KEY POINTS:
Patients with suspected skin cancer are being squeezed out of the public health system, an Auckland GP says.
Dr David de Lacey, who practises in low-income Glen Innes, said patients he referred to the Auckland District Health Board with suspected malignant melanoma were being rejected since last year.
The board's skin department now asked for laboratory proof - from tissue taken from the suspect skin spot - before it accepted patients.
But as melanoma could spread fast, the ideal course was to cut out the suspect lesion with a wide, 5mm margin - diagnosis and potentially treatment in one hit - rather than first doing a smaller biopsy just for diagnosis, he said.
Consequently he referred such rejected patients to a private specialist if they could afford to pay, or reluctantly did the treatment himself, at a cost to the patient of $250 to $300. Some had not paid.
"The GP is not the most appropriate person because the scar tends to be large and needs a plastic surgeon or specialist to be doing it."
A health board GP liaison officer, Dr Russell Smart, said national dermatology guidelines in 2000 recommended referrals have laboratory proof of malignancy.
"The ADHB dermatology department has had to recently insist upon this as a requirement so that specialist resources and funding are appropriately used to treat malignancies rather than the burgeoning number of benign skin lesions being referred."
The Waitemata and Counties Manukau boards had similar requirements.
Dr Smart said it was appropriate to take an "excision" biopsy - the whole lesion with a 2mm margin - and if proven malignant to refer the patient to a specialist facility for a "wide excision".
But this was not an absolute requirement. "Any referral of a suspected malignant melanoma without a biopsy would be seen urgently and dealt with."
Dermatological Society president Dr Kevin McKerrow said the hospitals were "calling the shots - we don't get a choice but to biopsy", but their request was reasonable. As well as being done for diagnosis, a small "punch" biopsy could help determine how deep to make the cut.
Cancer Society medical director Dr Chris Atkinson said access to many cancer-related services was difficult in some places, not just for suspected melanoma, but he could see the disagreement between Dr de Lacey and the health board from both sides.
