Case discussion: How would you treat this patient? [13 March]

This week’s case discussion is another learning opportunity with a simple, real-life and every-day scenario from Dr Slavko Doslo. An 73-year-old male presented for a skin check with few spots on his back.

This is not a stand-out lesion clinically. On dermoscopy, what makes you suspicious?

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Recommended reading: A Practical Guide to Skin Cancer in Primary Care by Professor David Wilkinson and Paul Elmslie

Skin Cancer in Primary Care Book“Well, here it is. After teaching my foundations of skin cancer course with HealthCert for 10 years, and with almost 3000 alumni, Paul and I have finally written the book! Many, many doctors ask me “which is the best book for me?”. Well, if you are a mainstream GP, this is it – in my view.

We wrote this because, as far as we could see, there is no such book on the market. And, most patients with skin cancer are treated by GPs. And, it is not easy. The book is simple and straightforward. All evidence based, clear and basic one to keep on your desk.

I hope you like it.”

David

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Dermatoscopy in General Practice

dermatologists

A review by Professor David Wilkinson of two articles that focus on dermatoscopy in general practice.

A note from Professor David Wilkinson:

“The purpose of my monthly research blog posts is to share interesting, recent material from the world’s leading journals. And, importantly, to provide useful updates on aspects of clinical practice. This month, I share two recent pieces for your review and consideration.

The first is a short commentary from Associate Professor Cliff Rosendahl, who is known to many of us and is a skin cancer GP in Queensland. I had the pleasure of supporting Cliff through his PhD when I was Dean of Medicine at UQ. In this piece, Cliff provides commentary on a paper that looked at use of, and interest in, dermatoscopy among GPs in France. The commentary from Cliff is below – he argues for improved teaching of dermatoscopy among medical students in Australian medical schools. What do you think?

The second short paper is fascinating, and speaks to a question I am asked a lot. Do patients care about the gender of the doctor doing their skin check? Remarkably there is very little research on this topic. Again, this short research report is below for your interest. This is a short report and is well worth a read! Fascinating findings – will any of this change your practice?”


Research article 1: Dermatoscopy in General Practice

‘Melanoma writes its message on the skin with its own ink and it is there for all to see. Unfortunately some see but do not comprehend.’ Since Neville Davis made this statement in the Annals of Plastic Surgery in 1978, the advent of dermatoscopy has facilitated earlier diagnosis of melanoma, as well as enhancing diagnostic accuracy for many dermatological conditions, both benign and malignant. Such is the level of evidence for the diagnosis of melanoma that dermatoscopy is now the standard of care in Australasia for clinicians treating pigmented skin lesions. With skin conditions accounting for up to 14.8% of all consultations in general practice it has been suggested that dermatoscopy is now as applicable in that discipline as is use of the stethoscope.

In their study in this edition of the BJD, Chappuis et al. deliver detailed findings of the first assessment of dermatoscopy use by French general practitioners (GPs), reporting that 8% of respondents possessed a dermatoscope and 16.9% had received training in dermatoscopy.

This low level of usage of dermatoscopy is not unique to GPs or to France. Studies on dermatoscopy use, cited in the study by Chappuis et al., suggest that while use appears to be high by dermatologists in Europe and Australia (94.6% in France and 98% in Australia), less than half of the dermatologists surveyed in a cross-sectional survey in the U.S.A. in 2010 had used a dermatoscope, although a more recent survey suggests use may have increased to around 79%. The only other study that attempted to quantify dermatoscopy use by GPs reported that one-third of respondents, in Australia in 2007, used dermatoscopy.

In the twenty-first century, debate about the merits of dermatoscopy is as inappropriate as debate about the merits of using an otoscope. Cited drawbacks such as cost and time constraints are no longer tenable and any perceived lack of efficacy of dermatoscopy is likely to be related to lack of training and experience rather than to science.

It is time for a paradigm shift in attitude and practice and such changes start not at workshops for graduate doctors, no matter how appropriate these are, but in medical school. The kit of stethoscope, patella hammer, ophthalmoscope and otoscope, which adorned the twentieth-century medical student’s white coat, should have the dermatoscope added to it. Instruction in the use of this relatively low-cost hand-held device should be an integral part of teaching in medical school as well as in advanced training programmes for GPs.

The study by Chappuis et al. found that GPs in France were receptive to training in dermatoscopy. The time is ripe to respond to this, not only for GPs in France, but for medical students globally. This will bring us one step closer to the dream of the late Bernie Ackerman: that no person should die of melanoma.

Click here to download the full paper  


Research article 2: Patient Preferences During Skin Cancer Screening Examination

The results are very interesting and you might also want to read to understand the patients psychology of choosing the gender of the doctor for their skin check. 

patient-preference-1  patient-preference-2

Click here to download the full paper 


Interested in skin cancer medicine?

The HealthCert Professional Diploma programs offer foundation to advanced training in skin cancer medicine, skin cancer surgery or dermoscopy and provide an essential step towards subspecialisation. All programs are university quality-assured, CPD-accredited and count towards multiple Master degree pathways and clinical attachment programs in Australia and overseas. The programs are delivered online and/or face-to-face across most major cities of Australia.

Courses in Skin Cancer Medicine:
Melbourne | Adelaide | Gold Coast | Brisbane | Perth | Sydney | Online

Courses in Skin Cancer Surgery:
Melbourne | Adelaide | Gold Coast | Brisbane | Perth | Sydney

Online courses in Dermoscopy:
Trimester 1: Jan Trimester 2: May | Trimester 3: Sep

Skin History, Skin Checks and Best Protocol

The alumni sessions are part of our learning support program for past course participants and give you the opportunity to refresh and consolidate your skills, review cases with the course presenter and ask questions in a supportive environment. In this online learning session, Professor David Wilkinson goes through all key aspects of the best protocol for skin checks, including the first patient consultation, taking the skin history, performing a full-body skin examination, and the next steps.

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Campaign Against Government Pathology Fee Cuts

pathology

The government has announced further fee cuts for healthcare services, and on this occasion with regards to pathology bulk billing, effective 1 July 2016. Over the last few years, the primary health care industry has suffered by a decrease in real payments due to frozen consult rebates, and for pathology this amounts to over 40 percent since 2000. Now, the government is introducing harmful pathology fee cuts. Continue reading “Campaign Against Government Pathology Fee Cuts”