Skin deep

1 January 2009

WENDY DUCKETT found herself specialising in a particularly antipodean field – skin cancer – soon after arriving in New Zealand. FIONA CASSIE finds out more about the nursing voice on the Skin Cancer Collegiate Association

Wendy Duckett never saw skin cancer in her first 20 years of nursing... well at least not knowingly.

But within a few years of arriving in New Zealand the UK-trained nurse found herself helping detect, cut out, stitch-up and heal that sadly too common down-under phenomenon.

With her eyes now opened she looks back guiltily and wonders if some skin lesions dismissed back in the UK by GPs as benign weren’t so harmless.

Duckett’s new awareness arose after the primary care nurse emigrated with her family to Auckland in 2004 and began work at the Glenavon Doctors Surgery/Skin Surgery Clinic.

The dual clinic saw her with a dual role as practice nurse and skin surgery nurse. It was the latter that saw her shocked at the number of melanoma and non-melanoma skin cancers having to go under the scalpel.

She works for Dr Sharad Paul, a renaissance GP who specialises in and teaches skin cancer surgery on both sides of the Tasman while also being a published novelist, café-bookshop owner and a philanthropist promoting reading in low-decile schools. The clinic does about 3000 free skin cancer checks and consultations a year as a community service and has operated on thousands of skin cancer lesions.

Duckett found herself assisting Paul on excising skin cancers and lesions plus skin ‘flap’ and skin graft procedures to restore skin cancer wounds. Finding herself suturing and managing post-operative skin cancer wounds she became more and more interested in the causes of these wounds.

She sought out further training to find there was no recognised course available in skin cancer medicine for nurses. In the end she crossed the Tasman for an intensive training programme developed by the University of Queensland for GPs and emerged in 2007 with certificates in primary skin cancer medicine and dermoscopy.

Duckett says dermoscopy, examining the skin with a small torch-like instrument, is like looking through a magnifying glass which lights up the skin and allows you to look deep into the dermis and detect patterns in moles and lesions.

As a nurse she can’t diagnose skin cancer, but she can refer on to Paul those lesions showing abnormalities.

When Paul and colleagues decided to set up the Skin Cancer Collegiate Association – a body aimed at supporting and improving skin cancer treatment in primary care in New Zealand – Duckett also came on board as the nurse director. In league with the University of Auckland, Paul now teaches an advanced skills certificate workshop in dermoscopy and minor skin cancer surgery.

The association provides online discussions and continuing education for more than 70 GPs and Duckett has also been providing a similar service for nurses, but so far has had limited uptake with about four nurses formally registered.

While she has found this disappointing, she is also philosophical that busy primary health care nurses have to chose what to specialise and keep accredited in, with not everybody sharing her passion for skin cancer.

Meanwhile, she is also taking an active role in promoting skin cancer awareness. She has spoken to a large group of beauticians on advising clients on the early signs and recognition of skin cancers, as well as a local arthritis society group and wants to branch out next year with presentations to local companies to keep building awareness. She has also made a presentation to her local practice nurse group and provides support for nurses in the community on post-operative wound management, skin grafts, cryotherapy and recognition of skin cancers.

The ongoing need for education is clear to her, with part of her work auditing the clinics’ findings, which have shown an increase in melanomas among 20-25 year-olds.

While much of the sun exposure damage is done in childhood and teenage years, Duckett emphasises it is never too late to protect yourself. And if you do get caught out with blistering sunburn it is important to monitor that area in the future.

She advises practice nurses to keep informed about skin cancer and talk to patients about any lesions causing concern. After the age of 20, people should not develop new moles and if a new or existing mole starts to change in shape and colour or starts to itch, bleed or grow rapidly it should be seen by their GP. A dry patch of skin or dermatitis that doesn’t respond to cream or doesn’t heal may also be a sign of a cancerous or pre-cancerous skin condition.

ONLINE

More information on the non-profitmaking Skin Cancer Collegiate and online clinical nurse education can be found at www.skincancercollege.org.nz

 

Types of skin cancer

 



Melanoma: the least common but the most serious form of skin cancer.

 

 

 

 

Squamous cell carcinoma (SCC): easily treated if found early but can be fatal if left untreated.

 

 



Basal cell carcinoma (BCC): the most common and least dangerous skin cancer. BCC can be serious, including surgery and scarring, if left untreated.