We know there is a lot of marketing surrounding skin check and mole mapping software/services. While these systems sound impressive and are often heavily advertised. A skin check by a dermatologist (with dermoscopy) is still the gold standard practice for the most precise skin cancer detection. Skintel is an affiliated provider with Southern Cross and NIB.
Why is a Skin Cancer Check the best practice?
When it comes to the software, some of these systems have reasonable diagnostic accuracy once a photo has been taken, but if a photo of the skin cancer is never taken in the first place, then the diagnosis is going to be missed. It really is that simple. Most people can spot an obvious skin cancer, but it is the non-obvious skin cancers that these systems struggle with and we expect they always will. It is vital to note that skin cancer is found in only 2% of moles. The other 98% can be the most unobvious patch of skin. This is why having a full skin check with a specialist dermatologist is vital.
Who is taking the photo?
Detecting a big, black melanoma is important. They commonly (not always) stick out like a sore thumb and are hard to miss. The photographer will normally take photos of these. However, basal cell carcinomas are about 10 times more common than melanomas. Unfortunately, BCCs are routinely flesh-coloured or pink, can be very subtle, and are commonly missed. Of course, there are several other types of skin cancers that are also flesh-coloured.
Because of this, when people come to us for skin cancer removal surgery, we are ethically obliged to encourage a skin check before the surgery.
We don’t charge extra for this, we simply want to ensure you have had a skin check that meets our standards.
Do you want a skin check or a mole mapping?
We get asked this question all the time! The objective way to answer this question is with indisputable facts:
- Only 29.1% of melanomas originate from a pre-existing mole (70.9% from previously normal skin)
- Only 7.6% of skin cancers are melanomas, meaning that…
- 97.8% of skin cancers have nothing to do with a mole whatsoever.
While this is common knowledge amongst dermatologists, it’s not widely known in New Zealand. Of course, you are more than welcome to double-check our numbers. The references are at the bottom of this page.
False reassurance is the worst outcome
Variations of skin checks go by a lot of names like mole mapping, skin cancer check, mole check, or spot check. Fundamentally it is a check of your skin to detect skin cancers. In medicine, there are two types of tests, a screening test and a diagnostic test. A skin check falls into the category of a screening test and to be worthwhile a screening test has to be highly sensitive. High sensitivity is a statistical concept that describes a test that has a low false negative rate, meaning that it misses very few skin cancers.
For a screening test, the worst outcome is being falsely reassured: to be told there is no skin cancer when there actually is. The falsely reassured person would go about their life oblivious and would not get re-checked as they have been (incorrectly) reassured. While no test or procedure is 100% accurate in medicine, when you get a skin check, you want to ensure that it has high sensitivity.
Why have a skin check at Skintel?
At Skintel, our dermatologists really excel at detecting subtle signs of skin cancer. This also allows us to discover early pre-cancerous lesions which we can often treat with non-invasive treatments, allowing you to avoid invasive surgery.
Why get a skin check?
New Zealand has one of the highest reported skin cancer rates in the world. A conservative estimate suggests that over 90,000 New Zealanders are diagnosed with skin cancer every year. However, due to widespread under-diagnosis and under-reporting the true number is likely to be much higher.
The more advanced a skin cancer becomes, the more difficult it is to treat. More advanced skin cancers also have a higher risk of coming back (recurring) after treatment. In general, the best thing to do is to have your skin cancer detected early which may avoid the need for surgery altogether.
If detected early, skin cancers can be treated by being frozen with liquid nitrogen, or sometimes by using a cream like Efudix (fluorouracil) or Aldara (imiquimod).
What happens during my skin check?
The doctor will first introduce themselves and take your relevant medical history.
Sometimes seemingly unrelated conditions and medications can increase the risk of skin cancer, so it is important to establish an accurate history.
Please bring a list with you if it is long!
If you have any lesions that you are particularly concerned about, this is a good time to ensure the doctor is aware of them. It is important to note that only qualified specialist dermatologists perform skin checks at Skintel.
The dermatologist will check your skin and will use a dermatoscope to help with the process. There are numerous different features to look for with the dermatoscope.
We want to ensure that you are comfortable throughout the process.
We are so serious about this that we even had a custom skin-check gown designed and manufactured (in New Zealand) for extra comfort. Chaperones are also available during your check, so please just ask.
What if the dermatologist finds something?
Firstly, we realise it can be scary to be diagnosed with skin cancer. We are here for you and will help you through the process. Our experienced dermatologists will discuss the next steps and you are more than welcome to bring a support person with you.
At Skintel, we are big believers in self-determination so we will always give you reasonable next steps and treatment options. Because you have come to us for our expert opinion, we will also recommend what we think is the best course of management. Medicine is not black and white, it is not about treating a condition but treating unique individuals. We take the big picture into consideration so we won’t coerce you into major surgical operations if it’s not necessary. We realise in some situations, quality of life may be more important.
In many cases, our dermatologists instinctively know what a lesion is and may be able to book you directly for treatment. Even if the dermatologist is confident about the diagnosis, we will still offer a biopsy for people who would be more comfortable with confirming a histological diagnosis before proceeding to treatment.
In other situations, a biopsy is required to help determine the diagnosis, and in some cases, medical insurance companies require a biopsy before proceeding to treatment.
Once a diagnosis has been made there are numerous different treatment options available that the dermatologist will discuss with you. This could include creams, zapping with liquid nitrogen, scraping or surgical removal. Often lesions don’t need any treatment at all and in some cases, we may take photos and monitor their progress.
Above all, if at any time you are unsure about the plan, please simply ask questions, we are here for you.
Frequently Asked Questions
Why do Google benchmark their artificial intelligence against dermatologists?
Dermatologists are well known to be the most accurate at diagnosing skin cancers and this has been demonstrated time and again in numerous studies. Google knows that dermatologists are the experts at skin cancer, which is why they use dermatologists to validate their artificial intelligence platform for skin cancer and proudly announce their platform as dermatologist-level.
We are also constantly keeping up to date with leading-edge medical research on treatments that may reduce or slow down the development of skin cancer.
References
- Esteva, A., Kuprel, B., Novoa, R. A., Ko, J., Swetter, S. M., Blau, H. M., & Thrun, S. (2017). Dermatologist-level classification of skin cancer with deep neural networks. Nature, 542(7639), 115–118. doi: 10.1038/nature21056
- Bangash, HK. Ibrahimi, OA. Lawrence, JG. et. al. Who Do You Prefer? A Study of Public Preferences for Health Care Provider Type in Performing Cutaneous Surgery and Cosmetic Procedures in the United States. Dermatol Surg. 2014;40(6):671-8. doi: 10.1111/dsu.0000000000000016
- Pampena R, Kyrgidis A, Lallas A, et al. A meta-analysis of nevus-associated melanoma: Prevalence and practical implications. J Am Acad Dermatol 2017; 77:938. doi: 10.1016/j.jaad.2017.06.149
- Cancer Society. Skin cancer: Facts and Figures, 2022, from www.sunsmart.org.nz/skin-cancer/facts-and-figures
