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Clinician perspective: Melanoma

Dr Tom Dewar

My starting point for a special interest in melanoma came when I was a GP registrar in Castlemaine in 2018. I took over the patient base of a retired GP. A lot of the patients were in the prime melanoma demographic of outdoor workers and over 60 years old. In the first year I excised eight melanomas, which is a lot for a GP with no special interest training in skin cancer and not undertaking skin checks.

No one else in my clinic was doing skin cancer as a special interest. I came to realise there was quite an accessibility issue for patients requiring ongoing monitoring, such that I started undertaking further training. I believe that melanoma fits into the broader picture of general practice in that skin cancer monitoring and management is comparable to a chronic disease, particularly in the very high risk group. Additionally the scale of the problem is vast. This volume of work, by necessity, means that there must be broad structural approaches to efficiently and safely managing skin cancer. It's why I was grateful to be asked to be a part of the Melanoma 2022 Summit, providing an opportunity to focus on such approaches.

For the first 12 months it was very difficult to get support to upskill as a skin cancer GP. You do your courses, although it takes time to set your antenna to the right sensitivity. The age-old adage is, ‘If in doubt, cut it out’, although in the early stages this will lead to a lot of biopsies. I later had the good fortune of being able to work with Melbourne-based dermatologists at a Bendigo Health skin cancer clinic. This was a great learning opportunity, although not available to all GPs. Peter MacCallum Cancer Centre is trialling a program in Bendigo in which GPs can discuss cases remotely with a dermatologist – programs like this give me great hope for the future of skin cancer management in rural areas.

The consumer statement summed it up beautifully – good care shouldn’t be good luck. I think that is such a fantastic way of describing the way skin cancer should be approached. We shouldn't be relying on good catches and things just working out the right way.

I'm very grateful to have been one of three GPs who were invited to be involved in the melanoma summit. Outside of metropolitan areas and some regional centres, melanoma detection is largely in the realm of primary care. We are, at the very minimum, the entry point for our patients, and a good early start to their involvement in the system can be crucial for good outcomes. I believe that the interventions identified at the summit will be of great value and I am excited to see their implementation.


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