SKIN & CANCER FOUNDATION AUSTRALIAA COMPANY LIMITED BY GUARANTEE ABN 23 001 578 105

In affiliation with St. Vincent’s Hospital, University of NSW, Westmead Hospital, The Children’s Hospital at Westmead, University of Sydney and the Australasian College of Dermatologists

years of service

Annual Report 2009

Celebrating

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Our Mission

The purpose of the Skin & Cancer Foundation Australia is to benefit people who suffer from diseases of the skin.

To achieve this, the Foundation aims to:

• Develop the science of dermatology and its sub-specialities;

• Be a centre of excellence in the provision of dermatology services, research and education;

• Remain financially independent; and

• Maintain visibility and relevance for our stakeholders, and for our dermatology trainees, students and nurses.

The achievements of the last 30 years have only been made possible by the

dermatologists and donors who support us, and with the invaluable commitment

of our loyal staff. Thank you!

Our Patron

HER EXCELLENCY PROFESSOR MARIE BASHIR AC, GOVERNOR

OF NEW SOUTH WALES

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Contents Page MAJOR MILESTONES 4

ChAIRMAN’S REpORT 6

ChIEF EXECUTIVE OFFICER’S REpORT 8

OFFICE BEARERS & CONTRIBUTORS 10

RESEARCh 11 Dermatopathology Dermatology

pRESENTATIONS & pUBLICATIONS 12

TRAININg ANd EdUCATION 14 Darlinghurst

FINANCIAL REpORT (INSERT) 15

TRAININg ANd EdUCATION 43 Westmead

CLINICAL SERVICES 44 Westmead Day Surgery & Clinic Darlinghurst Clinic Dermatopathology

pROdUCT ENdORSEMENT pROgRAMME 48 & COMMUNITy EdUCATION

FUNdRAISINg 49

CORpORATE SERVICES 50

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October, 1978

The Foundation was incorporated as a company limited by guarantee. The first subspecialty introduced was PUVA therapy, followed by Mohs (microscopic) surgery.

1979

Dr Susi Freeman commenced a contact dermatitis clinic, including patch-testing. An agreement with St Vincent’s Hospital allowed the Foundation to become involved in training of dermatology registrars.

February, 1980 The Dermatopathology division was established by Associate Professor Steven Kossard.

July, 1984

The Foundation opened a second centre at Westmead which became a licensed and accredited day procedure centre and consulting rooms.

1987

The Honourable Peter Collins, Minister for Health, officially opened the Bourke Street, Darlinghurst property which was purchased and renovated to provide administrative, laboratory and clinical facilities.

major milestones for the Foundation

1977

Dr Ken Paver, in association with Drs Ken Poyzer, Ray King and Ron Spencer initiated the Skin & Cancer Foundation to supplement the depth and range of dermatology services, teaching and research offered in public teaching hospitals.

“We estimate that 95% of

dermatologists who have

graduated in New South Wales in

the last 15 years have had at least one year of their training funded and provided by the Foundation.”

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the Foundation today The Foundation provides a full range of services for the diagnosis and management of skin conditions. We provide over 40,000 episodes of direct patient care each year and examine over 45,000 pathology samples. Over 100 full-time and part-time doctors and other staff work for us.

The Foundation predominantly funds its charitable mission in education and research through the surpluses generated by our patient billings for clinical and histopathology services. Increasingly we are also seeking donations and support from corporate partners and government to allow us to further expand our contribution to the practice and development of the science of dermatology.

We provide training and education estimated to be equivalent to $1.5 million annually across all our training activities which include training dermatologists, medical students, general practitioners, nursing and other staff as well as the general public. We estimate that 95% of dermatologists who have graduated in New South Wales in the last 15 years have had at least one year of their training funded and provided by the Foundation.

1988

The founder, Dr Ken Paver, was made a Member of the Order of Australia for distinguished services to medicine. Dr Paver donated his medal to the Foundation.

1991

First accredited Moh’s surgery Fellowship outside of the United States was established at Westmead. There have been 15 dermatologists who have now completed the Mohs Fellowship.

1994

First HIV dermatology clinic was established by Dr Margot Whitfeld.

1995

Mr Alec MacKelden was made a Member of the Order of Australia in recognition of his service to the Foundation as Chairman.

2000

A Fellowship in dermatopathology was established.

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chairman’sreport

Roger Gibson

Our 30th year has been particularly successful in terms of the fulfilment of our mission.

An increased number of registrars passed through our training programs, a greater number of our team participated in educational seminars, research activities were extended and we were able to bring Mohs surgery to many more patients. Our financial stability enabled more to be invested in laser facilities and more was invested in our technical support systems. Directors, staff and members should feel proud of the year’s achievements.

One of the objectives of our mission is to remain financially independent and that was again achieved. Our modest planned operating surplus of $86k was surpassed with an operating surplus of $366,865. That favourable variance is only relevant in that it underpins our ability to achieve our objectives. The Foundation remains in a strong financial position to continue its mission and meet the challenges of the years ahead.

All of our people extend themselves to achieve excellence and I want to acknowledge that, under the very competent leadership of the chief executive officer, Dr Lisa O’Brien, our staff and our visiting medical staff made these results possible. I particularly want to acknowledge the personal sacrifices made by our pathologists who gave additional time to meet the demand for our respected pathology service in a period when we were experiencing difficulty in maintaining dermatopathologist numbers because of the general shortage of pathologists.

Again we give the message to governments that the intentional shrinking of medical benefit

rebates serves neither the interests of the patients nor the health providers and only leads to a progressive loss of relevance of the basic common Medicare rates. Medicare has served Australians well but if governments continue, as they have done for more than three decades, to adjust Medicare rebates to only two thirds of cost increases, then the system must ultimately fail.

It is a source of some frustration that the authorities fail to recognise the differentiation between types of pathology operations that can gain from automation and those specialist labour intensive diagnostic operations, such as our dermatopathology operation, that cannot be forced to gain efficiencies from automation. The Government has frozen pathology rates for six years despite the relentless increases in operating costs. That freeze translates to a reduction of real rebate income of 23%. Not only does this pose a threat to the survival of laboratories that specialise in diagnostic and labour intensive work but it has also forced most pathology service providers to begin to remove the Medicare Benefit Schedule rates from the fee options for ordinary Australians.

The Foundation has lobbied politicians and we did receive a concession this year on the fee of one item number. We will continue to press decision makers to correct this situation but in the meantime we are dependent upon our referring doctors to recognise what is happening in the pathology industry when choosing appropriate pathology fee options.

The 30th anniversary of the Foundation is a cause to reflect on events of the last decade. The passing on 21 October 2008 of Mr Alec MacKelden, AM, Chairman of the Foundation

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for many years until 1990 is particularly notable. Alec led the Foundation through much of its growth and in 1995 was made a member of the Order of Australia for his work with the Foundation. I take this opportunity to acknowledge Alec’s work and his permanent place in the history of the Foundation.

I would also like to acknowledge the contribution of past directors who made such a valuable contribution to the Foundation. Dr Rob Rosen was a major force in supporting the chief financial officer through the financial redirection of the Foundation in 2005 and held the position of representative director of the Australasian College of Dermatologists on the Board for 11 years until 2007. Dr David Wong also contributed seven years on the Board and Dr Ian Hamann and Mr David Paddon each contributed five years during those challenging times. Earlier in the decade, Drs Michael Dwyer, Bill Coote, Chris Commens and Mr Wayne Cahill provided lengthy periods of service on the Board. One director who still provides honorary consultations at the Foundation is Dr Joe Krivanek who served for 20 years on the Board until 2005. Dr John Doyle has also spent 19 years on the Board. He is currently on leave of absence while he recovers from illness. We wish John a very speedy recovery.

Turning to the current Board, I take the opportunity to thank them for their contribution. They give their time without financial reward in director meetings, strategy and planning committee and finance and audit committee meetings together with other ad hoc allocated tasks. Our Board is made up of respected dermatologists and some of the country’s most capable business people. The Foundation is very fortunate to be served by such a fine Board.

I am also keen to acknowledge the support and encouragement we receive from our Patron, Her Excellency Professor Marie Bashir AC, Governor of New South Wales, and we offer our very sincere thanks to her.

Our membership increased by 38% over the course of this year. It was wonderful to meet so many members at the 30th anniversary celebrations. Membership is open to members

of the College and anyone with an interest in our mission.

With pride, I present this report on behalf of the directors and, on their behalf, I extend our gratitude to the dermatologists and pathologists, the nurses and our diligent administration staff who, together, achieved these outstanding results.

“One of the objectives of our mission is to remain financially

independent and that was again achieved.”

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The Foundation was incorporated in 1978 as an initiative of Dr Ken Paver, in association with Drs Ken Poyzer, Ray King and Ron Spencer to supplement the depth and range of dermatology services, teaching and research offered in public teaching hospitals. Its mission was to help dermatologists to better care for the skin of all Australians.

On the 23rd October 2008 the Foundation commemorated its 30th Anniversary, an exciting milestone, with a cocktail reception for members and staff at Government House. It was a lovely evening where staff who had played a pivotal role in our success over the last 30 years were acknowledged for their contributions.

During the evening Dr Andrew McDonald MP, Member for Macquarie Fields and Labor Parliamentary Secretary presented the awards and commended the Foundation for its contribution to healthcare in New South Wales. During the presentations visiting dermatologists Drs Eddie Lobel and Joseph Krivanek were recognised for their 30 years of service. We also recognised long serving employees, Associate Professor Steven Kossard, director of dermatopathology, and Eddie Aghajan, pathology courier, for 28 and 26 years of service respectively to the Foundation.

This year our strong financial performance has allowed us to achieve growth across most areas of our mission.

Registrar training is at the core of our mission and we welcome the nine new trainees who are undertaking training at the Foundation in 2009.

We have been successful in attracting government funding for several of these positions under the up skilling for overseas trained specialists programme and the extended settings for medical training programme. The latter programme has enabled us to extend our regional training programme from Griffith and Lismore, to include Nowra, Port Macquarie, Berry, Wyong, Wollongong, Kiama, Coffs Harbour, Bowral, Bourke and Brewarrina.

While registrar training is an important part of our work, we conduct a variety of other educational activities. A recent addition to our numerous activities is the commencement of medical student teaching in the Westmead clinics as part of our renewed affiliation with the University of Sydney.

It is particularly satisfying to welcome back dermatologists who have been trained at the Foundation. The Mohs Fellows of 2008, Drs Adrian See and Sam Kalouche are with us at Westmead and we welcome back Drs Johanna Kuchel and Monisha Gupta at Darlinghurst. We are pleased to welcome the new Mohs Fellow for 2009, Dr Derek Davies. In addition Dr Maria Jones-Caballero joined us as a visiting dermatologist at Westmead.

Research is another core component to our mission and one that we have given considerable focus to over the last year. The Foundation’s breadth of research and specialist expertise is enhanced by the return of Dr John Sullivan to Darlinghurst. The increased resources directed to our research activities assisted us in establishing a greater presence at this year’s Annual Scientific Meeting of the College where the Foundation

chief executiveofficer’s report

Dr Lisa O’Brien

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had seven posters accepted and a number of papers were presented.

Mohs surgery does not enjoy favourable Medicare Benefit Schedule reimbursement or banding rates. In addition, it is not a procedure generally available in New South Wales public hospitals. This means that some less fortunate Australians might be deprived, particularly in these tougher economic times, of access to this specialist procedure. The Foundation, as part of its charitable mission, has subsidised over 200 cases of this specialist surgery for patients who otherwise would not have been able to meet the cost.

It is a source of some disappointment that we have not yet been able to locate a suitable and/or affordable building to rehouse our Darlinghurst operations. Our search has been hindered by the downturn of the commercial property market which has resulted in less properties being offered for sale. The fact that our needs are quite specific combined with the small geographic area that is suitable, has meant that there have been very few suitable properties. We continue to review options as they come to hand.

In April 2009 the Westmead day procedure centre underwent survey inspection by the Australian Council on Healthcare Standards (ACHS). The team’s hard work was rewarded with accreditation for a further four years. The survey team reported ‘there was abundant evidence that there is safe and effective highly specialised care being delivered with a level of expertise that is well supported by both nursing, laboratory, CSD, clerical and the medical professions’. In addition, our anatomical pathology laboratory was surveyed by the National Association of Testing Authorities (NATA) and rewarded with three years accreditation. I congratulate all the staff on these great achievements and acknowledge the huge contribution required to achieve this result.

I would like to thank all of the doctors, staff and the Board of the Foundation for their support and their ongoing contribution to the success of the Foundation. I also acknowledge all those who have helped build the Foundation over the past 30 years. We can all be proud as we reflect on the Foundation’s numerous achievements.

“While registrar training is an important part of our work, we conduct a variety of other educational activities.”

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office bearers& contributors

Membership

Total members at 30/6/09 numbered 139 comprising:

Members of the Australasian College of Dermatologists: 115

Other: 24

Board of Directors

Mr Roger Gibson Chairman

Dr Stephen Shumack Dermatologist Representing Australasian College of Dermatologists

Dr John Doyle Dermatologist

Mr Ferdinando (Fred) Scali Chartered Accountant

Mr Vern Bowrey Media and Marketing Consultant

Mr Jeffrey David Director of retail and distribution industries

Mr Michael Herring Lawyer and Banker

Dr Gregory Crosland Dermatologist

Dr Bryan Pang Dermatologist

Senior Management Team

Chief Executive Officer Dr Lisa O’Brien MBBS FRACMA MBA MHRM&C

Director of Dermatopathology Associate Professor Steven Kossard MBBS FACD PHD

Medical Director – Darlinghurst Dr Rod Hannaford MB BS FACD

Medical Director – Westmead Dr Robert Paver MB BS FACD

Director of Research Associate Professor Pablo Fernández Peñas MD PhD FACD

Executive Director of Nursing / Business Manager – Westmead Sally Holmes RN, RM, B Nursing, Grad Dip Admin

Nursing Unit Manager – Darlinghurst Elisabeth Akhurst RN, B Nursing

Chief Financial Officer Rob Wilson B Com (Accting). CPA

IT Manager Matthew Barbic Bsc (Comp) UNSW

Contributors

Auditors KPMG Chartered Accountants

Solicitors FCB Clayton Utz Rockliffs

Bankers National Australia Bank Ltd.

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dermatologyAssociate Professor Pablo Fernández Peñas

Director of research

Mohs data collection at Westmead has been completed and the analysis of factors involved in defect size and type of closure used in Mohs surgery has been finalised. We have found that site and size of the tumour, together with surgeon performing the procedure, are important predictors of defect size and closure technique. We presented some of the findings at the Annual Scientific Meeting of the Australasian College of Dermatologists and we are finishing a paper for publication. Both studies have raised new questions and we are designing new studies to answer these questions.

During this year we have finalised the design and received ethics committee approval for a patient satisfaction study following laser procedures on the face. The objective of this study is to address the issue of the interactions between objective severity, subjective severity, quality of life and satisfaction. It will also be useful for quality control of the laser unit. The satisfaction questionnaire is a standardised comprehensive questionnaire that will give good insight into how we do things. The study has recently started and involves a medical student researcher.

We are currently designing a web formulary that will help GP’s and dermatologists to book the right patient for Mohs surgery.

A research policy has also been developed to facilitate the development of research studies and projects at the Foundation. The research unit at Westmead has also been advising on the implementation of electronic medical records and the codification of dermatological diseases. This project is the first step in developing a clinical database which will facilitate future investigative studies and clinical trials.

The scope and breadth of the large volume of skin biopsies that are analysed each year at the Foundation has provided the basis of investigative studies that have been produced over the last 30 years. The challenge of improving the diagnostic capacity in examining skin biopsies remains, as the pathogenesis of many of our dermatological conditions remains unclear.

As primarily a service-based unit, the scope of engaging in basic research has been limited as this would require the creation of a dedicated research unit with science-based investigators. Nonetheless, the field of dermatopathology provides a unique opportunity to correlate and also to link the findings with the explosion of investigative studies generating data in this field.

The current focus in the dermatopathology unit is to explore the relationship between the basic reaction patterns seen in the skin, and in particular the outermost complex structured epidermis that interfaces with the external environment. The perspective of comparing the reaction patterns seen in the oral mucosa with the skin may provide clues as to the relationship of autoimmunity, delayed hypersensitive and innate immunity in translating into these major reaction patterns.

Associate Professor Steven Kossard

Director of Dermatopathology

dermatopathology

research

“Our current focus is to explore the

relationship between the basic reaction

patterns seen in the skin”

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1. Fernández Peñas P, Paver R. Mohs Micrographic Surgery at the Skin & Cancer Foundation Australia ten years later (1997 vs 2007) poster – 2009

2. Fernández Peñas P, Paver R, Storey L. Determinants of defect repair post Mohs micrographic surgery poster – 2009

3. Sullivan JR, Akhurst E, Liu M. Psoriasis – Seriously Seductive poster–2009

4. Kossard S. Keratoacanthoma and infundibulocystic squamous cell carcinoma: a follicular pathway to neoplasia. 10th International Society of Dermatology Congress, Prague – May 2009

5. Kwong RA, Kossard S. A histopathological evolution of a cutaneous fibromyxosarcoma. Australasian College of Dermatology, Annual Meeting, Queensland – May 2009

6. Intong L, Green J, Sinclair R, Kossard S, Murrell D. Unusual frontal variant of loose anagen syndrome. Am Acad Dermatology Meeting, San Francisco – March 2009.

7. Paver R. Perioral Closures, International Congress of Dermatology, Prague – May 2009

8. Paver R. Pearls in Dermatological Surgery International Congress of Dermatology, Prague – May 2009

9. Paver R. Introduction to Procedural Dermatology first year registrars, ACD – January 2009

10. Whitfeld MJ. HIV GP prescribers group: ‘What’s new in HIV dermatology’ – 18 Feb 2009 Sydney

11. Whitfeld MJ. Australian Rosacea – Not one disease process, but two? Academy of Dermatology 42nd Annual Scientific Meeting 2009, Gold Coast – 18 May 2009

12. Whitfeld MJ. Dermatologic manifestations of Immune reconstitution in HIV – 10th International Congress of Dermatology Conference, Prague – 21 May 2009

13. Whitfeld MJ. Infectious disease specialists and dermatologists – ‘What’s new update’ Canberra Hospital HIV GPs – 24 June 2009

14. Preda VA, Whitfeld MJ. The expanding range of cutaneous conditions causing immune reconstitution inflammatory syndrome (IRIS) in HIV infection. Australasian Journal of Dermatology (2009) 50, A36 – poster

15. Sullivan JR. Pharmacology of Moisturisers formulation of topical products – Annual scientific meeting of the Australasian College of Dermatologists, Gold Coast – May 2009

16. Wallace BJ, Tan KB, Prett SL, Kossard S, Whitfeld M. Enfuvirtide injection site reactions: A case series with clinicopathologic appraisal. Australasian Journal of Dermatology (2009) 50, A17. Talk in the registrars forum by Brian Wallace

presentations and publications

presentations

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17. Preda VA, Wang L, Sullivan JR. Update on dermatologic toxicities of the epidermal growth factor receptor (EGFR) inhibitors and tyrosine kinase inhibitors (TKIs) an Australian perspective. Talk and abstract in AJD A25

18. Wang L, Preda VA, Whitfeld MJ, Sullivan JR. Physiological changes associated with mucocutaneous toxicities in oncology patients on epidermal growth factor receptor inhibitors (EGFRIs). Australasian Journal of Dermatology (2009) 50, A35 – poster

19. Liu M, Sullivan JR, Weninger W. A survey of two hundred patients with cutaneous psoriasis and psoriatic arthritis regarding symptomatology and perceptions of treatment priorities – poster

20. Liu M, Sullivan JR, Weninger W. Workup for biological agent therapy in moderate to severe psoriasis – poster

21. Preda VA, Younger I, Frankum B. Systemic tacrolimus (FK506) is effective in severe atopic dermatitis – poster

22. Pollack A, Preda VA, Sullivan JR. Future Practitioners: medical and pharmacy student knowledge of acne – poster

1. Lim P, Kossard S. Trichofolliculoma with mucinosis. Am J Dermatopathol 31 405-6 2009

2. Howes R, Girgis L, Kossard S. Eosinophilic annular erythema: a subset of Well’s syndrome or a distinct entity. Australas J Dermatol 59 159-63, 2008.

3. Kwong RA, Kossard S. Histopathological evolution of cutaneous myxofibrosarcoma. Australas J Dermatol 49 169-72 2008.

4. Preda VA, Whitfeld MJ. ‘HIV Management in Australia: A guide for Clinical Care 2009’. Chapter 16 In Press.

5. Preda VA, Whitfeld MJ. ASHM monograph HIV Management in Australasia a guide for clinical care 2009.

6. Preda VA, Leow LJ, Cheung K, Whitfeld MJ. Scalp Rosacea – an under recognised entity. Australasian Journal of Dermatology (2009) 50, A8.

7. Whitfeld MJ, Preda VA, Gunasingam N, Leow LJ, Shirato K. Rosacea – Not one disease process but two? Australasian Journal of Dermatology (2009) 50, A9.

8. Wallace BJ, Tan KB, Prett SL, Kossard S, Whitfeld MJ. Enfuvirtide injection site reactions: A case series with clinicopathologic appraisal. Australasian Journal of Dermatology (2009) 50, A17.

9. Wang L, Preda VA, Whitfeld MJ, Sullivan JR. Physiological changes associated with mucocutaneous toxicities in oncology patients on epidermal growth factor receptor inhibitors (EGFRIs). Australasian Journal of Dermatology (2009) 50, A35.

10. Preda VA, Whitfeld MJ. The expanding range of cutaneous conditions causing immune reconstitution inflammatory syndrome (IRIS) in HIV infection. Australasian Journal of Dermatology (2009) 50, A36.

11. Huiras E, Preda VA, Maurer T, Whitfeld MJ. Cutaneous manifestations of immune reconstitution inflammatory syndrome. Curr Opin HIV AIDS. 2008 Jul; 3(4):453-60.

publications

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congratulations

to the New South Wales Fellows who graduated in 2009. We congratulate the following on the successful completion

of their dermatology training:

Dr Monisha Gupta

Dr Johanna Kuchel

Dr Ann-Maree Kurzydlo

Dr Caroline Thoo

training and education Dr Rod Hannaford

MeDiCAL DiReCTOR, DARLiNGHuRST

Darlinghurst

Darlinghurst has provided training places for four dermatology registrars, and an overseas trained dermatologist. To supplement their training at the Foundation, the registrars rotate through a number of rural practices to gain exposure to a wider range of clinical problems and to rural dermatology. The newest post is South Coast-based and supervised by Drs Duncan Stanford, Robert Salmon, Andrew Mackenzie-Wood, Ian McCrossin and Andrew Moss. It is quite a complicated rostering system; however appears to be working well. Our relationship with St Vincent’s Hospital has put us in a strong position to provide rural training placements under the extended settings training programme.

As one of the Foundation’s key roles is education, we continue to provide clinical update meetings. These meetings are held over dinner in a lovely venue and allow good interaction between the audience and an expert speaker. The meetings focus on a wide range of topics – not just services provided by the Foundation, but reflect our desire to support the field of dermatology and provide further education. Earlier this year Dr Adrian Lim provided an authoritative update on sclerotherapy and filler injection techniques. Our most recent evening was on cutaneous T cell lymphoma provided by Dr Jillian Wells. Guests were pleased to learn of the multi-specialty lymphoma clinic run from Westmead Hospital. Last year Dr John Sullivan spoke about aspects of acne management.

Other educational initiatives involve hosting general practitioners enrolled in the College dermatology course developed by Dr Rob Paver.

Medical students from St Vincent’s Hospital and UNSW have participated in a combined clinical teaching programme with St Vincent’s Hospital which includes attending clinics. Medical students from overseas and Australia often request six week placements for dermatology experience. Dr Margot Whitfeld is continuing to teach in the area of HIV, in particular immune reconstitution.

The combined monthly St Vincent’s Hospital and Foundation clinical meetings have continued in 2009 with the St Vincent’s Hospital VMO staff conducting the sessions in conjunction with Associate Professor Steven Kossard from the Foundation. Registrars and consultants as well as local and overseas visitors to the meetings have continued to find them valuable learning experiences.

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Westmead

Dr Robert Paver

MeDiCAL DiReCTOR, WeSTMeAD

Since January 2009, we have increased from three to four registrar training positions with the addition of a rural registrar extended setting training position. Our four registrars now rotate through Westmead Hospital, The Children’s Hospital at Westmead and a rural rotation. This has been a complicated administrative task but the range of clinical activity and exposure has been very broad and an extremely useful training experience for the registrars.

The procedural dermatology monthly evening tutorial sessions have continued for the registrars this year and the main focus has been objective structured clinical examination (OSCE) practice for the exams as there were so many final year candidates.

The Mohs Fellow this year has been Dr Derek Davies. Derek first came to Westmead as a research Fellow in 1994. He has run his own large dermatology practice in Orange for many years but has taken part time leave from the practice to do the Mohs surgery Fellowship. This has been a major undertaking for Derek and we are very aware of how difficult this has been for him. Derek is an excellent surgeon and an exceptional Mohs Fellow. He enthusiastically contributes not only in the Fellowship activities but also with research, and is maintaining our discounted Mohs surgery service.

Congratulations to Drs Adrian See and Sam Kalouche who completed their Mohs training in 2008. We are delighted to welcome them as Mohs surgeons at Westmead.

Medical students from Sydney University have been attending clinics on a regular basis throughout this year. This has been a new initiative for Westmead and on all accounts has been very successful.

Another new initiative for Westmead was to further enhance the skill and knowledge of the nursing team. Dr Leslie Storey, an American Mohs Fellow, worked with us to develop and implement a competency-based training package for the nursing team that resulted in many nurses now being able to give local anaesthetic, suture wounds and perform biopsies. The nurses, under supervision of the medical specialists are now able to further assist in the delivery of services to our patients and of course, are thoroughly enjoying the opportunity to use these new skills.

General practitioner education has continued with GP’s attending general clinics for their clinical attachment through the Australasian College of Dermatologists GP training programme.

special note

Congratulations to Associate Professor Pablo Fernández Peñas on winning the best poster

prize at the Australasian College of Dermatologists Annual Scientific Meeting in May with his poster

titled ‘Mohs’ micrographic surgery in the Skin & Cancer Foundation Australia (SCFA): Ten years later (1997-

2007). Pablo won a $1,500 cash prize donated by Hamilton Laboratories.

The poster compared factors involved in Mohs surgery outcomes between 1997 and 2007. The first finding was that the number of Mohs surgery procedures has increased by 260%. Importantly, no changes regarding the size or site of the tumours were found which suggests that there is still the need for more Mohs surgery in Australia. The defect size, on the other hand, is smaller in 2007 than 1997, and this has lead to a decrease in skin grafts performed, while the number of side-by-side closures has increased.

training and education

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clinical services Dr Robert Paver

meDical Director, WestmeaD

Westmead Day Surgery and Clinic

The Skin & Cancer Foundation clinical unit at Westmead continues to provide a niche service for the dermatology profession, with this year consolidating the gains of the previous two years and focusing a little more on developing education and research activities.

At our strategic planning meeting in April 2008, we decided that the direction for 2008/2009 for the Foundation at Westmead would be to consolidate our services for Mohs surgery which had expanded rapidly in the preceding two years, and to focus on expanding our laser and general clinical services.

The clinics have expanded significantly since the purchase of the Sciton laser and under the leadership of Dr Shawn Richards. Currently there are ten dermatologists using the lasers. Some nurses have also shown a high level of interest in this new technology and have a true talent for laser therapy. A laser hair removal clinic and photo rejuvenation clinic are now operational with our nurses performing many of the treatments in partnership with the dermatologist. As a result of attending a very challenging external education programme and examination, two nursing staff are now accredited as certified laser safety officers.

The day surgery throughput was 2,239 cases of Mohs and non-Mohs surgery in 2008/2009 compared with 1,857 in 2005/2006. Mohs surgery continues to be the major clinical activity at Westmead; however the number of laser procedures is increasing.

General dermatology clinics on level two share space with the laser clinics and the area is often at capacity. Demand for general dermatology services remain steady and waiting times for appointments are generally low.

A major undertaking this year was achieving Australian Council on Healthcare Standards (ACHS) accreditation in April 2009 for a further four years. The survey team were ‘impressed by the customer focus and mission of the Foundation which supports close communication between professional colleagues’ and our goal of providing the right care at the right time, even if this requires financial support in appropriate cases. For example, we have been able provide over 200 episodes of discounted Mohs surgery as part of our benevolent activities during the last year.

Westmead has always placed an emphasis on quality systems and the management of our human resources. Nursing personnel were again sponsored to attend the annual Australian Dermatology Nurses Association Conference at the Gold Coast in May, and they have also had access to many hours of in-house and external education opportunities. The non-clinical staff, which includes receptionists, medical record clerks and medical typists, have received extensive on the job training by management and external consultants.

Westmead has also developed a wealth of brochures, health promotion information and advice in relation to skin health and skin cancer prevention, cosmetic enhancements and surgical procedures.

During the year we have been very disappointed to say farewell to Drs Keng Chen, Harry Wark and Leslie Storey. Keng has been doing clinics with us since he graduated. Harry has been our

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anaesthetist for many years since we opened in 1994 and Leslie has returned to America after a two-year rotation with us. We have been very fortunate to have these wonderful doctors with us for all these years, and we wish them all the best for the future.

Since July 2008 we have been delighted to welcome Dr Maria Jones-Caballero who is undertaking general dermatology clinics, and Dr Krishna Tumiluri who is a visiting oculoplastic surgeon. Drs Sam Kalouche and Adrian See undertook the Mohs Fellowship in 2008 and have now joined the Foundation as Mohs surgeons in addition to the general dermatology and laser services they have offered since completing their fellowships in 2007. Both doctors are important and valued members of our team.

Our staff and management continue to make an outstanding contribution to achieving our mission. None of this would be possible without the extra efforts made by every team member, and this is greatly appreciated. The year has been a particularly busy one with not only the increased clinic activity, but also the organisation-wide survey for ACHS accreditation. In addition we again achieved a financial surplus due to careful control and usage of resources.

I would again like to thank all the doctors, nurses, clerical and administrative staff for their efforts over the past twelve months, and I am looking forward to the upcoming year and encourage the team at Westmead to continue to strive and maintain our reputation as a centre of excellence, furthering the speciality of dermatology.

• Dr Phillip Artemi

• Dr Keng Chen

• Dr Derek Davies

• Associate Professor Pablo Fernández Peñas

• Dr Tanya Gilmour

• Dr Michelle Hunt

• Dr Maria Jones – Caballero

• Dr Sam Kalouche

• Dr Chris Kearney

• Dr Joseph Konya

• Dr Simon Lee

• Dr Tony Malouf

• Dr Robert Paver

• Dr Shawn Richards

• Dr Andrew Satchell

• Dr Adrian See

• Dr Duncan Stanford

• Dr Leslie Storey

• Dr Howard Studniberg

• Dr Simon Taylor

• Dr Krishna Tumiluri

• Dr Harry Wark

consultants to Westmead

“Westmead has also developed a wealth

of brochures, health promotion information and advice in relation

to skin health and skin cancer prevention,

cosmetic enhancements and surgical procedures.”

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Darlinghurst Clinic

consultants to Darlinghurst

clinical services Dr Rod Hannaford

meDical Director, Darlinghurst

It is with great pleasure that I report a number of new dermatologists working at Darlinghurst. Drs Hanna Kuchel and Monisha Gupta are conducting weekly general dermatology clinics. Hanna is also doing some vascular laser work. In addition, Dr John de Launey has increased his number of clinics and has a special interest in skin cancer surgery and acne.

Dr John Sullivan has rejoined the Foundation and is running a psoriasis biologics clinic, a general dermatology clinic and a cosmetic dermatology clinic. He is providing dermal filler and anti wrinkle injections, and some laser services. He is also starting a combined dermatology and rheumatology biologics meeting as well as maintaining his interest in acne through the All About Acne group. We have been successful in attracting funding for a nurse for the Foundation’s biologics clinic and for a new biologics service at St Vincent’s Hospital. This shared resource provides good coordination across the two services, and increased ease of access to day infusion services.

This year has seen some consolidation at Darlinghurst. Following a number of staff changes in both nursing and clerical staff, we now have a strong, cohesive and very motivated team who are keen to take Darlinghurst dermatology services to the next level.

Our efficient and energetic nursing staff have helped expand our Limelight IPL (Intense Pulsed Light) service for treating actinic damage and facial telangiectases. A new service combining the topical application of

20% ALA cream, followed by IPL, then Actilite light treatment has produced amazing results in reversing actinic damage and skin neoplasia more efficiently than either traditional photodynamic treatment or IPL alone.

In addition, we have been developing our cosmetic dermatology service and are now ready for our most recent service enhancement – the expansion of laser services at Darlinghurst.

This year we were sad to farewell Dr Diana Rubel, a long-time supporter of the Foundation who has moved to Canberra and Dr Anita Patel who has left the Foundation to concentrate on practice development.

Due to the economic down-turn, and the sharp drop in real estate values, there has been no progress on the acquisition of a larger building to replace 277 Bourke Street. We have reviewed numerous real estate options; however have been hindered by unrealistic and volatile price expectations and a declining market. We continue to review all the options as they arise, and as markets now appear to have stabilised we are optimistic that suitable new premises will soon be identified. Until that time, it is difficult to grow or further develop the Darlinghurst services to meet their full potential.

• Dr John de Launey

• Dr Catherine Drummond

• Dr Kate Dunlop

• Dr Tanya Gilmour

• Dr Monisha Gupta

• Dr Rod Hannaford

• Dr Joseph Krivanek

• Dr Hanna Kuchel

• Dr Eddie Lobel

• Dr Anita Patel

• Dr Diana Rubel

• Dr Mark Shifter

• Dr John Sullivan

• Dr Margot Whitfeld

• Dr Richard Wittal

46

dermatopathology

The dermatopathology service has completed yet another year with a record increase in histopathology reports. The year has been particularly challenging as the unit has not been able to recruit replacement pathologists to fill two full-time vacancies. Despite the shortfall of pathologists, the reporting turnaround time has been maintained. Over 80% of reports are completed within 48 hours, and all urgent reports are completed in 24 hours. Fortunately, we have now recruited an additional pathologist which will alleviate this situation significantly.

The increased workload has been handled through the outstanding skills of Drs Carolyn Choy, Karen Cheung and Susan Carr. In order to meet the service load, the capacity of the unit to fulfil some of the goals in teaching and clinically orientated research has been affected. The unit continues to achieve high scores in quality assurance programmes directed to diagnostic proficiency and laboratory procedures. These tests have been issued by the RCPA/NATA and the American Society of Dermatopathology.

We continue to monitor the quality and range of the immunoperoxidase antibodies used in the analysis of tumours including lymphomas. We also continue to report immunofluorescence tests for bullous dermatoses and the connective tissue diseases, and have built up a valuable resource of immunofluorescent images for analysis and for educational purposes. Our service has also developed a reputation for analysis of scalp biopsies for alopecia and this is an area which has also provided challenges as our current knowledge of the pathogenesis of alopecias remains incomplete.

The dermatopathology unit over the past year has continued to fulfil its goals in dermatopathological training. Weekly sessions have been directed to registrars as well as monthly meetings combining both registrars and consultants.

With the assistance of Dr Penny Lim, a visiting dermatologist from Malaysia, we have built up our histopathology image library, which will be an excellent resource. The Foundation’s research project officer also introduced an excellent format for summarising and reviewing the clinical cases presented at our monthly clinical meetings, allowing the clinical facets to be linked with their histopathology. These cases have formed the basis of an informative monthly CPC now available on the Foundation’s intranet site and also on the website devoted to dermatologic consultations for specialists, developed by Dr Ian McColl from Queensland.

clinical services Associate Professor Steven Kossard

Director of Dermatopathology

dermatopathologists• Dr Susan Carr

• Dr Karen Cheung

• Dr Carolyn Choy

• Dr Kerry Crotty

47

product endorsement programme andcommunity educationLisa Thornley

Business Development manager

“The Foundation also entered into

a new sponsorship arrangement with

Johnson & Johnson’s Neutrogena ultra Sheer sunscreen.”

The product endorsement and sponsorship programmes develop mutually beneficial relationships with companies of relevance to the Foundation’s mission so that partners can leverage the Foundation’s logo and reputation as the centre of skin care excellence.

Fees received from our partners allows the Foundation to continue to support its charitable objectives to create, manage and fund research activities to promote skin health and help reduce the incidence of skin cancer and other skin conditions and disease.

This year the product endorsement and sponsorship programmes have seen a combined growth of 54% from the previous year with an annual income of $55,500.

During the year, two new partnerships were developed which include Outlook Australia which was signed on as a new product endorsement partner for its range of Shade-A-Babe products now displaying the Skin & Cancer Foundation Australia’s endorsed logo. The endorsed products include a pram sun canopy, pram shades as well as a shade screen which protects passengers from strong sunlight, UV and glare within a vehicle.

The Foundation also entered into a new sponsorship arrangement with Johnson & Johnson’s Neutrogena Ultra Sheer sunscreen. This is the first range of sunscreen which Neutrogena launched in Australia, and contains unique Helioplex technology to provide broad-spectrum protection from UVB, as well as UVA rays, providing ‘photostable’ and durable protection.

Both are exciting partnerships which will see the Skin & Cancer Foundation Australia endorsed logo displayed on Shade-A-Babe products and the sponsor logo displayed on Neutrogena sunscreen as well as on marketing and launch materials.

48

fundraisingLisa Thornley

Business Development manager

This year, the Foundation received a total of $18,574.26 (2008: $39,402) which was a 53% decrease from the previous year. The decrease of donations is seen as a result of the economic downturn as we did not receive one-off payments from companies this year as we did the previous.

Another substantial donation was received this year from our loyal supporters The Kelly Variety Entertainers.

The Foundation, a registered charity, is grateful for the generous donations received from the public, patients and industry.

Mrs Marie BampfordNola, Karl & Greg Bezwarchny (In memory of Jeff Spiers & Mary Smith)Mrs Beverley Bloor (In memory of Kenneth Bloor)Ms Cynthia BrewDr Nerida BurtonMs Debbie CameronM CampbellMr Charles ClaytonMr James ClearyMr John CockburnMrs Lynette Cole Mr George ColemanDr John CollinsMrs R.L ConnMs Jennifer DruceMr Daniel DwyerDr Graham EdwardsMs Margaret FennellMr Alan FisherMrs F GoumasMr Ian R HatchMrs June HawkinsMr Leo Hernon

Ms Margaret HoltMrs Karola JungMr Jayalath (Gamini) KariyawasamMs Caroline LawrenceDr Steven Moi Hing LeeDr Marcia LlewellynMrs Elaine LowreyDr Peter MakinsonMrs Joanne Mellor-StuartProf Dedee MurrellMr P J Oakes Dr Lisa O’BrienMrs K PalmerMs Julienne PattisonMr Neil PerryMrs Rosemary PlayfairMrs Moya PriddisMr Peter ReesJ&T SavageMrs Min Suk SeoY ShanahanMs Robyn TassickerDr Harry WarkMr Robert Wilson

Donations to the Foundation are tax

deductible. Contributions are used to buy equipment

for research projects, teaching and to develop new clinical services for

our patients.

We thank the following donors for their generosity

and support over the past year:

Abbott AustralasiaAllerganAnthony Vavayis, ArchitectAspen PharmacareAvonBayer AustraliaBMT & Associates, Quantity SurveyorsCandelaCuteraCSL Biotherapies Galderma AustraliaHill Rogers, Chartered AccountantsHygiene AustraliaiNova PharmaceuticalsIonia Medical ISIS Projects, Fit-Out ConsultantsJohnson & JohnsonJones Lang LeSalle, Real EstateKann Finch Group, ArchitectsKelly Variety EntertainersMacquarie BankMerck SeronoN. Stenning & CoOutlook AustraliaQuifarmaRocheRockliffs, SolicitorsSchering PloughSolaris Paper Pty LtdStiefelStingray AustraliaSunsuper FinancialUnique Pharma

49

Rob Wilson

chief financial officer

corporate services

Our mission is to provide the Foundation with the highest standards of administrative and financial management. The unit is predominantly made up of the finance and administration team which includes the functions of accounting, debtor collection and information technology.

Last year we indicated that the team would strive for quality, and I believe that was largely achieved. The new practice management system being installed will be the best in

the industry. The new preventative maintenance systems have delivered the reliability we sought. The team also managed to achieve the best debtor

collection result to date and to keep administrative expenses within CPI increases.

This year, the team took over a large number of new administrative tasks allowing our nurses, receptionists and pathology staff to dedicate more time to patient care. The team achieved all this whilst reducing its staffing costs by 20%.

The current and previous governments have made the task of covering increasing costs more difficult by not supporting the Medicare rebates in terms of cost increases. Every year the Medicare Benefits Schedule Fee rebate scale increases by only two thirds of the health cost index which means the Foundation must find the substantial difference from other sources if its

mission is not to suffer.

Whilst that situation must be difficult for government to explain, a totally inexplicable inequity exists with pathology

fees. Our pathology operation is labour intensive and cannot enjoy the savings from automation available to most of the

industry, yet it is subject to the same freeze on pathology fee rebates that has been in place since 2004. Fortunately our referrers are largely

aware of the problem and we are asking them to assist us by setting fees that are appropriate to the patient’s ability to pay.

Every member of the finance and administration team is proficient and dedicated to their task and each contributes to an enjoyable working environment. I wish to record the gratitude of myself and the chief executive officer for their efforts in that regard. As a team we will strive in the year ahead to try to repeat the report card that we were proud to deliver today.

“The

new practice management system being

installed will be the best in the

industry.”

50

51

published by

SKIN & CANCER FOUNDATION AUSTRALIA

277 Bourke St

darlinghurst NSW 2010 Australia

7 Ashley Lane

Westmead NSW 2145 Australia

phone (02) 8833 3000

Fax (02) 8833 3090

www.skin.com.au

design: Fuel Creative pty Ltd. photography: Murray harris photography. printing: Focus press. © 2009 Skin & Cancer Foundation Australia All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any other information storage and retrieval system, without prior permission in writing from the publisher.