Dr Franz Strydom says rural GPs and nurses can become 50% more accurate in detecting melanoma once trained in dermoscopy.
Skin cancer, so often the curse of New Zealand farmers will be subdued if not banished, by a new initiative to educate rural health professionals on its detection.
With the backing of the Skin Cancer College of Australasia (SCCA), skin cancer expert Dr Franz Strydom is leading an initiative to train up more doctors and nurses throughout NZ on dermoscopy, a relatively new diagnostic technique proven to significantly improve detection rates of skin cancer.
“Coming from Tauranga where skin cancer rates are high, we have been dealing with it for a long time. Fifteen years ago, GPs were not diagnosing it and I stuck up my hand to help educate more of them,” Strydom said.
Strydom had witnessed first hand the invasive effects skin cancer was having on patients, many of them farmers or retired farmers, the sector with the highest rate in the country with the highest mortality rate in the world.
Those early education efforts dropped Tauranga District Health Board’s elective surgery waiting list by 30%, with more GPs performing often minor procedures to remove early stage cancers.
“We now see 60% of skin cancers performed by GPs, compared to only 5% earlier,” he said.
The effort has trained up over 1000 GPs and nurses.
But despite that success skin cancer mortality has remained stubbornly high, with one New Zealander a day dying from it.
“You have an almost equal chance of getting skin cancer here as in Australia, but a greater chance of dying from it here. Despite the good training, we just need to do more,” he said.
Early detection remains the key, with a superficial mole’s removal ensuring a 98% chance of cure.
“The alternative is the woman who waited too long at 18, now has $110,000 every three months spent to try to keep her alive on treatment,” he said.
Rural areas were already under stress prior to covid and farmers rarely visit the doctor unless properly sick. This means the opportunity to also check for moles and diagnose properly is a fleeting but potentially life-saving opportunity.
The use of a dermoscope enables the lesion to be magnified and viewed under polarised light, helping identify subtle and otherwise invisible changes in a mole.
“The machines are about $2000 each, but like any piece of kit also require training to operate and diagnose properly,” he said.
“But the results say a lot. Under normal examination a GP may remove 10-30 lesions, of which only one is melanoma.
“With training using the dermoscope that is cut down to 4-6, a significant saving in time, money and unnecessary procedures. You save money and you are saving lives.”
He said he was particularly heartened by the interest rural nurses were taking in the training courses. Their presence has added considerable manpower to rural clinics’ ability to identify at risk patients.
“Here in NZ, we can use nurses for these sorts of things, but it’s not allowed in Australia,” he said.
Strydom said he and his team were committed to running “as many courses as required” and also have an online course to outline the basics of dermoscopy to practitioners.
Recognising the isolation rural practitioners can face, the SCCA also ensures access to experienced colleagues to assist with diagnosis.
Run as a not-for-profit organisation, the SCCA is aiming to make the training valid as a university-level medical qualification.
As the farmer population continues to age, he did not expect to see cancer rates in that older demographic drop off any time soon.
“The older you get, there is an exponential increase in skin cancers you get. The other problem is farmers spend their whole life working in the sun, then retire and play golf in the sun,” he said.
However earlier, accurate detection would ensure the cancers are treatable.
Direct healthcare costs for skin cancer in NZ are estimated at $123 million a year.
