Melanoma surveillance photography, including total body photography and digital dermoscopy are commonly known as mole mapping, and dermatologists say it is a vital tool for the early detection of melanoma.
There is currently no Medicare rebate for mole mapping, and with prices ranging from $250 to $450, it is beyond the reach of many, especially high-risk patients who may need to have their photographs updated every year.
Many experts say total body photography saves both lives and money as it helps doctors detect deadly melanomas earlier, reducing the need for invasive surgery, expensive cancer treatments and palliative care.
The director of the Victorian Melanoma Service at Melbourne’s Alfred Hospital, Professor John Kelly, said financial help for patients who needed mole-mapping photography was “absolutely vital”.
“I think this should be a priority,” he said.
“Melanoma is our cancer unfortunately. We have the highest rates in the world.
A set of total body images provides doctors with a baseline record of the size, shape and position of every mole so medical specialists can assess if subtle changes are flagging the presence of melanoma.
Dermatologists say total-body photography is especially important for patients with large numbers of moles, when it is difficult to tell if a mole has changed or if a new mole, which may be a melanoma, has developed.
‘A lot of patients don’t have $400’
There is currently no formal screening program for skin cancer in Australia, unlike other cancers such as bowel, breast and cervical cancers.
Leading dermatologists from the Australasian College of Dermatologists last week applied to the Medical Services Advisory Committee (MSAC) to have a Medicare rebate introduced for mole-mapping photography for patients at high risk of melanoma.
MSAC is an expert committee that appraises new medical services and provides advice to the Federal Government about whether they should be publicly funded.
But due to the committee’s rigorous requirements, dermatologists making the application say they are not optimistic it will succeed.
Associate Professor Robert Miller works as a dermatologist in Townsville where there is a high incidence of melanoma.
He has spent the past four years spearheading the push for a Medicare rebate for mole mapping.
“I’ve done it because I feel very strongly that this technology will lead us to earlier diagnosis of melanoma and that in turn will lead to fewer people dying from this terrible disease,” he said.
“We also believe it saves money because it costs something like 1,000 times the amount of money to treat someone who’s had melanoma spread through their body than it costs to treat a very early melanoma simply by just cutting it out,” Associate Professor Miller said.
“The costs of melanoma that has metastasized are huge.”
But he said many of his patients cannot afford mole-mapping photography.
“The problem is that a lot of patients don’t have 400 bucks,” he said.
“I had a lady come in yesterday and she said: ‘My husband and I are having some financial troubles and I just can’t afford it’.”
Associate Professor Miller said about half his patients do not have the photography because of the expense.
“There are at the moment a significant proportion of people who need it who are not availing themselves of it because of the cost,” Professor Kelly said.
Medical ethics ‘Catch-22’
The dermatologists say they have faced an uphill battle to convince the MSAC epidemiologists deliberating on their application because providing evidence from randomised trials would be “unethical”.
“We are caught in a bit of a ‘Catch-22’ in terms of generating the kind of evidence that would make MSAC happy,” Professor Kelly said.
“How could you put one lot of high-risk patients in a group that doesn’t get photography as the comparison group? You would be culpable in the death of perhaps several patients,” Associate Professor Miller said.
The committee is due to make its recommendation to Federal Health Minister Greg Hunt in the coming days.
A spokesperson for the Federal Department of Health said it would be inappropriate to comment until the outcome of MSAC’s deliberations are made public.