Skin cancer medicine in primary care: towards an agenda for quality health outcomes

Abstract

The number of skin cancer clinics functioning within Australia's primary care environment is increasing rapidly, and significant concerns have been raised about the type and quality of work done by some doctors in some clinics.• Mainstream general practice is threatened by perceived fragmentation, and specialist practice in dermatology and plastic surgery is threatened by encroachment into their domains of practice.• We propose an agenda of training, standards, accreditation, audit and research to ensure that skin cancer clinics provide

Measuring performance in skin cancer practice: the SCARD initiative

“…The proliferation of dedicated skin cancer clinics staffed by GPs has raised concerns about quality of care. In 2007, the chair of the Ethics Committee of the Australasian College of Dermatologists stated: “… but we need to know the competence of all clinicians in all skin cancer clinics, which should be open to examination by the public and professional peers.” 9 There is currently no accreditation process in Australia for GPs who promote themselves as skin cancer practitioners 5 . SCCANZ has developed SCARD as a part of its commitment to develop an accreditation process that will facilitate assessment of competence in the practise of skin cancer medicine.…”

Accuracy of clinical diagnosis of skin lesions

“…Similarly in Australia, there has recently been interest in the diagnostic performance of doctors with respect to skin lesions which they decide to biopsy or excise 18,19 . This interest has particularly focused on assessing the performance of practitioners working in ‘open access’ designated skin cancer clinics, which are primarily staffed by GPs, and have been a recent rapidly emergent phenomenon, particularly in the state of Queensland 20 . The Australian studies have shown that practitioners diagnose a wide range of skin lesions with moderate to high sensitivity.…”

Dermoscopy in the southern hemisphere: a success story

“…Within Australia, dermoscopy appears to be commonly utilised in the wider medical community , particularly in the non-dermatologist skin cancer medicine community (although no robust data are available), and an agenda for quality health outcomes has been recently proposed, including training and education in dermoscopy [3] to further improve this service that is in high demand. This agenda has been undertaken by several providers in colleges and universities in Australia, who also provide education in dermoscopy at a high level.…”