Home' GP Pulse : GP Pulse March 2017 Contents Features
ISSUE 60 : March 2017 : P9
Understand the basics of dermatoscopy
learn to do it and use it.
Skin cancer academic and Distinguished
Fellow of the College, Dr Sharad Paul,
originally trained in plastic surgery, with a
focus on burns and trauma. When he first
came to New Zealand 26 years ago he says
he was surprised by our extremely high
rates of skin cancer, and quickly developed
an interest in skin cancer diagnosis,
dermatoscopy and research.
In 1996 he established the Skin Surgery
Clinic in Auckland, which handles all aspects
of skin cancer – from simple mole removals,
to complex ear/nose/eyelid/lower limb skin
cancers that need complex reconstructive
techniques such as flaps and grafts. Dr Paul
teaches skin cancer diagnosis and surgery
for both the Universities of Auckland and
Queensland, and is an Adjunct Professor at
the Auckland University of Technology.
He believes general practice manages skin
cancer extremely well, particularly given New
Zealanders have less access to dermatologists
than many other countries.
“If you look at OECD figures, we have the
lowest access for patients to skin specialists.
This means GPs have to deal with most skin
cancers – I estimate about 80 percent of skin
cancers are managed in general practice.”
His advice to GPs is to get as much
experience as they can seeing patients with
“You can read about skin cancer all you
like, but you need to do it. It’s like trying to
describe an elephant – until you’ve seen one
it’s a bit meaningless.
“It is very important GPs use a
dermatoscope. There is no need to panic –
anyone can miss a melanoma, particularly if
it’s a very rare one. But if you upskill and use
a dermatoscope your chances of missing one
are much less.
“It’s worth practices considering having a
skin cancer specialist so they can see lots of
potential skin cancer patients as well as being
able to give others in the practice a second
“ With practice, you can get a detection rate
of under one to eight. That means if you are
suspicious something might be melanoma,
you’re not taking more than eight biopsies for
every one melanoma.
“And remember, for a pigmented lesion like a
mole that you suspect is melanoma, take out
the whole thing, not just biopsy a part of it as
you can to diagnose a squamous or basal skin
He says GPs are also well placed to give
patients prevention advice.
“A GP is the doctor people see the most, so
talk to your patients about sun protection and
not using sunbeds.”
The Health Promotion Agency says the
prevention messages for GPs to pass on to
Key tools and resources for the detection and
management of melanoma
Standards of Service Provision for Melanoma Patients in New
Zealand – Provisional. 2013.
High Suspicion of Cancer Definitions.
Tools for Skin Lesion Diagnosis.
DermNet NZ website: A site owned by the DermNet New Zealand
Trust, that provides independent, high quality and up-to-date information
on skin diseases and their management.
Dermatoscopy – An algorithmic method based on pattern analysis. 2011.
Kittler, Rosendahl, Cameron.
Minor Surgery. A visual guide for office-based surgery from
beginner to expert. Dr Samantha Murton.
MelNet Common Skin Lesions and Dermatoscopy Courses.
Clinical Cases in Skin Cancer Surgery and Treatment. 2016. Drs
Sharad Paul and Rob Norman.
Health Promotion Agency: Recommended protection steps; Early
Slip on a shirt/top with long sleeves and
a collar and into the shade.
Slop on sunscreen that is at least SPF
30, broad spectrum and water resistant.
Apply 20 minutes before going outside
and reapply every two hours.
Slap on a broad-brimmed hat that
shades your face, head, neck and ears.
Wrap on close fitting sunglasses.
A melanoma risk predictor model has been
available since 2016 to health (hauora)
professionals with access to the Best
Practice Advocacy Centre (BPAC) patient
management system. The tool estimates
the probability of your patient (tūroro)
developing melanoma in the next five
years by consideration of their personal
combination of risk factors.
It enables GPs and patients to discuss an
evidence-based management plan, including
appropriate strategies for prevention,
surveillance and early diagnosis.
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