Melanoma tragedy prompts free skin checks
A Christchurch woman who lost her brother to melanoma organised a free skin-check day as the public health system is unable to meet the demand due to a dermatology shortage. Cecile Meier reports.
Leeann Marriott’s brother Andrew Bulman’s deadly skin cancer was discovered late and took his life 26 weeks after he was diagnosed.
The loss of her 48-year-old brother gave Marriott, a real estate agent, the determination to help other families avoid the same heartbreak.
The father-of-one ‘‘gave it everything but the melanoma was just too aggressive and too fast’’.
‘‘It’s an awareness thing, he never thought to get our skin checked.’’
New Zealand and Australia have the highest rates of melanoma in the world.
Yet, the public health system does not fund skin-cancer screenings due to a lack of consensus around their effectiveness and a shortage of dermatologists.
New Zealand has 17 dermatologists working in the public health system, which is about a third of the 48 dermatologists it should have for its population, according to Ministry of Health workforce planning data and recommendations.
In comparison, Australia has four times more public dermatologists per 100,000 people and subsidises skin-checks.
Marriott created SkinCanNZ to promote skin cancer awareness, starting with a free skin-check day at Christchurch’s Charity Hospital on Saturday, with support from the Canterbury District Health Board (CDHB)’s skin cancer working group and eight dermatologists who volunteered.
The 150 slots for the day were fully booked within 12 hours of launching the website, with over 200 people on the waiting list, Marriott says.
‘‘Many people with concerns about moles or lesions on their skin can’t afford the $200-plus to see a dermatologist while others even struggle to cover the cost of a GP visit to get them checked out,’’ Marriott says.
DERMATOLOGY SHORTAGE
CDHB clinical director of dermatology Victoria Scott-Lang is on parental leave with a second baby due in a couple of weeks but volunteered on Saturday. She says the public system is unable to offer skin-checks as there is a severe shortage of dermatologists, with a total of 60 dermatologists working around the country, including 17 in the public sector.
The CDHB has 2.4 full-time equivalent dermatologists, serving the Canterbury and West Coast regions.
It receives between 40 and 60 referrals to its dermatology department each weeks.
Patients are seen within 100 days of referral – if their referral is accepted, she says.
‘‘We have very strict criteria about which patients we can accept. A significant number of patients who are referred to us are unfortunately not able to be offered an appointment because of this,’’ Scott-Lang said.
Patients accepted in the service usually have severe inflammatory skin diseases including eczema and psoriasis, blistering disorders, severe undiagnosed rashes, and children with rare skin disorders.
Association of Salaried Medical Specialists chief executive Ian Powell said the dermatology sector had been in crisis for a few years due to an ‘‘abysmal failure in health workforce planning . . . in a time of high financial constraints for DHBs’’.
"DHBs are encouraged to turn a blind eye to staff shortages.’’
Small services such as dermatology, which are not as acute as others tend to get disregarded, he says, leading to a lack of funding for training and positions.
GPs FIRST PORT OF CALL
Australia subsidises skin-checks but it has not been a focus in New Zealand, Scott-Lang says.
Instead, DHBs have been training GPs in dermoscopy – assessing moles through a strong magnifying glass and subsidising them to remove at-risk moles.The CDHB trained about 100 GPs in dermoscopy in recent years, a move supported by the Cancer Society.
CDHB programme lead Carol Limber says GPs are the first port of call for anyone worried about their skin.
The Ministry of Health’s faster cancer treatment initiative has contributed to additional training for GPs across Canterbury in the early detection and management of potential skin cancers.
‘‘If patients present to their GPs with suspicious moles that cannot be removed locally . . . patients are referred to Christchurch Hospital’s plastic surgery team and are triaged. Patients with high risk moles are seen urgently, within weeks, for assessment and removal if required.’’
The CDHB subsidises the removal of potential skin cancers at GP practices so patients can be treated quickly without the need to see a specialist.
A HARD FOUGHT BATTLE AGAINST MELANOMA
Leeann Marriot says growing up, she and her brother spent their days in the sun during family holidays in Nelson.
‘‘Sunscreen of the day was either baby oil or Coppertone. We never thought anything about skin cancer. We were just kids who enjoyed playing out in the sun and thought nothing of getting burnt.’’
In February 2015, Andrew’s wife noticed that things were ‘‘not working quite right in his brain department’’. He was admitted to Christchurch Hospital with swelling of the brain and a CT scan revealed three brain tumours. A series of tests and surgeries followed until he received a melanoma diagnosis with five years to live.
In April 2015, he was admitted to hospital with blinding headaches. Another scan showed the melanoma had spread and was ‘‘everywhere’’. His prognosis dropped down to 3-6 months.
He went through 10 radiotherapy treatments after which doctors decided nothing more could be done for him, Marriott said.
‘‘My brother seemed, to me, so brave and he faced everything head on. He continued to work when he could but as time went on he became more and more tired.’’
By July, he became more and more unwell but was determined to be around to celebrate his wife’s birthday on July 30.
A week after that, he died peacefully with his wife and dog Dexter by his side, Marriott says.
Marriott wants to encourage corporates to hold free skin-checks for employees, push for permanent sunscreen dispensers in parks and playgrounds, advocate for skinchecks to be covered by medical insurance and bring the cost of detection down for high-risk patients.
SKIN CANCER LARGELY PREVENTABLE
Cancer Society of New Zealand medical director Chris Jackson says demand for skin cancer detection is expected to increase, with the World Health Organisation estimating the number of new cancer cases to rise by about 70 per cent over the next two decades.
‘‘We hope that workforce planning and reviewing access to services will be a central function of Labour’s proposed National Cancer Agency.’’
The Cancer Society does not recommend routine population screening for skin cancers because of a lack of evidence of effectiveness, but is in favour of free or subsidised skin-checks.
‘‘While we value the immense expertise of dermatologists, welltrained GP’s are often more accessible than a dermatologist and can provide quality skinchecking services.’’
Skin cancer is largely preventable, with over 90 per cent of all skin cancers linked to excess sun exposure.
People should regularly check all areas of their skin, including skin not normally exposed to the sun and should ask others to check back, scalp and back of the neck.
‘‘The majority of melanomas are detected by people themselves or those close to them. If anybody notices a change in shape, colour or size of a pigmented lesion, mole or spot, or the development of a new lesion, they should go to their GP immediately to get it checked.’’
From now, through to next April, all New Zealanders should remember to protect their skin from the sun, especially between 10am and 4pm.