The requirement to respect autonomy - The Royal New Zealand ...

ORIGINAL SCIENTIFIC PAPErSquantitative researchshould screening for melanoma ever be recommended,it will need to be performed in primarycare. Several self-referred whole-body photographyand sequential digital dermoscopy imagingservices have been developed and are being usedby the public, yet there is little published evidencethat they can effectively detect melanomaat an early stage in the primary care setting.This descriptive study looks at the thickness ofmelanomas diagnosed using a whole body photographyand sequential digital dermoscopy systemavailable in New Zealand (NZ) and compares themto those detected by traditional means, as reportedto the New Zealand Cancer Registry (NZCR). 8MethodsA number of proprietary whole-body photographyand sequential digital dermoscopy screening systemsfor melanoma have been developed, includingMoleMap NZ. The MoleMap database was queriedfor patients who had histologically confirmedmelanoma, or melanoma-in-situ, diagnosed followingwhole-body photography and sequential digitaldermoscopy. Demographic and histological detailswere obtained and compared to similar data ofmelanoma patients detected by standard methodsas reported to the NZCR during a 10-year period. 8Patients undergoing whole-body photographyand sequential digital dermoscopy are largelyself-referred, although an increasing number (approximatelya third) are being performed at therecommendation of a general practitioner and/or specialist (personal communication, Mr BlairStewart, MoleMap NZ). Each proprietary systemis different; for MoleMap, a standardised historyis obtained at each visit by a trained ‘melanographer’,usually an experienced nurse, and includesdemographic data and individual risk factors formelanoma.Panoramic views of the body are first taken tomap the location of the suspect skin cancer(s), followedby macroscopic views (30 mm field of view,‘macro’) and then dermoscopic views (15 mm fieldof view, ‘micro’) of the lesion(s) (Figure 1).WHAT GAP THIS FILLSWhat we already know: Thickness (Breslow) is the major determinant ofsurvival in malignant melanoma, even for thin melanomas (