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Addressing inequity in skin cancer detection

9 Dec 2022

South Australian nurses will have the chance to lead skin cancer detection at numerous pop-up screening clinics across the state in 2023/2024, as part of Project Check Mate, a newly funded pilot program led by Rosemary Bryant Research Centre (RBRC), Uni SA. Marion Eckert, Director (RBRC) and Professor of Cancer Nursing; Greg Sharplin, Research and Strategy Manager and Senior Research Fellow (RBRC); and Pam Adelson, Research Fellow (RBRC), discuss how rural and remote nurses can help to increase early detection of skin cancer in their regions.

Pilot Project Check Mate’ is tak­ing a unique and sus­tain­able approach to ear­ly skin can­cer detec­tion, by mobil­is­ing and upskilling region­al nurs­es to assist local GPs in pro­vi­sion­al diag­noses of skin cancer. 

Recent­ly award­ed a grant from The Hos­pi­tal Research Foun­da­tion, the pilot will launch in South Aus­tralia in ear­ly 2023 to address skin can­cer screen­ing bar­ri­ers expe­ri­enced in region­al and remote Australia.

The fund­ing was gen­er­ous­ly matched by health pro­mo­tion char­i­ty Skin Check Cham­pi­ons, who for around 10 years have organ­ised pop-up, nurse-led skin check clin­ics across Australia. 

Greg Sharplin, Senior Research Fel­low, empha­sis­es that col­lab­o­ra­tion is at the heart of the project. 

Hope­ful­ly at the end of the pilot we can tell a real­ly good sto­ry about how many checks we’ve con­duct­ed, how many poten­tial lesions we picked up, and also how many nurs­es we were able to train,” he says.

High­er rates of skin can­cer in region­al Australia 

Skin can­cer rates are around 30 per cent high­er in region­al areas than they are in met­ro­pol­i­tan areas. Bar­ri­ers to hav­ing skin checks in region­al and remote areas include dis­tance, reduced access to ser­vices, and the demands and respon­si­bil­i­ties of lifestyle tak­ing prece­dence over health care. 

In Sep­tem­ber of this year, at a Skin Check Cham­pi­ons’ pop-up screen­ing in region­al Queens­land, nurs­es scanned 630 peo­ple and detect­ed 300 lesions, and of those, 50+ lesions had fea­tures sus­pi­cious of Melanoma.

Nurs­es have a real oppor­tu­ni­ty to own a bit of this space because no one’s real­ly doing that work at all in region­al areas,” says RBRC Direc­tor Prof. Mar­i­on Eckert. 

There are only around 550 der­ma­tol­o­gists across the coun­try, so it’s just not pos­si­ble [for them to deliv­er the ser­vices that com­mu­ni­ties require].”

Scott Mag­gs, Skin Check Cham­pi­ons (front cen­tre), Jane Homberg­er, Skin Smart Aus­tralia (cen­tre) and nurs­es after a skin check pop-up clin­ic in Sep­tem­ber. The dots on the manikins are patient placed if they had a sus­pi­cious lesion found.

The nurse-led screen­ing approach 

Nurs­es will be trained by Skin Smart Aus­tralia to use a der­mato­scope, a hand­held, non-inva­sive instru­ment that mag­ni­fies and illu­mi­nates the skin sur­face and allows for the visu­al­i­sa­tion of sub­sur­face skin struc­tures that are not vis­i­ble to the naked eye. The instru­ment will cap­ture dig­i­tal images that can be for­ward­ed to a GP or der­ma­tol­o­gist to fol­low up, diag­nose or monitor.

Skin can­cers, as a pri­mar­i­ly visu­al diag­no­sis, are con­sid­ered one of the prime areas for tech­no­log­i­cal health inter­ven­tions. The pilot pro­gram will also be test­ing arti­fi­cial intel­li­gence (AI) to assist clin­i­cians with pro­vi­sion­al diagnoses. 

Pop-up clin­ics will be estab­lished at three or four large region­al events, in region­al SA between 2023 – 24. Screen­ing at each event will be free for any­one who would like to be checked, though there will be a strong focus on attract­ing high-risk groups includ­ing farm­ers, peo­ple who haven’t had a skin check before, and peo­ple who tend to work outside.

Melanoma Insti­tute Australia’s 2022 State of the Nation – A Report into Mel­ono­ma, details a five-point strat­e­gy to achiev­ing zero deaths from melanoma by 2030.

One of their rec­om­men­da­tions is that first of all, we need to have a stan­dard of care for actu­al­ly doing skin exams,” says Research Fel­low Pam Adelson.

We don’t have that in Aus­tralia. A lot of GPs don’t use a dermatoscope.

[Pic­tures tak­en by it] can be trans­ferred to a der­ma­tol­o­gist, so it’s ide­al, espe­cial­ly for those who are not locat­ed near services.”

Call­ing region­al SA nurses

UniSA is invit­ing region­al nurs­es of South Aus­tralia, who may wish to be involved in der­moscopy and screen­ing, to get in touch. Event details are to be con­firmed but are expect­ed to take place from Jan­u­ary 2023

For more infor­ma­tion or to sub­mit your expres­sion of inter­est, con­tact Mar­i­on at Marion.​Eckert@​unisa.​edu.​au

An oppor­tu­ni­ty for rur­al and remote nurs­es to lead the way 

In part­ner­ship with Skin Smart Aus­tralia, UniSA also hopes to devel­op a skin can­cer screen­ing train­ing pro­gram aimed to upskill region­al and remote nurses. 

Der­ma­tol­o­gists are large­ly city-based, and we know that GPs are stretched. Nurs­es [are] the largest work­force that can do der­mo­scop­ic assess­ments and take pic­tures with the der­matas­cope. So, we’re quite keen to upskill nurs­es who are inter­est­ed in work­ing inde­pen­dent­ly and with their GPs,” says Pam. 

If you’re a nurse work­ing in a rur­al or remote loca­tion, and you’d like to learn more, please con­tact Mar­i­on at Marion.​Eckert@​unisa.​edu.​au

CRANAplus also offers the online short course Skin Assess­ment, which can assist remote health­care work­ers to devel­op a sys­tem­at­ic assess­ment approach to clients who present with skin symptoms.