Monday 10th September 2012
Roisin Mackle’s specialist nursing post helps people with early or pre-cancerous skin lesions.
The number of people with skin cancer in Northern Ireland has trebled in the past decade. This has led to the need for more treatment and education, and has highlighted to the public the need to change their habits and behaviour.
I was appointed as a Macmillan early skin cancer clinical nurse specialist (CNS) in March 2009 to help the South Eastern Health and Social Care Trust meet the growing needs in this area of care.
It’s a unique role because I can assess, diagnose, treat and review people with early or pre-cancerous skin lesions and those of a non-melanoma skin cancerous type. It differs from the traditional skin cancer CNS role where patients have more complex skin cancers and require more counselling and support, which is provided by the complex skin cancer CNS in the Trust.
People with early or pre-cancerous lesions usually have a good prognosis and are rarely affected with a poor outcome if treated early on. However, the CNS service is available to people with the initial diagnosis of melanoma or other skin cancer diagnosis for support and information.
An important element of the role is educating and giving advice to patients and relatives about diagnosis, treatment planning and preventative measures to avoid further episodes of skin cancer.
The first year in post involved a robust and extensive educational programme to ensure that theoretical knowledge and clinical skills were developed. This included a dermatology short course, a dermatology surgical course for nurses, observation of a practical skills portfolio, clinical placements with similar specialist practitioners and study days on hand-held dermoscopy. This training programme has allowed me to holistically treat the patients attending the nurse-led clinics.
As part of the process of improving services for patients, I hope to provide a screening service using advanced digital dermoscopy. This would require further training to optimise the benefits of the service. At present I use a hand-held dermoscopy to magnify and illuminate the lesion being examined and depend on photographic images for monitoring purposes.
A digital dermoscopy would help to identify lesions which are less typical, or help make an earlier diagnosis of those with a potential to develop into a melanoma. The digital dermoscopy stores the information and allows for more precise monitoring of the lesion at subsequent appointments. However, due to financial constraints on the NHS at the current time, the cost for the equipment required for this service may be delayed.
It’s a very rewarding post as I get to accompany the patient through most of the care pathway. Patients have the option to see a doctor and there is usually a dermatologist clinic running alongside the nurse-led one for support and further discussion if required. It’s also great to see the effects of my practice and intervention.
Email Roisin Mackle, Macmillan Early Skin Cancer CNS, South Eastern Health & Social Care Trust
1. The Northern Ireland Cancer Registry.