Fair Go can reveal that skin cancer screening clinics can give very different opinions on whether moles and lesions are a serious risk and require treatment.
Reporter Gill Higgins went to three different clinics in a matter of weeks and each specialist gave a different diagnosis and treatment plan.
All three providers used dermatoscopes (which provide a magnified image of the lesion) and took photos of any lesions that looked suspicious for future reference.
One provider suggested a potential melanoma should be cut out straight away, another suggested chemotherapy cream for a different lesion, while another said no action was required but just to follow up in a year. It questions the reliability of advice and whether all clinics should be audited.
The only apparent difference between providers was the level of experience of the person assessing the lesions. Expert dermatologist Dr Louise Reiche believes it’s important to check this when deciding who to go to.
She says the word “specialist” has morphed over time, so it pays to ask or check the provider’s website for how much training the professionals have and how many years they’ve been involved in screening.
Dermatologists undergo years of additional education after their medical training, as do some doctors who specialise in skin cancer, while other GPs who offer skin cancer screening may focus on general skin health and appearance medicine.
Reiche understands that 100 per cent agreement is unlikely between providers but says, “it should be in the high 90s”. She says the Fair Go experience is a wake-up call and that comprehensive auditing could help.
At present all dermatologists are audited, as are some providers who carry out work for Southern Cross or a DHB, but many others may not be.
Fair Go asked Health Minister Andrew Little whether the Government would introduce this to improve patient confidence. But the minister said it was a matter for a professional body such as the Royal College of GPs.
In the meantime, Reiche also suggests asking for copies of any photos of moles and skin lesions so that a second opinion from a GP can be sought. It also makes it easier for a patient to check their own skin for any change. She wants people to know they have the right to access their own photos even if this isn’t offered by a provider.
Pensioner Marianna Luketina from Otaki Beach had her first private skin cancer screening recently. It wasn’t out of choice. She used to see her GP for regular checks at a cost of $20 with a community services card. But due to increasing demand, the service was stopped and Luketina had to go to a private provider which set her back $200.
She worries that “a certain percentage of the population would hear those costs and say I’ll leave it”. And the problem doesn’t stop at screening. There’s the cost of treatment too.
A private provider charges in the region of $500 to remove a suspicious mole. If a GP carries this out, it’s no longer that much cheaper. Costs vary around the country but can be as high as $400.
Serious melanomas and moles requiring plastic surgery (e.g. ones on the face and neck) can still be done at a hospital at no cost, but the excision of smaller lesions including potential melanomas, are now likely to be carried out by GPs.
As Luketina still has a mortgage with only a pension to rely on, she says the cost is far too high.
Fair Go questioned Little about introducing a substantial subsidy to make public health service treatment of skin cancer more affordable.
The minister said there were no immediate plans to ease the financial burden, but he expected some extra funding would become available once the health reforms get under way.
“I can’t say when that will happen, but my expectation is we will see a change”.
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