Skin in the game: Dermatologist Amanda Oakley’s unwavering dedication to progress

Growing up in Surrey, England, Dr Oakley was familiar with medicine as her father, uncle and brother were all doctors. She took a year off after leaving school, initially planning to study psychology but later securing a place to study medicine at Bristol University.

She knew within a few days of starting the course that medicine was the right field for her. But she hadn’t considered a specialty. It wasn’t until her PGY2 year – in New Zealand with an expiring visa – that she decided to go into dermatology.

“The immigration officer gave me a shortlist of medical specialities that would ease the next visa,” she says.

Dermatology was on the list, and having sampled a bit of dermatology during her elective year in Trinidad and Tobago and remembering a conversation with a colleague who had started the pathway, she decided to give it a go.

“I got a position at Auckland Hospital as registrar, and within the first two or three days, I was completely hooked. That was December 1982 – just the other day.”

The immigration officer had given her another list of potential options for remaining in the country – one was to marry a New Zealander. “So, I did that as well,” she says with a laugh.

Now separated from her Kiwi husband, Dr Oakley has two daughters in their 30s and four grandchildren aged five and under.

She hopes to spend more time with her family and be actively involved in her grandchildren’s lives.

“I’m trying to divest jobs that I don’t really need to do. That’s just worked out quite tricky because there’s so much going on. As soon as I come off one committee, I seem to be on another one.”

What started as something of a visa requirement has turned into her life’s work – she insisted on wearing a hat for the outdoor photographs to accompany this article, despite the photographer trying to persuade her otherwise. Her most famous achievement is probably DermNet, co-founded in the early days of the internet. The idea was sparked by a quirky sponsored lunch during a New Zealand Dermatological Society meeting in Napier, when she was working at Waikato Hospital, she says.

“[The pharmaceutical company], instead of having someone speak on psoriasis, had someone speak on the internet, and he did it by cleverly doing a show-and-tell…[he covered] how you could show dermatology.”

Impressed, Dr Oakley approached the sponsor, proposing a collaboration, and in 1996, she and her colleagues, Drs Mark Duffill and Marius Rademaker, with the backing of the New Zealand Dermatological Society, officially launched the DermNet website.

As editor-in-chief, she became “somewhat obsessed” with building what she thought of as an online public library for dermatology before the days of Google and Wikipedia.

She initially envisioned the target audience as patients, but that quickly changed to health professionals: “A patient may visit a website once, but a health professional will go back and back and back and back.”

Specifically, her target was Kiwi GPs. However, the website attracted attention outside of New Zealand, with most users coming from the US. DermNet is now the world’s leading free dermatology resource.

Primary care is still Dr Oakley’s target audience, as that’s the first port of call for most patients with skin problems. However, she says primary care doctors often misdiagnose skin conditions, with only 30 to 50 per cent of GP diagnoses being the same as a dermatologist.

Referrals via the teledermatology system at Waikato Hospital – where GPs can send a referral marked urgent or non-urgent with attached images for the dermatologists to assess and decide next steps – often are inaccurately prioritised. Some marked “non-urgent” contain melanomas or serious skin conditions that should have been considered a priority. But, due to the hundreds of referrals received each month, they drop down the list.

On sabbatical, Dr Oakley hopes to combine her passion for using technology to solve dermatology problems, cut waiting lists and speed up diagnoses.

She was granted a sabbatical in 2017 to utilise machine learning and algorithms to diagnose common skin conditions, but has only taken it up this year. Events intervened. There was the death of colleague Anthony Yung in 2018 and then the COVID-19 pandemic.

“At that time, I had the vision that DermNet would have an artificial intelligence image-based product and I was going to explore the best way of managing that,” she says. The idea won her the 2017 Clinicians’ Challenge Active Award from the Ministry of Health.

However, AI has fast developed since 2017 and, in 2023 – when hardly a week goes by without reading about generative AI’s role – a simple AI diagnostic tool is no longer enough, Dr Oakley says.

“That concept is proven, especially for the role of skin cancers”, with several companies offering diagnostic programmes.

Skin cancer is the low-hanging fruit, as the images are generally clear and consistent. Other skin conditions are trickier.

“It’s not good enough to give us the diagnosis. We’ve got to look at what are we going to do with that diagnosis,” she says. “We’ve got to diagnose all dermatology, not just suspected skin cancers. We’ve got to provide the referrer and the patient with consistent, accurate, personalised information.”

AI could help take images correctly, ensuring they are in focus and not too close, and create more patient buy-in with personalised information. It could also offer recommendations and advice to GPs.

Getting this AI-supported referral system going is the focus of her sabbatical. She hopes for a national rollout with an emphasis on supporting primary care.

“It’s so exciting. I’m really filled with enthusiasm for this project.”