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Tiina, aged 60, has fair skin, light auburn hair and blue eyes, so is a prime candidate for skin cancer. Prior to the clinic visits her skin was independently assessed by three specialists and, fortunately for her, given the all-clear.
Tiina has a number of benign (non-cancerous) spots on her skin (age spots and sun-induced freckles, for example) and several skin tags (harmless skin growths) but nothing of any cause for concern, according to our experts.
Tiina visited 27 skin cancer clinics in NSW and Queensland. Following each visit she completed a survey giving details of the questions asked, method of skin assessment, equipment used, and any recommendations for procedures, tests or skin care advice given. CHOICE's expert specialists then assessed the completed surveys.
The good news
According to our experts, most of the consultations were undertaken appropriately.
The doctors didn’t misrepresent themselves as being skin specialists — although when asked, over half said they had years of experience or a 'special interest' in skin cancer.
In most cases the consultation process was conducted appropriately and thoroughly, with the doctors asking Tiina for her history — has she ever had sunburn, is there a family or personal history of skin cancer, has she noticed any changes to her skin, for example.
Tiina was given a full body examination (removing all clothing except her underwear) in all but one of the 27 skin cancer clinics.
The bad news
Doctors at three clinics recommended a biopsy — the removal of a sample of tissue for diagnosis — of a spot on Tiina’s cheek, which our experts thought was unnecessary. At one clinic, the doctor suggested the 'suspicious' skin lesion "could be solar keratosis, BCC [basal cell carcinoma], intraepidermal carcinoma or HMF [Hutchinson melanotic freckle]".
These diagnoses range from relatively harmless to quite serious. In his review of this visit, one expert’s response was: "This doctor has given a rather wide-ranging diagnosis despite his use of a dermatoscope ... After making this statement he didn’t suggest a second opinion from a specialist and was willing to wait a year to review the patient, despite his uncertainty."
In two cases Tiina was told the biopsy wouldn’t result in scarring, which our experts disputed. "Advice about biopsy leaving no scarring is quite incorrect," said one.
One clinic recommended the removal of a skin tag on Tiina’s neck without explaining why. After requesting a written report to take away with her so she could consider the procedure, Tiina was ushered out of the consulting room.
Our experts all disagreed with this outcome. As one summed it up, "It is preferable to discuss the diagnosis and ask if the patient wants any benign lesions (such as a skin tag) removed. It would be important to discuss the pros and cons of different techniques of doing so, including cost, time to heal, side effects of treated versus untreated condition."
The majority of clinic doctors that gave advice on how often Tiina should have her skin checked said she should return to the clinic yearly, as a matter of course. Given that Tiina’s skin was fine, our specialists thought this unnecessary, and that instead she should have been advised to return only if she noticed any changes in her skin.
Most surprisingly, only one of the 27 clinics visited gave Tiina advice on skin/sun protection (and this was merely to wear a hat). As one of our experts said, "Given [Tiina’s] pale skin, advice should have been given on sun protection measures such as wearing a hat, long-sleeved clothing and sunscreen products."