Amanda Oakley

Nurse-led skin cancer screening extends specialist reach but depends on the nurse selecting which lesions to forward for diagnosis, and performance varies with experience. We evaluated whether real-time decision support using artificial intelligence (AI) improves malignancy detection in routine nurse-led teledermoscopy screening across MoleMap clinics in New Zealand and Australia (January 2024–July 2025). In this real-world study, clinics using AI decision support were compared with standard clinics. Nurses examined patients, captured dermoscopic images, and forwarded selected lesions to teledermatologists, who provided the reference diagnosis. The analytic cohort comprised 1,102,382 lesions from 98,422 patients across 577 sites. AI-assisted screening was associated with a higher malignancy detection rate than standard screening (25.5 vs 15.7 malignancies per 1,000 lesions; odds ratio adjusted for nurse experience 1.73, 95% CI 1.68–1.77), a finding consistent across all nurse-experience tiers and the three major malignant subtypes. AI assistance was also associated with a shift in recommended management: 21 additional intervention recommendations and 13 additional safety-netting recommendations (self-monitoring, short-term follow-up, or specialist referral) per 1,000 lesions, approximately balanced by 34 fewer no-action recommendations. The reference standard was teledermatologist diagnosis and allocation was not randomised; findings are therefore associational and require prospective, outcome-based confirmation.

Background: Scabies remains an important public health issue in New Zealand, particularly amongst socioeconomically disadvantaged populations. This study evaluated scabies‐related referrals to a regional dermatology service, including treatment patterns, symptom persistence, and equity outcomes. Methods: A retrospective observational study was conducted of scabies‐related referrals submitted to Waikato Dermatology between July 2024 and June 2025. Data was accessed through the Best Practice Advocacy Centre (BPAC) New Zealand database, with reference to clinical records and the New Zealand ePrescription Service (NZePS). Demographic characteristics, referral patterns, treatment before and after dermatology review, and persistent symptoms were reviewed. Diagnoses were categorised as dermatologist‐diagnosed or possible scabies, based on specialist clinical assessment with reference to the International Alliance for the Control of Scabies (IACS) diagnostic criteria. Results: Over the 13‐month period, 149 referrals were reviewed, of which 117 (78.5%) were dermatologist‐confirmed or possible scabies. The median age was 30 years, and 35% identified as Māori. Referrers explicitly suspected scabies in 89 referrals (76.1%), while burrows were documented in only 18 referrals (15.4%). Following dermatology review, combined permethrin and ivermectin prescribing increased significantly, from 14 (12.0%) to 46 patients (39.3%) (McNemar p < 0.001). Persistent symptoms were reported in 63 patients (53.8%) and were significantly more common in dermatologist‐diagnosed scabies than in possible scabies (odds ratio 6.0, 95% confidence interval (CI) 2.2–16.4; p < 0.001). Symptom persistence was significantly more common in Māori patients than New Zealand European patients (75.6% vs. 47.3%; odds ratio 3.5, 95% CI 1.4–84; p < 0.001). Conclusion: Most scabies‐related referrals were clinically consistent with dermatologist‐diagnosed or possible scabies, and clinical recognition by referrers was generally high, although classical supporting features were inconsistently documented. Persistent symptoms were common and likely multifactorial, more in keeping with treatment complexity, reinfestation, and socioeconomic barriers than true antiparasitic resistance.

This study evaluates the SUNTRAC tool in guiding initial skin cancer risk stratification among renal transplant patients in New Zealand. Higher retrospectively applied SUNTRAC grades in 219 patients were associated with higher incidence of skin cancer, supporting the tool's effectiveness in guiding initial skin cancer risk stratification in this population.

Background/Objectives: The only funded indication in New Zealand between October 2018 and April 2021 for the biologic secukinumab, an interleukin‐17A antibody, was severe psoriasis. This unique period of limited availability of secukinumab allowed the evaluation of who received it and health equity.Methods: Anonymised dispensing data were obtained from the New Zealand Ministry of Health and matched with the New Zealand deprivation index, ethnicity and census data.Results: Compared to the most socio‐economically deprived, the least deprived were significantly more likely to receive secukinumab, respectively, dispensing rates per 100,000 (95% confidence interval) 4.00 (3.29–4.71) and 6.56 (5.61–7.51) p < 0.0001. Compared to European ethnicity, Māori, Pacific peoples and Asian were less likely to receive secukinumab, respectively, dispensing rates per 100,000 (95% confidence interval) 6.30 (5.81–6.79), 3.27 (2.56–3.99), 3.31 (2.28–4.33), 4.33 (3.48–5.19) p < 0.0001 all groups.Conclusions: Between October 2018 and April 2021, the data suggest that the dispensing of secukinumab was inequitable. Those having severe psoriasis and being socio‐economically disadvantaged or of Māori, Pacific and Asian compared to European ethnicity, were significantly less likely to have received secukinumab. Dermatologist workforce shortages in New Zealand are likely to compound the problem.

Objectives: Vulval lichen planus (VLP) is a chronic inflammatory dermatosis that is often refractory to treatment and results in poor quality of life. The management of recalcitrant disease is not well described in the current literature. Hydroxychloroquine (HCQ) has a role in treating oral and cutaneous lichen planus and may be used in VLP based on expert opinion. This review aimed at adding to the limited existing evidence on the role of HCQ for VLP. Materials and Methods: This is a case series of 23 people with VLP treated with HCQ. Outcomes were assessed based on physician global assessment. Results: Twenty-three people with a mean age of 66 years were included. Ten patients (44%) had a much improved response to HCQ, 1 patient (4%) had a partial response, and 7 (30%) had minimal/no response to treatment. Five people (22%) experienced side effects that resulted in stopping HCQ. Conclusions: This series demonstrated some efficacy of HCQ in treating VLP. We are limited by the small participant numbers due to the rarity of this condition and a lack of an objective assessment tool. Further controlled studies are needed to assess the effectiveness and tolerability of HCQ in treating this complex condition.

This article discusses how the carbon emissions from virtual consultations have the potential to be much smaller than in-person consultations, predominantly through reduced transportation.

We undertook a retrospective observational review of patients referred to a tertiary dermatology department with vulval complaints over 12 months. The most common provisional diagnoses made by the referrer and final dermatology diagnoses were lichen sclerosus (54% and 38%), dermatitis (12.7% and 16.5%) and psoriasis (5.1% and 6.3%). Referrers may benefit from further education about skin diseases of the vulva, topical steroids for vulval complaints and the importance of clinical photography.

The large language models GPT-4 Vision and Large Language and Vision Assistant are capable of understanding and accurately differentiating between benign lesions and melanoma, indicating potential incorporation into dermatologic care, medical research, and education.

UNSTRUCTURED The large language models GPT-4 Vision and Large Language and Vision Assistant are capable of understanding and accurately differentiating between benign lesions and melanoma, indicating potential incorporation into dermatologic care, medical research, and education.