Molespec

MoleSpec is a specialist assessment and treatment programme designed to find, assess and treat the type of skin cancer most commonly associated with moles: melanoma.

Melanoma and other skin cancers kill about 350 New Zealanders each year, and the incidence of these diseases is continuing to increase. (Melanoma, is the most common major malignancy in people under the age of 40, with risk peaking in middle age.) The best way to protect yourself is by early detection, as the outlook for melanoma is critically dependent on the depth of the cancer. With early-stage melanoma, a cure, or at least a better prognosis, is very likely. Early detection is best achieved by having a complete skin examination and assessment of moles by the person best qualified to do the job – a dermatologist, a specialist doctor fully trained in the assessment and treatment of all skin disorders and skin cancers – not a nurse, technician, general practitioner or mole clinic doctor.

During the course of a MoleSpec assessment, a comprehensive examination is made of the patient’s skin. State-of-the-art dermoscopy (also called dermatoscopy) equipment is used; a cross-polarised light scanner and cross-polarised light dermatoscopes complement the traditional instruments. This detects subtle changes in blood vessels and pigmentation, allowing early diagnosis of melanomas and other skin cancers. Digital photographs may be taken and recorded, although this is not often necessary. At the same time, precancerous keratoses, such as solar keratoses, can be easily treated with cryosurgery.

Any skin disorders or abnormalities are noted at the same time, and treatment, when appropriate, can be offered. Dermoscopy is also used in the assessment of benign skin lesions and some rashes. Only a dermatologist has the expertise to advise on appropriate treatment of all skin cancers, abnormal moles, precancerous growths and benign lesions.

About the Developer of MoleSpec

MoleSpec was created by Dr David Nicholls, MBChB., Dip G-U Med, DTM&H, FRACP, Dermatologist, and is a programme designed to be the most expert and efficient way of assessing moles and skin cancers.

Dr Nicholls works in private practice at Christchurch Dermatology, based at 154 Leinster Road, Christchurch. He graduated in medicine from the University of Otago, specialising in internal medicine before going on to specialise in dermatology, a discipline in which he has more than 25 years of experience.

Dr Nicholls’s training in dermatology was completed in Auckland, New Zealand, and at the prestigious St John’s Hospital for Diseases of the Skin in London, England. Practising in Christchurch, he held the post of Consultant Dermatologist at Christchurch Public Hospital until 2003. He is also a senior clinical lecturer in pathology at the Christchurch Clinical School, Otago School of Medicine. He has published numerous papers, in local and international peer reviewed medical journals, and has made significant contributions to medical literature.

Dr Nicholls is an International Fellow of the American Academy of Dermatology and a member of numerous specialist societies, including the International Society of Dermoscopy, the British Association of Dermatologists, the Australasian Society of Dermatopathologists and the New Zealand Dermatological Society (Inc). Dermoscopy has been a routine part of Dr Nicholls’ practice for more than 15 years and this, plus the assessment and treatment of skin cancer and melanoma, is one of his major interests within dermatology.

Information About Skin Cancer – Including Melanoma

Melanoma
Melanoma is a major killer. Every year more than 300 New Zealanders die of melanoma. Incidence of melanoma has increased explosively every decade since the 1930’s with most cases resulting from excessive exposure to the sun. Sunburns are major risk factors, especially if they occur in childhood. Melanomas are in fact rare in childhood but the risk gradually increases with age, plateauing in the sixth decade of life. If not diagnosed until they have developed to an advanced stage, they are often fatal because the disease spreads to other parts of the body. Risk factors for melanoma include:

• Multiple sunburns (just one can increase risk)
• Fair skin that burns easily and light-coloured eyes
• A past history of melanoma
• A close relative (parent, child or sibling) with melanoma
• Sunbed use
• Lots of moles, especially if they are large or irregularly shaped

Treatment of melanoma is by surgical excision. In most cases this will be done under local anaesthetic. If melanoma is confirmed, a wider excision is often necessary to ensure complete removal of any microscopic deposits of melanoma.

Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common cancer on earth and is steadily increasing in incidence. It is more common in fair-skinned people and, although it is ocassionally seen in teenagers, it becomes more common with age. This form of skin cancer is diagnosed almost every day Christchurch Dermatology. It is often unsuspected and only picked up on a skin examination. Typically, basal cell carcinomas look pearly or translucent and have a rolled edge. They are often ulcerated and may bleed. They are usually slow growing but may be extremely destructive and mutilating. They may eat into muscles, nerves, cartilage and bone. Dermoscopy is extremely helpful in diagnosing this form of skin cancer. The best treatment may vary, according to age, the site of the lesion and other factors.

Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is about four times less common than BCC. It does have the potential to metastasise (travel to other parts of the body), but is usually much less aggressive than melanoma. In the majority of cases, surgical excision is the most appropriate treatment.

F A Qs

How does MoleSpec differ from mole mapping?

In mole mapping, a technician or nurse examines the skin and selects moles for more detailed assessment. Digital photos are taken, as well as magnified images of the moles through a dermoscope head. At a later stage, the images may be examined by a doctor or dermatologist. MoleSpec is different in that the patient receives a comprehensive skin examination in “real-time” by a fully qualified specialist dermatologist, who is expert in using state-of-the-art dermoscopy equipment, and is also able to detect any other skin cancers or skin disorders at the same time, as well as advise on appropriate treatment.

Are photographs of my moles necessary?

In a few cases, digital images may be recorded through a dermoscope head and archived for future comparison. This is not usually necessary. In most cases, if a mole is considered to be abnormal, then removal is usually the most appropriate choice.

Are further examinations necessary?

At the end of the consultation you will be given an assessment of your level of risk for melanoma as well as other skin cancers. If it is low, routine follow-up may not be required, but if your level of risk is high, follow-up is encouraged.