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Reducing melanoma mortality

From Dr Stephen Hayes

GPSI in dermatology

Bitterne, Southampton

I note the item 'Surge in skin cancer referrals' (News,

2 February) about GP referrals threatening to overwhelm clinics.

Melanoma kills more women than cervical cancer, before you add the men, is still increasing, and is curable only if detected early. Given the lack of GP training, the relative rarity of melanomas, and the devastating result of a missed diagnosis, it's hard to blame GPs for over-referring.

Dermatologists would do better in my view to offer more GP training than discourage referrals.

The dermoscope is a relatively cheap and simple bit of kit which magnifies lesions and reveals diagnostic features invisible to the naked eye. A good course backed up with study and audit should enable a competent GP to confidently reasure the majority of the 'worried well', in particular with seborrheoic warts and benign moles which make up most of the unneccesary referals to skin cancer clinics.

More information is available from and the excellent Menzies atlas of dermoscopy (under £40 with an interactiveCDR from Amazon). Since all practices offer cervical screening, surely we could run to one trained dermoscopist per practice?

There is significant potential to reduce melanoma mortality. Will we only do this when there is a QOF payment?

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