Who is excising BCCs and SCCs? (Answer: not dermatologists)

By David Rowley

10 May 2019

GPs are responsible for close to 83% of all basal and squamous cell carcinomas excisions in Queensland, according to new research.

Data from the QSkin study of close to 44,000 people aged 40 to 65 who had keratinocyte excisions between 2011 and 2015 found that around 10% had them done in a hospital setting, with dermatologists handling around 6% of excisions and plastic surgeons responsible for 9%.

The study found close to 90% of the excisions were being performed in private rooms, the remainder occurred in hospitals, with private institutions handling more than three times as many as those in public hospitals – 7.9% compared to 2.4%.

Larger cancers on the nose, eyelid, ear, lip, finger or genitalia were more likely to be treated in hospitals than in private clinical rooms.

During four years of follow-up, there were 18, 479 skin cancer excision episodes among 8613 people, the researchers from the QIMR Berhofer Institute in Brisbane noted.

Their study, published in the Australasian Journal of Dermatology, noted the role of GPs in Australian skin cancer care had increased over the years “with skin cancer screening now considered a routine part of general practice”.

“GPs have the option to acquire additional training in skin cancer management, and a proportion opt to focus their practice in this area,” they wrote.

There had also been a sharp drop in the number of Australian dermatologists involved in excision compared to figures from the only previous study on the subject, 2002’s National Non-Melanoma Skin Cancer Survey – 22% then compared to the current 6%.

The new figures also highlighted the strong regional GP skew in Queensland compared to the rest of the country.

“It has been suggested that (GPs) in Queensland are performing skin cancer treatments that would normally be referred to a specialist in other states, mainly because a larger proportion of the population lives in rural and regional areas where access to specialists is limited”.

But they also noted the important role of GPs in the area because “patient demand for services is too great to be met by specialists alone”.

On the issue of costs, they said 80% of skin cancer excision episodes treated by GPs and 30% by general surgeons didn’t require any out-of-pocket payment but those that did ranged from a median of $59 for GPs, $177 for dermatologists, $230 for “general surgeons” and $316 for plastic surgeons.

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