I an glad to announce that there will be a World Day of Dermoscopy run by the International Dermoscopy Society in partnership with various other non-invasive world skin diagnostics bodies on Saturday 11th May. Top world speakers will address a wide range of subjects, and thanks to our sponsors it will be free of charge to health practitioners who register. Details Here.
I am honoured to have been asked to give a presentation on the dermoscopy on non-pigmented benign skin lesions. The scientific committee is led by such luminaries as Professor Giuseppe Argenziano of Italy and Professor Aimilios Lallas of Greece, Professor Awatef Kelati of Morocco is scientific organiser, and speakers of the highest quality from around the world will be teaching.
The full programme isn’t published yet, but the abstract below gives an idea. As you can see, it will not just be about the diagnostics of benign and malignant lesion but also the application of dermoscopy to other cutaneous problems including issues around varying appearances in skin of diverse colours.
I recommend early booking, the last time the IDS put on a free global meeting like this (to replace the planned regional conference in Warsaw, Poland in 2020 that was cancelled by Covid) it was our most popular meeting ever with 6,000 delegates leading to strain on the broadcasting technology!
The death from metastatic melanoma has been reported of 24 year old Gregor Lyn. From the story as widely reported, the bare facts are that he went to see his GP about a lesion on his neck in 2019 but was advised that it did not fit NHS criteria for removal. Clearly the GP did not suspect skin cancer or else they would have made an urgent referral. Mr Lyn then went to a private practitioner (details are sketchy) who removed the lesion, or part of it, but did not send the specimen for histological analysis. Histology was an extra £65, which Mr Lyn declined to pay. Next year he went back to his GP as the lesion was still bothering him, was referred to dermatology but was found to have stage 4 melanoma which had spread to his lungs, chest and brain. He died in hospital 2 years after the initial consultation.
My first reaction is of course to think, how sad. But ‘How could this have been avoided?’ is the next thought, and a few others.
The coroner has written to the NHS authorities and raised the issue of the lesion not being sent for histopathology on cost grounds in the private sector while this would have happened automatically in the NHS. But that seems to me not the main issue (although there are VERY strong guidelines about sending all excised skin lesions for histology with the arguable exception of 100% definite warts diagnosed dermoscopically by a skilled person). Without being too judgmental (I have no idea what the lesion originally looked like and its not always easy) the facts is that a GP examined a skin lesion that was in fact a deadly melanoma but they did not suspect a melanoma. The surgeon (whether they were medically qualified or not) also failed to make the correct diagnosis of this skin lesion, as well as incomplete excision and failure to perform histopathology. I’ll bet my second favourite guitar that neither of them used a dermoscope when they examined it.
The last 2 years I was asked to teach the Portsmouth GP trainee group, and expect to do it again this spring. I was given 2 hours to teach them the whole of dermatology. Out of that, I could budget just half an hour to teach these young doctors skin lesion diagnostics. That’s all they will get in their 3 years as GP trainees. Does that sound anything like enough? Skin cancer kills 3,000 people a year in Britain, more than cancer of the cervix, road traffic accidents and meningitis put together. There is no screening program, and people can only see an NHS dermatologist after a GP referral. Everything depends on GPs being able to make a proper diagnosis, but the system is not set up so as to favour this.
The picture below shows a thick, non-pigmented melanoma that was mistaken for something else, leading to delay. It’s not always so easy, which is why GPs need good training.
I hope that the right lessons are learned from this sad affair. It sounds from the speed of disease progress as if poor Mr Lyn had a highly aggressive nodular melanoma, and from the GP’s failure to diagnose it may have been a non pigmented one, which are the hardest to diagnose. Nodular amelanotic melanomas are the black mambas of skin cancer, they are REALLY out to get you and he may have been a dead man walking before he even noticed the lump. There is no guarantee that he would have been saved even if his GP had got the diagnosis right first time, or that the specimen was analysed, but would arguably have had a much better chance.
I am running a one day skin lesion diagnostics and dermoscopy course for GPs in Southampton on Wednesday 24th April 2024, also my Skin Cancer Symposiums friends from New Zealand and Australia are running a 2 day event in Manchester on 28/29 August, and a Masterclass on 30th August. If the GP concerned (I don’t know their name) would like to come on my Southampton course, I’ll give him or her a free place on the course and never speak a word of blame.
I’m glad to announce a new day course aimed at beginners and improvers in skin lesion diagnostics with an emphasis of dermoscopy as a tool for triage. This is so totally necessary given the huge increase in urgent referrals to skin cancer clinics, most of which turn out to be for harmless skin lesions. OK, ‘better safe than sorry’ is an old proverb, but there is only so much capacity in the NHS and if clinics are flooded with avoidable ‘urgent suspected skin cancer’ cases most of which are moles, warts, blood blisters, pimples and skin tags-or even basal cell cancers which are important but not urgent- then patients with more deserving needs, such as scarring acne or life-destroying eczema, psoriasis and other rashes are getting a bum deal by being pushed to the back of the queue and forced to wait much longer to be seen, often over 6 months. The obvious fix for this is to train GPs and practice nurses up better in skin lesion recognition, and that is what Euroderm Skin Diagnostics (me and some experienced chums) set out to do at very modest cost.
The course is from 9 to 5 on Wednesday 24th April at the Leonardo Royal Hotel in central Southampton. Details below. Delegates will benefit from a systematic training in the basics of integrated skin lesion recognition with an emphasis on dermoscopy to separate the harmless from the dangerous and to safely manage the ‘grey area’ in between. A memory drive will be given to each delegate loaded with PDFs of the presentations plus abundant additional learning material amounting to a virtual text book. Refreshments and a seated lunch in the restaurant included. Minimal to no Pharma sponsorship (*) will make for a more relaxing day and time to talk with friends and colleagues. Inclusive cost £200, discount to £160 if booked by 1st February 2024.
The training is designed for GPs, practice nurses, specialist skin nurses, occupational health clinicians, elderly care clinicians, trainees in dermatology and plastic surgery, and any clinician whose work involves evaluating skin lesions. Inclusive cost is £200, early bird discount £160 if booked before 1st February 2024.
To book, make payment by bank transfer to
Euroderm Skin Diagnostics
Sort code 30-99-50
Account number 40158868
And email course organiser Dr Hayes on stevehayes272@gmail.com for confirmation and a receipt.
If you prefer to pay by cheque, please make payable to Euroderm Skin Diagnostics and post to
Stephen Hayes
96 Winchester Street, Botley, Hampshire SO30 2AA
(*) We might have one rep, usually we have none.
Dr Stephen Hayes
Associate Specialist in Dermatology, UHS (retired)
UK and Europe board member, International Dermoscopy Society
Honorary Life Member, Primary Care Dermatology Society
Author ‘Skin Cancer Diagnosis Made Easy’ (Amazon Kindle)
This item was on today’s BBC radio news. Saving lives by earlier detection through screening was mentioned but it was light on specifics and I heard nothing about skin cancer diagnostics and screening. Skin cancer kills some 3,000 people a year in Britain (compared with, say, cancer of the cervix, for which there is universal adult female screening and a vaccine, kills only around 850 people a year).
The full article is linked below.
https://www.bbc.co.uk/news/health-67486722
Skin cancer screening is a controversial topic. Some people feel that it is obvious that all adults should be able to have an annual skin check, and this is promoted by doctors who profit from providing such skin checks, but the overall pick up rate of early skin cancers is too low to justify regular screening in all but the highest risk individuals. The NHS certainly won’t pay for it, although when studying in Australia I saw a reasonable yield of skin cancers picked up by skilled GPs screening sun burned white adults, who paid around £55 for a very thorough skilful skin check.
People are bound to worry about moles, since occasionally a ‘mole’ may be fatal, and with most GPs getting barely a couple of hours of skin cancer diagnostics training in their entire career, if that, it is not surprising if they cautiously over-refer many patients with benign lesions on urgent skin cancer pathways, while at the same time sometimes missing melanomas due to lack of training and experience. But, as I have seen, this puts avoidable strain on the overall dermatology service, and patients can suffer.
The article below, also from today’s BBC news, mentions the problem of urgent suspected skin cancer referrals impacting the care of patients with other skin conditions in the related article. Again, I see this in my daily work, its a problem we don’t hear enough about. And it’s affordably fixable.
https://www.bbc.co.uk/news/uk-scotland-67544495
Prof Colin Fleming, a consultant dermatologist at NHS Tayside, told BBC Scotland News it was hard for many dermatology services to “recover lost ground since the pandemic” partly because the services had to concentrate on skin cancer. (or rather suspected skin cancer-SH)
“This has meant that many NHS dermatology services have maintained reasonably short waiting times for cancer detection and treatment but many life-altering conditions, such as eczema or psoriasis, now have long waits to be seen.
It is for these life-altering but not life-threatening conditions that some patients are now turning to private health to get treatment for.”
He’s right. Most dermatology departments have just about managed to keep suspected skin cancer waiting times reasonably low, because the NHS imposes strict targets for this activity which are enforced by managers, but this is at the expense of people suffering from unpleasant, life-altering non-cancer skin conditions such as psoriasis. The problem gets worse when suspected skin cancer referrals go up, and boy have they been going up!
In the department I worked in up until my retirement this week, urgent suspected skin cancer referrals have been rising by an average of over 10% per annum, and this year alone have jumped another 25%. This is down to GPs who are, no offence intended ‘consciously incompetent‘-they know that they aren’t very good at skin lesion diagnostics, and no surprise as they haven’t been given enough time in the curriculum to study the subject properly, and they are scared. It is also party due to overworked GPs delegating work to health care assistants and nurses, who typically panic and refer everything, even based on a poor quality photo without even seeing the patient. This shouldn’t happen, but it does.
Fixing the problem is eminently possible through better postgraduate education in skin lesion diagnostics. This is not, as the saying goes, rocket science. The NHS could, and should, mandate all GPs to do something like 6 hours every 5 years of skin lesion diagnostics training. They already mandate compulsory regular updates in CPR, child protection, ‘PREVENT’ and other areas. Finding the time and the money for skin lesion diagnostics refresher and update is therefore not an issue-GPs are already mandated by NHS regulations around appraisal and revalidation to do at least 30 hours a year of continuing education which they must usually find time and pay for themselves, surely not an unreasonable expectation for highly paid and highly trusted professionals. Their remuneration package, in the region of £100,000 a year for a full time GP, includes an element calculated to cover this kind of expense, but in any event there is a lot of training that is cheap or free.
It is all very well for cancer charities and other protagonists to call for more scanners, blood tests, Artificial Intelligence and other flash stuff to improve early cancer diagnosis, don’t we love our technical fixes? But you don’t need a brain the size of a planet to realise that if GPs are the first link in the chain for a cancer that kills 3,000 people a year and they have had less than an hour’s training (*) to do that job, there may be simpler and cheaper things that you can, and should do first. As CRUK said above ‘Fix the NHS’
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(*) You might not believe this, but I have walked this path for many years and I know what I have seen. On at least 4 occasions, most recently last February, been asked to teach dermatology to a city-wide group of 40 or so GP trainees. This was all to be done in 2 hours-the whole of dermatology. I spent 70 minutes teaching about common rashes like acne, eczema, psoriasis, infections etc, 20 minutes on life-threatening rashes like toxic epidermal necrolysis, staphylococcal scalded skin syndrome and pemphigus etc, leaving just 30 minutes to teach them all about diagnosing skin lesions. That’s all the formal skin lesion diagnostics teaching they will get in their 3 years as a trainee before they embark on a 30 year career as a family doctor, during which time they will be asked to look at questionable skin lesions every week. This is considered normal, but not by me.
I am glad to be able to announce, on behalf of Skin Cancer Symposiums, an International Dermoscopy Masterclass to be delivered by 4 highly regarded world researchers and teachers. The Masterclass is an advanced level refresher and update and comes right after an accredited 2 day dermatoscopy symposium on the previous two days 28 and 29 August at the same venue. It will be a brilliant refresher and update for dermatologists, dermatology trainees, GPs with a special interest, specialist skin cancer nurses and other clinicians whose work regularly involves evaluating skin lesions. The Masterclass will also be suitable for beginners who have attended the previous 2 day symposium, especially if they put in some pre-course study.
The 2 day skin cancer diagnostics symposium held over 28th and 29th August at the same venue is designed to give a good grasp of the use of the dermatoscope (hand held skin microscope) for diagnosing skin lesions. It is aimed at beginners and improvers with the dermatoscope but will also be of great value to the more experienced. The main symposium teachers are Professor Cliff Rosendahl and Professor Amanda Oakley. These are two incredible people, who have made huge contributions to the benefit of dermatology patients both in their home countries and world wide.
I owe Cliff a personal debt as he gave me generous hospitality and taught me a new level of skin lesion diagnostics in his Brisbane clinic when I visited Australia on a sabbatical 5 years ago. I first heard of his global reputation at a Primary Care Dermatology Society Dermatoscopy Masterclass in Manchester in 2016, where Professor Harald Kittler was teaching. In a discussion about the clothing fabric sign, he mentioned that it had first been described by Cliff, whom Harald praised as an ‘ordinary’ GP who was an example to us all as he had done, and published, great research from his own GP surgery in Brisbane. (I have been in that surgery, it’s a modest one story building in the suburbs of Capalaba, a small town just outside Brisbane).
Cliff earned a full professorship by research on skin cancer diagnostics he did in that little clinic, driven by his passionate interest in melanoma hunting after his brother in law died from metastatic melanoma that was originally misdiagnosed by a GP. They never blamed the GP, he didn’t know any better and did his best, but Cliff devoted the rest of his career to make sure that as many GPs and others as possible WOULD know better, and this is the driving imperative behind Skin Cancer Symposiums, and is why he has taught all over the world, including Iran, Turkiye, Ukraine, Britain and elsewhere. He is a brilliant teacher, I have adapted my own teaching a lot based on what I learned from him.
The name of Amanda Oakley from Waikato, New Zealand, is also highly regarded, for it was she who established the acknowledged number one global dermatology web learning portal, www.dermnetnz.com. Among several other distinctions she has earned, Amanda was made Companion of the New Zealand Order of Merit in the late Queen’s 2018 birthday honours for services to medicine, and rightly so-the Dermnetz web site is acknowledged by everyone who knows anything about dermatology as by far as the most user friendly, reliable and comprehensive learning portal for doctors, nurses and patients. I and thousands of others use it daily. Amanda will be teaching about the evolution of melanoma, a subject she has especially researched, and the development of teledermatoscopy in New Zealand as part of an extended session on this vital subject.
Joining the team on the 30th with be Professor Bengu Nisa Akay from Ankara, Turkiye, and Dr Ausama Atwan from Newport, South Wales. Nisa is a highly regarded researcher and brilliant teacher, who was on excellent form when I saw her presenting to a room of over 1,000 dermatologists at the EADV in Berlin a few weeks ago. I asked her to present with the team in Manchester on some of her strongest areas, namely the dermatoscopy of pigmented skin lesions in darker skin types, childhood skin tumours and facial pigmented lesions. her images are brilliantly well focused and show a range of appearances that is most instructive. If you are a health care professional working in skin lesion recognition, especially if a number of your patients have Mediterranean skin types, you really don’t want to miss this.
Dr Ausama Atwan is a clinical lecturer at the University of Cardiff and has published on a highly effective teledermatoscopy scheme that he and colleagues worked out of Newport hospital in South Wales. It has been such a success that the Welsh NHS has asked him to assist in rolling the system out across the whole of Wales. In designing the programme, I have emphasised the developing technique of teledermatoscopy (which we are starting to roll out at the Hampshire hospital where I work) because it is a proven solution to the problem of high and rising levels of demand for suspicious and potentially dangerous skin tumours to be professionally evaluated. Cliff, Amanda and Ausama will each be presenting on different aspects of using modern technology to diagnose potentially deadly melanomas earlier while screening out harmless lesions more efficiently. This is just something what we HAVE to do, and these are three people who have done it and written it up, all working in different health care setting, so there will be a lot to gain if you are hoping to modernise and improve your skin lesion diagnostics systems to cope with increasing demands and expectations.
Ausama is a UK board member of the International Dermoscopy Society.
Finally, I will be presenting on the many faces of basal cell cancer dermatoscopy from my 20 year archive of images, considering the varied appearances of BCCs of all shapes, sizes, histopathological sub types and bodily locations. The programme is as below, although it’s just possible there might be some changes but this is what we are going to the printers with!
Dr Stephen Hayes at the European Academy of Dermatology and Venereology annual congress, Berlin, October 2023. Stephen is the author of this blog, an e-book ‘Skin Cancer Diagnosis Made Easy’ a skin lesion diagnostics educator and board member (UK and Europe) of the International Dermoscopy Society, and writes a regular column for the Primary Care Dermatology Society bulletin.
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Programme: Skin Cancer Diagnostics Masterclass 30th August 2024 Manchester
09.00 Introduction and housekeeping
09.10 Hunting BIG game: diagnosing difficult and dangerous skin tumours – including amelanotic melanomas. Professor Cliff Rosendahl, Brisbane, Queensland, Australia
10.00 Childhood skin tumours including melanoma. Professor Bengu Nisa Akay, Ankara, Türkiye
10.30 The many faces of basal cell carcinoma Dr Stephen Hayes Hampshire, England
11.00 refreshment break
11.20 Diagnosing pigmented facial lesions Bengu Nisa Akay
11.40 The evolution of melanoma. Professor Amanda Oakley, Waikato, New Zealand
12.00 challenging and instructive cases with electronic voting.
12.45 Lunch
13.45 Teledermatoscopy in New Zealand: then, now and in the futureProfessor Amanda Oakley
14.10 How we made teledermatoscopy work in South Wales. Dr Ausama Atwan, Newport, Wales.
14.40 Deploying photographic technology to detect featureless melanomas. Cliff Rosendahl
15.00 Making teledermatoscopy work-forum discussion
15.10 refreshment break
15.30 Dermatoscopy of lesions in pigmented skin Bengu Nisa Akay
16.20 Dermatoscopy of actinic keratosis, Bowens and SCC Dr Ausama Atwan
16.00 A case study of familial melanoma Cliff Rosendahl
16.40 Any questions? Panel discussion forum
17.00 Finish
I will post more about the symposium and Masterclass later. I earnestly commend it to all clinicians whose work involves skin lesion recognition. With melanoma and other skin cancers killing more Britons annually than road traffic accidents, cancer of the cervix and meningitis put together, and the NHS dermatology service under unprecedented pressure, can you afford not to? See you in Manchester.
Dermoscopy 