Dr Nick Mouktaroudis is a GP and co-owner at Partridge Street General Practice. He’s passionate about health education, has a special interest in Skin, and a lot of expertise to share when it comes to helping people cope with and improve Skin Conditions. We recently had occasion to have a think about how we started Skin Cancer Surgery and Medicine at Partridge Street General Practice and we have a little story below.
Imagine a perfect day in a perfect General Practice. Focus on a busy yet unrushed GP, consulting with another valued patient. The flow of the consult is perfect, the communication great, everything is as it should be.
We have to imagine days like this because they very rarely occur. Flow is fleeting and perfection is often aimed for and seldom reached.
Going back to that consult, we can see that the GP is busy – but is definitely not unrushed. You can feel the pressure in the room as the patient seeks answers and closure and the GP senses the minutes ticking by. The consult comes to a close and both stand, the patient heading towards the door, the GP wishing them well, the patient’s hand is on the door and then. It happens.
‘By the way Doc, what do you think of this?’
The GP turns away from the flashing screen and sees, across the room, a spot on the patients leg.
Should we get the patient back at a later date? Offer reassurance we don’t feel confident giving?
Or, as the GP in this story does, do you reach for the dermatoscope, call the patient back, and look. There’s no such thing as a quick look and so the light comes out, the gel is applied, and a good thorough look is had.
It’s an ugly duckling, a chaotic little mishmash of colours and globules.
It would turn out to be a nasty – a nasty better appreciated in the pathologist’s dish than in the patients bloodstream.
A good result.
At the end of the day, the GP sat and wondered how this could be avoided in the future – how could we improve and be better. These challenges see us but we do not always see them.
This was our practice and so we had to change.
Patient safety is paramount. We decided to solve for quality improvement and patient safety at the same time and made the decision to upskill one of our GPs, Dr Nick Mouktaroudis. He undertook multiple courses and extensive study in Primary Care Skin Cancer Medicine, Surgery, Therapeutics, and Dermatology. Following this we spent time and money upgrading our procedure facilities, equipment, and systems to support Dr Nick. We then allocated time for dedicated skin checks and adjusted our online booking and reception protocols.
These were the first steps and in conjunction with our most recent AGPAL accreditation we have repeatedly run through this cycle, improving every time. We now have dedicated times for skin checks and skin cancer surgery, as well as protocols, systems, and education supporting Dr Nick and the other GPs in the practice. Patients enjoy seeing a GP they know and trust who can deliver appropriate care at a Primary Care level and price point. We receive great feedback from patients and local sub-specialists. It’s a clear win for patients, GPs, and our practice – and the mindset of continual quality improvement that we share with AGPAL was the way to get there.
What is a Skin Check?
A Skin Check is a Comprehensive Skin History and Examination which is done at Partridge Street General Practice.
Your GP will ask you questions to assess the extent of Your risk/exposure to UV radiation and Your risk of solar related cancers.
They will examine you head to toe, examining the skin surface, focusing on any areas of concern (including the eyes, mouth, and anywhere else you may have noticed any spots, lumps, or bumps).
Are there any tools used for the Skin Check?
A proper examination needs proper equipment and we use handheld LED illumination with magnification as well as polarised light and clinical photography.
A dermatoscope is used to examine specific skin lesions. This is a particular type of handheld magnifying device designed to allow the experienced examiner to further assess skin lesions and determine whether they are suspicious or not.
Who should have a Skin Check?
We encourage all Australians over the age of 40 to have a Skin Check annually. Australians have one of the highest rates of skin cancers in the world.
Australians who have above average risks should be having Skin Checks before the age of 40 and sometimes more than annually.
You should have a Skin Check at any age if You are concerned about Your skin or particular skin lesions/areas.
We ask You to identify any lesions of concern prior to the Skin Check wherever possible.
These may include new lesions that You have noticed or longstanding lesions that may be changing in some way or that You are concerned about. If You are worried – Ask!
Risk factors for skin cancer
People at higher risk of skin cancer are those who:
have previously had a skin cancer and/or have a family history of skin cancer
have a large number of moles on their skin
have a skin type that is sensitive to ultraviolet (UV) radiation and burns easily
have a history of severe/blistering sunburns
spend lots of time outdoors, unprotected, during their lifetime
actively tan or use solariums or sunlamps
Does My GP take photos of My Skin?
During a skin check at Partridge Street General Practice Your GP will ask Your Specific Consent to take photos if they are concerned or want to make note of a particular skin lesion.
Photographs are useful as an adjunct to description of the lesion and act as a reference to position and comparison if required.
The photos will be uploaded onto Your Private Medical Record at Partridge Street General Practice.
What if My GP finds something?
This will depend on what Your GP has found.
If they are concerned about a particular skin lesion they may suggest a biopsy to clarify the diagnosis.
A biopsy is a surgical procedure during which they take an appropriate sample of tissue from the lesion of concern and send it to a pathologist for review.
Generally pigmented lesions (coloured spots), will be biopsied in their entirety whereas non pigmented skin lesions may be sampled partially if the lesion is too large to sample in its entirety.
The results of the pathology report will guide further treatment.
Your GP may elect to treat without a biopsy if they are confident of the diagnosis.
This may include freezing/cauterising a lesion, cutting it out (excising), or offering topical treatments such as creams.
Biopsies are scheduled in the Partridge Street General Practice theatre and our Practice Nurse will assist Your GP.
What do I wear for a Skin Check?
Your GP will ask to examine you down to your underwear.
A sheet or towel will be provided for you to preserve your comfort and dignity.
A chaperone (Our Practice Nurse) is always offered.
Please avoid makeup or nail polish as the Skin Check involves the face and skin under the nails.
How long is a Skin Check?
Allow half an hour for Your GP to perform a thorough history and examination.
Do I need to see My GP or should I see a dermatologist?
GPs are Primary Care Physicians on the front line of Skin Cancer detection.
All GPs can check your skin, though not all GPs have formal training or a specific interest in skin cancer medicine and dermatoscopy.
Dr Nick Mouktaroudis has trained extensively in General Practice, Skin Cancer Medicine and Surgery, and has formal qualifications in Skin Cancer Medicine.
Dermatologists are sub-specialists in all skin conditions including Skin Cancer Medicine and Surgery although some will focus on other skin conditions.
Can I do more than a Skin Check?
You can Reduce Your risk by:
Avoid unnecessary exposure to the sun
Wearing sunscreen regularly and on all sun exposed areas.
Wear Hats and Sunglasses when appropriate.
Be aware of Your skin – both You and Your partner can check at Home.
Need more information? Leave a comment or see us in person. We’re Here to Help!
You can see any of our Great GPs right here:
Dr Gareth Boucher
Dr Penny Massy-Westropp
Dr Monika Moy
Dr Katherine Astill
Dr Nick Mouktaroudis
Dr Nick Tellis