The Guild's Peter Waterman writes in Retail Pharmacy.
The summer season brings with it a
greater awareness of the dangers of added
exposure to the sun and outdoors – exposure
that can lead to skin damage and the possible
risk of skin cancer.
Skin cancer is an all-too-common form of
cancer in Australia, with the incidence in this
country being among the highest in the world,
two to three times higher than the rates found
in Canada, the US and Britain.
Cancer Australia projects that by year’s end,
an estimated 13,283 new cases of melanoma
will have been diagnosed in 2016, accounting
for 10.2 per cent of all new cancer cases
diagnosed this year.
It also projects that the year’s death toll from
melanoma will be 1,774 people, with males
making up 1,229 of this total.
Early detection through screening is key
to improving survival rates, and community
pharmacies increasingly are offering such
services on a structured basis.
One such system is Spotcheck, a skin spotscreening
service that utilises the expertise of
doctors practising in skin-cancer medicine.
With no appointment necessary, skin spots are
photographed and sent to a doctor who is an
expert in skin spot analysis. Patients receive the
results within 48 hours.
Dr Tony Dicker, one of the doctors behind
the Spotcheck system, says about 250
pharmacies are offering the service, including
retail pharmacy brand Chemmart.
“We’re doing over 1,000 spots a year and
finding about one in six spots is a cancer,”
“Myself and Dr Gary Pellizzari diagnose the
images and data sent to us from the pharmacy.
We both work in skin-cancer clinics and are
trained in dermoscopy diagnosis.
“Despite the ease of access to skin clinics,
people are still dying from melanomas, so we
thought about how we could get to people
who need to have spots checked but, for some
reason, don’t go to a doctor or clinic.
“The result is the Spotcheck system for
pharmacies. Pharmacies are ideal because
they’re very accessible as well as being places
that people go to for health advice and
Dr Dicker says the Spotcheck system in
community pharmacies has resulted in the
diagnosis of more than 50 melanomas.
“When we diagnose a melanoma we
immediately contact the patient and tell them
they have to see a doctor and have it cut off,”
he said. “If they don’t have a doctor, we can
help find one for them.
“Through Spotcheck we often are the
first point in the diagnosis and are finding
Spotcheck involves the use of a dermatoscope
attached to an iPhone, which in turn has a
dedicated app loaded for the process. The unit
is able to capture the picture and all the data
needed for the diagnosis.
“It’s important to note that with our system
the images and information are not stored on
the phone, but rather on our servers, which
comply with the stringent requirements for
storing medical data,” Dr Dicker said.
“The information we gather includes a
contact number and email address for the
patient, so we can contact them quickly if we
find something significant.
“Every person who sends in a spot receives a
diagnosis – not a percentage risk, which some
other phone apps do. Ours is a diagnosis by a
doctor who has special training in analysing
“We’re capturing people who haven’t
presented to a doctor in the first place,
people who would not have had a skin
check. We’re capturing people who haven’t
had the time to see a doctor. They like the convenience of the walk-past, drop-in service
provided by the pharmacy.”
Dr Dicker rejects criticism of the checks
being carried out in pharmacy.
“We are doctors doing the diagnosis and
the pharmacies are merely gathering the
information for us,” he said.
“The nice thing is that the system works
and we’re finding things earlier. We have a
structure behind us to help refer patients and
close the loop so patients get treatment as
quickly as possible.
“If we can save lives, we’re ahead of the game.
“We agree that a full skin check is the gold
standard, but the people presenting at the
pharmacy aren’t even showing the doctors
these spots, let alone getting a full skin check.
This process can start the journey for them.”
Carolyn Wynen, co-proprietor at Chemmart
Casey Central in Victoria, says the pharmacy
has been conducting the Spotcheck program
for three years.
“It’s been a very worthwhile service and
we’ve been able to identify some spots of
concern,” she said. “Of course, there are a
whole lot more that aren’t [of concern], but
the patient gets peace of mind after having
the spots checked.
“People often think they’ll leave a spot to
be checked until the next time they visit the
doctor, but when they go to the doctor, they’re
sick, and their focus is on that illness, so the
spot is forgotten about.
“With us, we find patients are saying, ‘While
I’m here can you check this spot for me?’ They
get the spot checked and if there’s nothing to
worry about they get peace of mind.
“There are also instances where we do help
find spots of concern that need to be acted
Ms Wynen says accessibility and not having
to book ahead are key factors in the service.
“It’s important to stress that we’re not
diagnosing and we’re not operating outside our
area of expertise,” she said.
“We’re facilitators of the service, working in
conjunction with doctors who are experts in
“We’re qualified health professionals and we
have the professionalism to give advice within
our realm of expertise – we’re certainly not
saying we’re skin experts. The important thing
is that people are having any skin spots they
are concerned about checked.”
A spokesperson for Guild Insurance
reinforced the need for patients to be advised
that pharmacists and pharmacy assistants in
the Spotcheck service are simply facilitators.
“It’s important that pharmacists don’t give
advice or offer opinions that are outside their
expertise,” the spokesperson said.
“There may well be pressure from a patient
asking for help on choosing a spot or
requesting a diagnosis. It’s important that only
the pharmacist provides general advice, such
as referring to the ABCDE [‘asymmetrical
shape, border, colour, diameter and evolution’]
melanoma detection guidelines, and ensures
that the patient understands that diagnosis is
conducted by the Spotcheck doctor, using the
data gathered in the pharmacy. If a patient
has concerns, a recommendation to have a full
skin check by a qualified health professional
should be made.”
“Patients should also have an initial
professional skin check by a GP or
dermatologist. This will help determine personal
risk factors and the frequency of future checks.
“Providing skin checks in pharmacies may
well assist people to keep their skin top of
mind and help identify anything that may
require checking by a GP or dermatologist.”
Dermatologist and AMA (NSW) past
president Associate Professor Saxon
Smith is a strong advocate for skin checks
being performed by doctors – but sees an
important role for community pharmacies as
part of a collaborative approach to reducing
the incidence of skin cancers.
He says the ‘slip, slop, slap’ campaign’ is
regarded with a degree of apathy and too
many Australians fail to give credence to
warnings about skin cancer.
“Patients also are not looking at expiry
dates on sunscreen, they’re not storing it
properly and many don’t actually know how
much to put on,” he said.
“These are all important messages that
we need to get out and I think community
pharmacies are an ideal setting for this sort
of education – the get-smart-about-sunprotection
“At the moment, Australians seem to be
suffering from education fatigue about sun
protection and we need to address that.
“Some 30 per cent of young adults in
Australia still actively sun tan despite
knowing it increases the risk of skin cancer.
Plus, 65 per cent of all adults in Australia
have been sunburnt at least once in the
past 12 months. So education message and
prevention are critical.”
However, when it comes to checking for
skin cancers, Associate Professor Smith says
the first stop should be the family doctor.
“Without question, skin cancer checks
should be performed by doctors,” he said.
“One of the problems is that a check in
pharmacies only looks at one spot or a few
spots and that’s inadequate.
“It’s important that the patients have a full
body check, as looking at only one or a few
spots raises the dangers of an inaccurate
diagnosis or a wrong diagnosis. A top-to-toe
examination is needed. We also need to have
a full history of the patient, which is not
available in pharmacies.”
Associate Professor Smith says another
issue with checks in pharmacies is that in
these cases the patients are often telling the
pharmacist or pharmacy assistant which spot
they want checked.
“We know from Australian research that 60
per cent of melanomas picked up by doctors
are ones the patient was totally unaware of,”
“In a pharmacy, a patient may ask a
pharmacist to check a spot they’re worried
about, but be unaware of other spots,
which we would pick up in a full body
Associate Professor Smith also raises
concerns about the technology used in some
non-medical-practice checks for skin cancer.
‘You’re looking at a 3D lesion in 2D,” he
said. “You’re not feeling the lesion and
the dermatoscope reduces the capacity to
“Also the colour of the lesion is
important in diagnosis and this may not be
accurately reflected by some dermatoscope
examinations. The dematoscope should be
regarded as an aid, not a tool in diagnosis.”
Associate Professor Smith says a
collaborative and collegial approach among
health professionals to reducing skin
cancers is important.
“There’s so much we can do together, but
we have to know our individual professional
limitations,” he said.
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