New Zealanders who find a suspicious mole or spot will be able to have it examined and cut out at their local general practice under a $23 million government plan to shift routine procedures out of hospitals and into the community.
Health Minister Simeon Brown announced the funding on Saturday morning, calling it the first stage of a wider move to deliver more care closer to where people live. “New Zealand has among the highest rates of melanoma in the world. Skin cancer is our most common cancer, and it is one of the most treatable, but only if it is caught early,” he said in the government release.
The money will pay for general practitioners to upskill so that more clinics can offer the service. That includes training in dermoscopy, which uses a specialised magnifier to examine a spot closely, and skin excision, so that lesions can be removed on site rather than in a hospital theatre.
Brown said the current picture varies sharply around the country. “For too many New Zealanders, what happens after a suspected skin cancer is spotted depends on where they live. In some parts of the country there are excellent community skin cancer services. In others, the only options are a long hospital wait or paying to go private,” he said.
Skin lesions are only the first item on the list. The government said the same $23 million pool will later cover cataract follow-up appointments with optometrists, testing for bowel cancer in people who already have symptoms, and respiratory care. It follows $5 million allocated last year, which paid for participating practices in every region to treat abnormal uterine bleeding and carry out minor gynaecological procedures without sending patients to hospital.
The numbers behind the announcement are large. About 90,000 non-melanoma skin cancers are diagnosed here every year, and in 2022 there were 3,116 melanoma registrations, according to the SunSmart figures compiled by the Cancer Society from the New Zealand Cancer Registry. A further 4,000 or so people are found each year to have in situ melanoma, meaning a melanoma that has not spread. Almost all of that burden is already handled outside hospitals, with most skin cancers treated by a family doctor or a skin specialist and only a small share needing hospital care.
Environmental Health Intelligence New Zealand, which publishes the official melanoma surveillance figures, says New Zealand and Australia have the highest melanoma rates in the world, and that more than 90 percent of melanoma cases here can be attributed to ultraviolet radiation from the sun. Melanoma was the third most commonly registered cancer in 2020 for both men and women.
The postcode problem the Minister described is not an abstract one. In the Waikato, the Pinnacle network already runs a suspected skin cancer excision service in which a GP photographs a lesion and sends it to a teledermatology service, which decides whether it looks malignant and whether it can safely be removed in a clinic. If it can, the referring GP takes it out, or passes the patient to another GP with more surgical experience. The catch is that the funding is rationed. A patient qualifies only if they hold a Community Services Card, or live in the most deprived fifth of neighbourhoods, or are MΔori or Pacific. Everyone else pays, or waits.
That is the gap a national scheme would have to close, and it is where the announcement is thinnest. The release does not say when the skin cancer service starts, how many practices are expected to take part, how many GPs will be trained, or whether patients will face the same income and deprivation tests that apply in existing regional programmes. It also does not say what a patient will be charged for the appointment itself, as opposed to the procedure.
Skill levels are the other practical question. The Waikato scheme splits the work into basic excisions, which any vocationally registered GP is expected to manage, and advanced excisions involving layered closures, which are restricted to doctors with extra surgical training who sit in a quarterly peer review group. Building that second tier nationally is slower work than writing a cheque, which is presumably why the funding is aimed squarely at training.
The economics favour doing this in a clinic. Researchers estimated the health care cost of skin cancer in New Zealand at $454.6 million a year, and projected it would reach $689.7 million by 2049 as the population ages. Melanoma is also the clearest case for catching things early. Costs per patient in that research ranged from about $1,450 for an in situ melanoma to more than $77,000 for advanced disease that cannot be cut out.
Deaths have been falling. There were 333 melanoma deaths in 2021, down almost 12 percent from the 2015 peak of 378, and the age standardised death rate of 3.5 per 100,000 was well below the 2011 high of 5.3. Researchers writing in the New Zealand Medical Journal linked much of that improvement to the arrival of two drugs for advanced melanoma, Opdivo and Keytruda, rather than to earlier detection. Even so, the Cancer Society notes that more New Zealanders die from melanoma than die on the roads.
Brown argued the change should help hospital patients as well as GP patients. “It also means better use of our hospital specialists, who will be able to focus on the more complex cases that require hospital level care, helping to bring down waiting times for those patients,” he said.
Whether that holds depends on how much of the current hospital queue is made up of straightforward excisions that a trained GP could have handled, and on whether enough practices have the room, the theatre time and the staff to take the extra work on. Those are questions the coming months will answer rather than the announcement. For now, the promise is a nationally consistent service in place of a patchwork, and $23 million to start building it.
Have you waited months for a skin lesion to be looked at, or paid privately to get it done sooner? Tell us what happened where you live in the comments below.
This article was written by AI, briefed to report the facts, hopefully without some of the bias people bring to the job π
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