Reducing unnecessary removal of skin lesions

Media release, 5 April 2013

Training and support important to reduce unnecessary removal of skin lesions

An internationally recognised New Zealand specialist in dermatology says GPs need more training and support to recognise benign or harmless skin lesions to prevent them being removed unnecessarily.

Honorary Associate Professor Amanda Oakley, President of the New Zealand Dermatological Society, has told the National Melanoma Summit in Wellington that unnecessary removal of harmless skin lesions causes physical, psychological and economic harm.

Melanoma Summit New Zealand 2013, with the theme ‘Connecting melanoma expertise in New Zealand’ is hosted by MelNet with support from the Health Promotion Agency, Cancer Society of New Zealand and Melanoma Foundation of New Zealand.

“As soon as you cut into the skin you’re taking a risk that you’re going to leave a scar. Five percent of surgical wounds get infected so will take longer to heal,” Dr Oakley says.

“An antibiotic might be prescribed and around five percent of people experience complications when they take antibiotics. Many more don’t complete the course.”

She says even when a removed lesion is diagnosed as benign it raises fear in the patient about similar lesions, leading to further unnecessary surgery.

“I understand that GPs are worried about missing melanoma, but we need to educate our primary care doctors to recognise benign lesions so they can be more confident in telling their patients ‘don’t worry about that’.

“We have wonderful GPs in New Zealand, but there is a gap here and we need to work together to help them develop their skills to achieve the best outcome for the patient.”

Dr Oakley says all GPs should have basic training in recognising benign and malignant skin lesions early in their career and larger practices should make sure that one or two of their doctors are focused on skin cancer diagnosis and management.

She says it’s very difficult to get information about unnecessary removal of benign lesions because statistics aren’t kept. “The right level of removal is probably around 3-to-5 benign lesions to every malignant one, but in some practices as many as 20 benign lesions are being removed to every malignant one.

“The last ten years has seen improved understanding of the features of benign and malignant skin lesions thanks to advances in digital imaging and the use of dermatoscopy.”

A dermatoscope is a handheld microscope-like device that allows structures deeper in the skin that aren’t visible to the naked eye to be seen.

Dr Oakley says dermatoscopy must be accompanied by photography. “Digital imaging has made an enormous difference. It’s so easy to image a lesion and send it with the lesion to the pathologist. A digital image also means you can get another opinion no matter where you are in the world through telemedicine. It’s better than seeing the patient face-to-face and it’s cheaper.”

Dr Oakley, who practices in Hamilton, is an Honorary Member of the American Academy of Dermatology (an award rarely given to a non-American citizen) and created and manages DermNet NZ, a vast online dermatological resource that receives more than one million visitors a month.

Sponsors of the Melanoma Summit are: Roche Products, Cancer Society of New Zealand, Genesis Oncology Trust, Path Lab, Melanoma Foundation of New Zealand, Bristol-Myers Squibb, Abbott Molecular and New Zealand Dermatological Society.

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