No medicare funding forces closure of regional service detecting melanomas

This was despite detecting 62 melanomas in patients as young as in their early 20s in the 30 months it was operating.

Dermatologist Dr Leith Banney said the Dermatology Solutions clinic was operating in Rockhampton with a Vectra machine.

Dr Banney said she wanted to provide tele health services to regional Queensland so set up a three dimensional whole body imaging service where they could detect skin lesions and do skin checks remotely.

"We also recorded rashes and I am still doing that part of the work online, just not the skin lesions because we no longer have our office in Rockhampton," she said.

"I think there were a few reasons why remote reporting of skin lesions didn't work, but it was just not financially viable in the end."

Dr Banney said part of the reason why the clinic did not work was that it was using new technology and people were slow to take up the technology.

"There was also no medicare rebate for the service we were providing so it was expensive for people because it's labour intensive to image all of their skin lesions and send that through to a specialist online - they were the main factors," she said.

"We were operating for just under three years - 30 months - and in that time detected 62 melanomas in people of all ages."

Dr Banney said it was incredibly disappointing that a service such as theirs was not entitled to medicare funding.

"It's been a real journey for us - we still do have the machine in storage and we hope to open up in a different location, but we haven't made a final decision about what to do yet," she said.

Dr Banney said a lot of people did not realise the importance of early detection of skin cancers and melanomas.

"Unfortunately, because sun damage is just so wide spread in Queensland, people just accept it as normal walking around covered in sunspots and not being concerned about any of that - where early detection could really make all the difference and save your life if you are on to it," she said.

"I guess we thought (with the Rockhampton clinic) that we were saving people travel to see a specialist they would normally travel to Brisbane.

"There is a visiting dermatologist that comes to Rockhampton once a month, but he can't possibly service everyone and so we felt that the amount of travel saved to the individual would have been a big cost saving and we're going to present our data at a conference later this year about melanomas diagnosed and kilometres of travel saved."

Dr Banney said she could not give exact figures, but thought there was probably only 70 to 80 dermatologists in Queensland with most in the south east corner.

She thought a Vectra machine such as theirs was part of the solution in the early detection of skins cancers and melanomas.

"I think there's a lot of towns that really need some service, but they're not big enough to support a dermatologist to move there and live full time," she said.

"Statistically, we're supposed to have a dermatologist...for every 50,000 people so towns of 50,000 or greater should have a dermatology service."

Dr Banney said stories of people not being diagnosed with a melanoma or skin cancer after visiting their doctor were sadly not uncommon.

"A melanoma is a really difficult condition (to diagnose) because you rarely get a non pigmented symmetrical lesion that's growing - but the key thing is that's it's growing and changing, and an itch can be a feature as well," she said.

"Anyone can miss a melanoma, it can be very difficult to diagnose, but the index of suspicion should be really high if the patient is concerned about something... and patient's concerns do need to be taken seriously."

As to whether GPs need more training in the detection of skin cancers and melanomas, Dr Banney said there was so much asked of regional GPs.

"They're expected to be everything and know everything - I think there is a lot of training available and GPs vary enormously in their skin cancer experience," she said.

"But I think...GPs do need to upskill themselves with respect to skin cancer if they are going to practise in Queensland."

Dr Banney advised patients to get a second opinion if their GP tells them that a skin lesion was okay, but they were still worried about it.

"You do have some very good skin cancer GPs in the region who would be the right person to see in that situation," she said.

"I think there are very good GPs and doctors in Rockhampton, whose services are stretched to capacity and I think our service in particular provided support for people with multiple moles, or dysplastic or atypical moles.

"They're the people who are hard to monitor and this technology helps to detect change so people can come in and have repeat scans and the software detects any new lesions, any changing lesions, so it was a really lovely way to monitor people remotely and in an sensitive way."

Central West Hospital and Health Service executive director of medical services Dr David Walker said their GPs could undertake many skin cancer surgeries locally ensuring central west residents could receive care closer to home without having to travel away.

But he said there were no specialist dermatologists within the region or a visiting specialist dermatology service.

"If referred to a larger centre to see a dermatologist for complex care, patients can access the Queensland Patient Travel Subsidy Scheme for assistance with travel and accommodation costs," he said.

Dr Walker said consultations with a specialist dermatologist could also be arranged via telehealth and were well-supported by the Princess Alexandra Hospital's telehealth dermatology service.

"Everyone should have a skin check at least once a year. Skin cancers are largely preventable, and the good news is that melanoma and other skin cancers are readily treatable if they are detected early. Being aware of your skin can save your life," he said.

A Federal Health Department spokesperson said a Vectra machine was used to undertake melanoma surveillance photography and MSP was not covered under the Medicare Benefits Schedule.

"For a new medical service to be funded through the MBS, an assessment by the Medical Services Advisory Committee is required," the spokesperson said.