Is melanoma treatment in New Zealand failing national standards?

September 22, 2017


Increasing population and demand for general practice services, combined with more GPs working part-time and many reaching retirement age, means that New Zealand needs to train more GPs. Medical students need time in general practice. Hospital doctors spend three months in a community attachment during their first two years, and doctors in GP registrar training programmes also need to be working in practices. There is insufficient capacity for general practices to accommodate all these trainees, and when some practices take on postgraduate doctors, they have no room for medical student placements. There are a number of strategies which may help increase capacity, including assistance for practices to add consulting rooms and incentivising non-training practices to participate. The proposed combined University of Auckland and University of Otago School of Rural Health would help address capacity issues in rural areas, including support of integrated vertical approaches whereby postgraduate doctors help train their more junior colleagues.



The New Zealand Ministry of Health’s “Faster Cancer Treatment” programme aims for timely care for patients with cancer, including melanoma. Melanoma care guidelines detail investigation and treatment timeliness standards. This audit assesses compliance with these.


Patients admitted to Waikato Hospital for melanoma surgery during the year ending February 2016 were retrospectively identified. Time intervals between care events were calculated. Demographic, lesion, surgical and histopathological characteristics were analysed.


For patients referred with skin lesions suspicious for melanoma, referral to first treatment (Standard 2.1), referral to diagnostic skin biopsy (Standards 2.2, 2.3), biopsy histology report to first treatment (Standard 2.4), referral to first treatment (Standards 2.2, 2.3, 2.4, 4.4) and biopsy to first treatment (Standards 2.4, 4.4) compliance was 0%, 17.6%, 21.7%, 9.3% and 21.7%, respectively. For patients referred with biopsy-confirmed melanomas, referral to first treatment (Standards 2.2, 2.4) and skin biopsy to first treatment (Standards 2.2, 2.4, 4.4) compliance was 42.2% and 42.9%, respectively.


Compliance was low. Attention to logistical constraints in the department reviewed may improve this. Recommendation inconsistencies within and between suspicious-lesion and confirmed-diagnosis referral pathways suggest the investigation and treatment events selected and intervals mandated by the guidelines may usefully be reconsidered.


Brian, T, Adams, B, Jameson, M.  Cutaneous melanoma: an audit of management timeliness against New Zealand guidelines. September 2017. NZMJ:130(1462).

See also NZMJ editorial: Simcock, J. Is melanoma treatment failing national standards?

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