Association, says. The association brings together about 600 members who have all been diagnosed with varying degrees of severity. Several of their members say that they have not been taken seriously by their GPs when they have raised concerns about their own spots. What is melanoma? Melanoma, often called mole cancer, is the most serious type of skin cancer and can occur in both new and old moles throughout the body. Cancer occurs when the genetic material (DNA) gets damage that changes the cells. The color we get when the skin gets sunburned is the skin’s way of defending itself against more sun. Too much UV radiation can eventually lead to DNA changes in the pigment cells. – Most of these injuries are repaired by the body itself, but in certain cases the cells can begin to divide uncontrollably, and a tumor can grow, says Ingrid Stenstadvold Ross, Secretary General of the Norwegian Cancer Society. If the melanoma is detected early, the prognosis for recovery is good. Source: Kreftforeningen The thinner, the better The prognosis, or the chance of recovery, from melanoma at a very early stage – is basically good. – For melanoma, thickness is crucial for prognosis. The thinner, the better. We count from 0.1 millimeters, and every 0.1 millimeters counts, explains dermatologist Xiatong Li at Volvat. Dermatologist Xiaotong Li at Volvat Majorstuen, checks and removes moles every single day. Join in when he checks reporter Kristin Granbo moles for a routine check. He says that with each passing month, a melanoma can grow thicker. – The thinner the melanoma, the smaller the area of the skin around you must remove, and in the very thinnest cases there is usually no suspicion of spreading. Although it develops very differently from person to person, it is generally much easier to treat and much better prognosis if you arrive early. Dermatologist Xiatong Li says that it is easier to treat and better prognoses if you come early with a melanoma. Photo: Ksenia Novikova / news Only in New Zealand do more people die But in Norway we are late in discovering melanoma, the Cancer Society writes on its pages. As a result, the cancer can develop, and in some cases it becomes fatal. Last year, 295 people died of melanoma in Norway, according to figures from the Cancer Registry. The mortality rate from melanoma in Norway is actually more than 40 per cent higher than in the other Nordic countries, according to figures from the Norwegian Cancer Registry and Nordcan. Only in New Zealand do more people die of melanoma than in Norway. – Four doctors say the stain is harmless Mari Tronbøl in Oslo is still waiting for hours to have her stain removed when in April 2021 she thinks something smells rotten, literally. – It is a strange feeling, the smell comes from the body, and when I take a look down at my stomach I see that the stain is dissolving. Tronbøl travels to the emergency room where the doctor takes a look at the stain and tells her, as doctor number two, that this is not dangerous. They also lack equipment to remove the growth, and the doctor puts her on penicillin instead. The emergency room writes in an e-mail to news that patients with suspected mole cancer should be handled quickly, but not as immediate help in the emergency chain, of which the emergency room is a part. (You can read the entire answer at the bottom of the case). Tronbøl gets an allergic reaction to the penicillin, and again she ends up in the emergency room, in a new place. – I am being taken off the medicine, and here doctor number three says that this stain that bothers me in the stomach, still does not look dangerous. Mari Tronbøl is examined by three doctors who all think the mole on the stomach looks completely harmless. A fourth doctor also thinks it looks harmless, but removes it. Photo: Ksenia Novikova / news 31 patients complain to their GPs Between 2017 and 2021, 31 people with malignant melanoma, or mole cancer, complained to the Norwegian Patient Injury Compensation (NPE) about delayed diagnosis at the GP. Of these, 16 patients were upheld and compensated because it has taken too long to receive an examination or referral further. Eight people had findings that were not followed up, or were not examined by the doctor. Three people did not receive a sample or examination, while in three of the complaints NPE found that the patients should have been referred on, or referred on earlier. It has been upheld that the person was given a lack of control after treatment, while it has been upheld that the test result or referral was misplaced or overlooked. After many meetings with doctors, Mari Tronbøl’s stain is finally removed, as she has requested. Photo: private – I think you should call your doctor In May 2021, a surgeon at Aleris removes the stain to Mari Tronbøl. Although this doctor also points out that it looks harmless, it is routinely sent for analysis. – After two weeks, Ahus calls and offers me an hour. Tronbøl has not yet received the diagnosis in the mail, and she does not first understand why she is called to the hospital. – Then the woman on the phone says that “I think you should call your doctor”. The spot on Tronbøl turned out to be mole cancer. And after removing the stain and the outer layer of skin, a PET scan shows that the cancer has grown down into the skin. The cancer has also spread to the lymph nodes. New surgery and immunotherapy await. Tronbøl’s GP has been made aware of the case, and does not wish to comment. Mari Tronbøl herself has taken this picture from one of many rounds of immunotherapy. Photo: private – GPs diagnose 70 percent of melanoma patients – The GP has a very important role in skin cancer diagnosis, says researcher Trude Eid Robsahm in the Cancer Registry. Statistics show that they diagnose just under 70 percent of melanomas. – The vast majority have local disease and a thin tumor at diagnosis, fortunately. The professional communities should ensure that GPs have good knowledge of all types of melanoma, says researcher Trude Eid Robsahm in the Cancer Registry. Photo: Jarand Waaland / The Cancer Registry Robsahm says that everyone who has advanced disease at diagnosis is actually diagnosed too late. – And it is these who have the greatest risk of death. These spots can go unnoticed However, there can be many reasons why a melanoma goes unnoticed by your doctor. For example, that the tumor is located in a place that can be difficult to detect, such as the back of the body or on the head under the hair. Many also do not know what to look for. Robsahm says this mainly applies to patients, but can also apply to doctors. A type of melanoma, which for example may lack color, is also challenging to recognize, especially for the GP, but also for the dermatologist, the researcher says. She believes the professional communities have a job to do to ensure that GPs have good knowledge of all types of melanoma. Mari Tronbøl had to undergo several operations when a melanoma had spread to the lymph nodes. Photo: private – I could have released this Mari Tronbøl has not complained to the doctor or the treatment she has received. – I’m not out for my GP, she says. There is still something about the system she wants to “shake life in”. That she had to visit so many doctors before someone took her problem seriously, she thinks is sad. – It shows how badly the medical profession takes moles seriously. It should go away when you ask for it, Tronbøl thinks. In the last year, she has been through many rounds of cancer treatment, and she is struggling with a number of side effects associated with the treatment, such as fatigue and bleeding in the mucous membranes. She points out that she is very happy with how she is being cared for at Ahus, where she receives treatment, even though she would like to have been without it. This summer, she will have the last treatment for the time being, and only after a new PET scan will she find out how it went. – If my stain had been removed the first time I asked for it, then I think I would have let go of this. Mari Tronbøl was put on immunotherapy when the doctors found mole cancer with spread to the lymph nodes. Photo: private Response from the emergency room in Oslo and in Aurskog-Høland Director of the Aker Department, Dario Mariani Mardal: «We can not comment on this case in particular, but comment in general on the medical issue. Patients with suspected malignant melanomas, melanoma, should be treated quickly, but not as immediate help in the emergency department, of which the emergency department is a part. Patients must contact a GP, the GP will refer on if necessary. Aker Emergency Room does not have equipment to remove or biopsy (remove a piece of tissue sent for examination) skin changes. This is often done by doctors with surgical competence, but also general practitioners (GPs) can do this. ” Business manager Kristin Halvorsen in Aurskog-Høland municipality: «On a general basis, I can say that the emergency room is for everyone, but not for everything. The emergency room is for acute illness and injury that needs quick help. The emergency room is probably not the right body to consult if the need to assess and possibly remove a mole, it is the GP or dermatologist who should look at. There is no one who can say with certainty whether a mole is malignant or benign without removing it and sending it for analysis (something the GP does). ”
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Four doctors thought Mari’s mole was harmless – half a year later the cancer had spread
