Melanoma, the most common form of skin cancer, stands out among cancers because it can be seen with the naked eye and, when caught early, is almost always curable.

“Early diagnosis is the absolute key.” That’s the mantra of Dr. Robin Billick, Chief of Dermatology at the Jewish General Hospital (JGH) since the division was created in the mid-1980s. He has been practicing at the JGH since 1980.

Substantial progress has been made in treating very dangerous advanced or metastatic melanoma that has spread elsewhere in the body, Dr. Billick noted. Just a decade ago, there were few promising treatment options. Now, new treatments such as immunotherapy, which mobilizes the body’s own immune system to fight cancer, can be very effective.

However, those treatments are costly. “We can do great things now with metastatic cancer, but if we found that cancer six or 12 months earlier, we would save the patient a lot of treatment and save our health system hundreds of thousands of dollars. That’s what makes early diagnosis so important,” he said.

Tele-Dermatology provides early skin cancer detection

Dr. Billick and his dermatology team at the JGH are doing all they can to ensure more skin cancers are found, and treated, early. One important element is their Tele-Dermatology service, which allows anyone with a JGH hospital card to take a photo of a suspicious mole or lesion and email it to the Dermatology department for prompt evaluation.

“As long as the photo of the lesion is clear, we can have 90 to 95 per cent accuracy in the diagnosis,” Dr. Billick said. “It’s quick, and it’s an essential service that is efficient, saves a lot of money and saves many patients time and anxiety. If the lesion does look suspicious, we can get them in for further evaluation and treatment.”

However, he added, “We need more doctors to read pictures.” The JGH Foundation did step in last year to help fund a new medical recruit in Dermatology, part of a long history of JGH Foundation support for the hospital’s Dermatology services, starting with a major gift from the Steinberg family that helped create the department in the 1980s.

Since then, funding from donations to the JGH Foundation has provided many extras in the department that are vital to ensuring its services are more efficient and up to date. Donors have allowed the purchase of better surgical curettes that can be re-sterilized and reused. “They’re invaluable,” Dr. Billick said.

JGH Foundation funding also allows the Dermatology Division to provide important educational services for its team so they can remain up to date in the rapidly evolving field. “The funding has allowed us to have 15 or 20 prominent researchers deliver lectures or grand rounds to our team in recent years,” Dr. Billick said. “It gives our team a huge benefit, and we hope to do even more.”

Shortage of dermatologists in the Quebec public system

With his long experience, Dr. Billick has seen a big evolution in the role of dermatology in medicine and within the Quebec healthcare system, which has resulted in a serious shortage of dermatologists in the province’s public system. There are about 227 dermatologists in the province now, he said, with a big shortage in the public system to treat serious skin conditions.

“Unfortunately, dermatologists have little incentive to remain in the public system since we’ve gone from the highest to lowest in terms of remuneration compared to other specialists in the public system,” Dr. Billick said. “That’s why there are more than 100,000 Quebecers waiting to see a dermatologist and why we offer our tele-dermatology service. We could take care of many more if we had the right level of staffing.”

The Dermatology Division provides its services to patients through three clinics, the only such specialty clinics in the McGill University hospital system, Dr. Billick said. One clinic is for melanoma, one for non-melanoma skin cancers such as basal cell and squamous cell carcinoma, and one for lymphoma, cancer that starts in the body’s lymphatic system, an important part of the immune system.

The JGH Dermatology Division is also involved in considerable research work, which has also received support from the JGH Foundation. The work is led by Dr. Phillippe LeFrançois, who along with his team, maintains a bank of tumour tissues which they grow and study with the goal of developing vaccines to prevent skin cancers.

“JGH Foundation donors support our research, our specialized equipment and our good work for patients,” Dr. Billick said. “This allows us to continue to be a leader in the field.”

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