Dr Chris Boberg talks about melanoma care

Can you share a bit about your specific role with these groups? 

“I’m the co-chair for MelNetNZ, which was launched in 2009 and is a forum for all health professionals working in melanoma care to share knowledge, discuss equity, and how to best optimise care for melanoma patients across New Zealand. We meet monthly and host the biennial two-day Melanoma Summit, which is highly successful at getting people across New Zealand together to present the latest updates and current research on this cancer.

“I am also a member of the Ministry of Health’s New Zealand Melanoma Standards Working Group which came together in 2012 under the umbrella of MelNetNZ. This group is really superb – it’s multifactored and covers the full spectrum of NZ clinical leaders in melanoma care – everything from key melanoma health professionals including general practice, oncology, surgical, nursing and researchers – with the shared mission of implementing quality care standards and quality indicators  for melanoma patients. Early detection and dermoscopy in practice are my areas of expertise. We are now engaging with the newly established Cancer Control Agency to evolve quality indicators and we hope to publish both the recently updated melanoma standards and the key quality indicators during the second half of this year.”

What sparked your particular passion for melanoma care? 

“My passion started early as a med student. I became curious about how this little spot can kill people and do it so quickly. In the 80’s we didn’t have the technology to figure these things out just yet and we were reliant on a good keen clinical eye. Dermoscopy came up clinically in the late 90’s, and we’ve only figured out how to use it well during the last decade with the advent of the now famous Chaos and Clues algorithm – a supported decision to excise a suspicious lesion.

“We can now easily teach a doctor Chaos and Clues and the fundamentals of dermoscopy over a two-day course and there are opportunities for revision, advanced learning, and updates. If melanoma is picked up at the early non-invasive ‘insitu’ stage, it’s very survivable. 

“It’s really neat that this has all evolved over the course of my career, and that I’ve been able to champion dermoscopy and early detection in New Zealand and now teach it to our young GPs. As you can imagine I’ve become really wrapped up in all of this – once started - you just can’t shut me up!”

What have been your key learnings or experiences having been a GP rep on these groups?

“Being involved with these groups has validated the absolute importance of GPs on the front line to be able to identify early cancer symptoms - any cancers, but especially skin cancer. No one should die from melanoma. It is no longer a lofty goal as we can now detect it early, and GPs play a huge role in that."

Have you encountered any challenges during your time with the group?

“We’ve had challenges in both groups that we’ve had to overcome, but that’s what it’s all about. Learning how to become an equal voice, as a GP, on a multifactored working group, involving the complete spectrum of specialities; covering melanoma care in New Zealand was both fun and rewarding. For example, it was a challenge introducing Keytruda to New Zealand as a potential treatment option for melanoma.

"In 2017 we were seriously lagging behind the world not having access to immune therapy for melanoma. When we held the New Zealand Melanoma Summit in 2018 we invited Professor Antoni Ribas as a key note speaker (he is one of the key global researchers in immune therapy and melanoma - based in UCLA) and we facilitated his communication with the Minister of Health. This eventually led to it being seriously considered and after a few months, adopted as a treatment.”

Do you have any advice to members interested in becoming a College representative?

“If you’re really passionate about an issue, don’t be afraid to step forward. Start networking and talking to people. You are a dedicated GP already and you will make a difference. There are plenty of groups like this – be prepared to give your time for the common good, and to advocate for general practice. We, as GPs, make massive contributions to healthcare every day. It’s about getting out there and sharing our narratives. I just love being a GP and taking on these challenges.”

Do you have any advice for a College representative going to their first meeting?

“When I started on my first Spot Check Project in 1988, I thought, ‘what the hell do I know about health promotion?’  However, in 1990 I was invited to represent the College on the National Cancer Society Health Promotion committee. I met wonderful people who were understanding and helpful. We had vibrant discussions. I became an expert in the Ottawa Health Promotion Charter and I learnt so much from one of the members over time - Betsy Marshall. She became the first Executive Officer when MelNet NZ was set up in 2009 and made a huge contribution.”

“So my advice is, don’t be afraid. Educate yourself on the way, talk to people, and always promote the virtues of our profession and advocate for it. You can also get a reference group or two together and get advice from them; discuss the issues and seek feedback at your regular cell group. If you are doing something special like this, your colleagues always like to have a sense of involvement with you. Talk to older guys like me! - I’m happy to do that.” 

Are there any resources from the programme or group that you’d recommend to members?

“GPs can join MelNetNZ for free, and you’ll be updated on upcoming summits and key papers released on melanoma care. The Ministry’s draft standards are rolling out soon too."

“We really want to encourage all GPs to train in dermoscopy. It’s easy to learn in just two days. There’s one maiden course here in New Zealand.

“Finally, the gold standard service is full skin checks for high risk people. Also, most GPs can learn basic surgery incisions, and it’s fun!”

On a final note, is there anything else you’d like to share with members? 

“I’d encourage members with a special interest in skin cancer to join the NZ Skin Cancer Doctor (NZSCD) Society. We’ve got 38 members (growing rapidly) who are dedicated GP Skin Cancer Fellows. It has a training and credentialing structure and all that jazz. I love supporting the focused skill set training and quality standards in this area, and it’s what New Zealand has to have. For me at this age, this society is just great and a wonderful outcome.”