ࡱ> pro'` 2bjbj{P{P 8^::* BBBVL*\V-uZ,,,,,,,$.h1j,B%S"u%%,?,&&&%48B,&%,&&n)*B) |كS%L)0+T,0-),1%1))&1B)P& )",,{&-%%%%VVVVVVVVV Skin Cancer Collegiate  Association of New Zealand President: Dr Sharad Paul Treasurer: Dr Keith Monnington Secretary: Dr Lise Kljakovic Nurse Representative: RN Wendy Duckett E-Newsletter No 1. - 01 April 2009 Thank you for joining SCCANZ. This is the first in an occasional series to keep you up to date with what is happening in the field of skin cancer management in Australia and New Zealand. Who is SCCANZ? We are a new organisation formed to represent doctors with an interest in skin cancer management in NZ. If you have Googled SCCANZ, you will have come across an Australian organisation with the same acronym. This is the Skin Cancer College of Australia and New Zealand, which has evolved out of the original Skin Cancer Society of Australia. They dont actually have a presence in NZ that role is filled by us as a body that is representative of NZ skin cancer doctors as well as being a provider of education and mentorship. We are working with the RNZCGP and have applied for accreditation as a CME Provider so that our online CME and Journal Clubs will be endorsed. The two SCCANZ organisations will be working closely together, and members will have reciprocal rights. SCCANZ (Australia) has close links with the University of Queensland Primary Care Skin Cancer Unit which offers a Masters degree in skin cancer medicine, and Healthcert, which organises workshops and conferences. Our chair, Dr Sharad Paul is heavily involved in teaching surgery at these courses as a Senior Lecturer (skin cancer) at the University of Queensland. Websites Our Website  HYPERLINK "http://www.skincancercollege.org.nz/" http://www.skincancercollege.org.nz/ The Australian SCCANZ  HYPERLINK "http://www.sccanz.com/home/" http://www.sccanz.com/home/ Healthcert Courses  HYPERLINK "http://www.healthcert.com.au/events_skc.htm" http://www.healthcert.com.au/events_skc.htm Forthcoming Events First and foremost is our inaugural 3 day workshop, to be held 24 26 July, at the Rotorua Convention Centre, covering both dermoscopy (Dr Amanda Oakley) and surgery (Dr Sharad Paul). There are 40 places available; at the time of writing, there were 14 confirmed (paid) bookings, with another 16 who have requested places but yet to send payment. Please let me know if you want to attend first come first served. It is the first University accredited Primary Care Surgery and Dermoscopy Course in New Zealand. The following weekend is the SCCANZ Annual Conference in Brisbane. I attended this in 2007, and have booked for this year. 2007 was a huge event, with renowned speakers from all over the world, and around 300 delegates (some indication of just how big a problem skin cancer is in Australia and latest epidemiology shows that the North Island is just as bad). For more information  HYPERLINK "http://www.skincancerconference.com.au/" http://www.skincancerconference.com.au/ The conference is preceded by a dermoscopy master class with some of Europes top dermoscopy experts. For those who want to learn dermoscopy but stay at home, there is an online course for the Australian Diploma in Dermoscopy commencing in May. Closing date for enrolments is 25 April. I have it on good authority that NZ residents who are already experienced in taking dermoscopic photographs can skip the compulsory workshop on the Gold Coast. The 26 week course costs $3900 Australian. A dermoscope and camera is essential. For further info  HYPERLINK "http://www.sccanz.com.au/training/australian-dermoscopy-diploma-2009/" http://www.sccanz.com.au/training/australian-dermoscopy-diploma-2009/ Bay of Plenty Skin Cancer Project. GPs in the Bay of Plenty DHB region are now fully funded by their PHOs for skin cancer management, with surgery that can be performed in a primary care setting being free to the patient (no co-payments allowed). The PHOs have a contract with the DHB which provides a budget. Funds are accessed by GPs via co-ordinated primary options (CPO). It has taken nearly 2 years to get to where we are now. The timeline is as follows. December 2006, a call for expressions of interest from GPs with skin cancer experience to provide primary care based skin surgery under contract to the DHB. 46 applications received, following a retrospective audit of histopathology, 23 selected. February 2007, two one-day workshops conducted to provide a refresher course in skin cancer diagnosis, management and surgery. A grading tool is developed by Dr Rick Hudson who has been working alongside hospital surgeons excising skin cancers. April 2007, a pilot is underway with 17 GPs (GPSIs) credentialed at either intermediate or advanced level. Skin lesion referral letters are initially triaged by Rick into intermediate, advanced or hospital. The hospital ones go to the surgeons, the rest to the surgical scheduler who allocates them to GPSIs on the bases of closest appropriately credentialed. August 2008, the initial 6 month contract dating from Feb is rolled over. A board is established chaired by Andy Humphrey, the Tauranga Hospital GP Liaison. Over many meetings, a 4 tier credentialing framework is established, based on experience, education and qualifications in skin cancer medicine, together with a more comprehensive lesion grading system. This is followed by a service specification. It was always intended that if the pilot was successful, the service would be devolved to the PHOs in the region. After intense negotiation between the PHOs and the DHB, with several alterations to the service specification, a contract is signed. Initial figures indicate that the number of skin cancer excisions in the 2 public hospitals has fallen by 30%. December 01, 2008 the service goes live. Over 60 GPs have now been credentialed, at either basic, intermediate, advanced or advanced plus level. This is managed by a PHO credentialing committee. Premises are also credentialed. Contracted GPs can manage lesions within their credentialing level and submit a claim to the PHO for payment, except that all lesions considered advanced or advanced plus must first be approved by the triage and grading service, which currently is funded separately by the DHB, but will shortly go to tender. Lesions requiring hospital or specialist care are referred on to the hospital surgeons. Patients can still elect to access private treatment, either by GPs or specialists. And now for something completely different some epidemiology. Submitted by Dr Sharad Paul Did you know? About 2,000 new cases of invasive malignant melanoma are diagnosed each year in New Zealand and the age standardised rate was 35.8 (male) and 32.0 (female) per 100,000 in 2003. The lifetime risk in the Celtic-descent New Zealand population is estimated to be 1:25. Age-standardized annual rate in Auckland 1995-1999 was reported as 56.2/100,000 (BOP and Northland thought to be higher). It is an interesting comparison with Australia, as barring Queensland the rate in Auckland is higher than other states, whose rates are listed below. M F Overall NSW54.334.843.4Vic40.733.836.6Qld74.051.561.8WA56.337.946.2SA44.735.239.2Tas41.840.640.5ACT49.032.040.2NT37.527.032.7 Waikato Postgraduate Medicine Inc Dermatology Evening April 02 2009 an educational evening was conducted by the Dermatology department of Waikato Hospital with a focus on skin cancer. This very well attended session comprised a lesion quiz, and a presentation each by the 3 specialist dermatologists and the 3 registrars. Dr Anthony Yung gave an overview of non melanoma skin cancer with some excellent slides, and photos of some horrendous lesions fortunately rarely seen in general practice. Dr Yung treats KA as if it was SCC, and pointed out that 16% of cutaneous horns have a SCC in the base. Dr Hiromel de Silva provided an overview of topical fluoruracil. Apply bd for 2 weeks on the face for AKs, up to 4 weeks on the hands and 6 weeks on the feet. Bowens may require repeat courses. If there is no reaction, check compliance, frequency, duration and diagnosis. Dr Ritia Vyas covered topical Imiquimod. From an RCT of sBCC 79% clearance following 6 weeks of 5 times a week at 12 week follow up. Aldara degrades on contact with air, if reusing sachets, make only pin prick, squeeze out what is needed. Tape the hole closed. If a sBCC has not cleared at 6 weeks, but there is still a reaction to Imiquimod keep going. If the lesion recurs later, use a different treatment. Dr Amanda Oakley, as well as chairing the evening and presenting the quiz, presented an overview of the PDT service now available at Waikato Hospital. It is mainly used for sBCC, but sometimes for SCC in situ (unregistered), actinic cheilitis and chronic infections, where other treatments are unsuitable. Most lesions treated are on the face, ears or neck, plus some on lower legs. It is useful if there are contra-indications to surgery such as bleeding disorders or lymphoedema. It is not indicated for SCC, melanoma or morphoiec BCCs. Dr Eugene Tan gave a presentation on the virtual lesion clinic, for which negotiations with the DHB over funding are in progress. Lesions referred to dermatology are photographed by melanographers (the same as Molemap) and viewed by dermatologists who then advise on management or arrange for the patient to be seen in clinic. In a trial of 100 patients, there was 100% sensitivity for malignant lesions with good specificity. The correlation with histology was marginally better for the teledermatology than it was for face to face consultation. Exclusions are numerous lesions, inflammatory dermatoses and lesions in hair bearing areas. Dr Marius Rademaker presented some important points from the new melanoma guidelines. No imaging investigations are recommended for stage I or II disease, and SNB provides prognostic information but no survival benefit.  HYPERLINK "http://www.cancer.org.au/Healthprofessionals/clinicalguidelines/skincancer.htm" http://www.cancer.org.au/Healthprofessionals/clinicalguidelines/skincancer.htm This was followed by an overview of Vitamin D. Maximum vitamin D3 synthesis occurs with of the minimum erythema dose, further sun degrades it. UVA received at the same time further damages the skin skin damage increases linearly with UV exposure. Finally the answers to the quiz were given, with Marius (who had not previously seen the photos) being asked to provide the answers. The highest score by a GP was 28/30 one better than Marius. An excellent session, superbly chaired by Dr Oakley. I look forward to her dermoscopy presentation at our workshop. And thats all for now. If you have anything to report, share, or discuss, please email it to me.  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