Skin cancer surgery in Australia 2001–2005: the changing role of the general practitioner

Abstract

Objective: To describe changing patterns of skin cancer surgery by Australian general practitioners and make comparisons with specialists. Design and setting: Analysis of Medicare Australia item number reports for skin cancer excisions and for flap and graft repairs between 2001 and 2005. Main outcome measures: GPs’ and specialists’ rates of non‐melanoma skin cancer (NMSC) excisions, melanoma excisions, flap repairs and graft repairs; excision to flap ratios. Results: NMSC excisions in Australia increased from 338 712 (2001) to 451 628 (2005), a mean annual increase of 1.11/1000 population (P = 0.04); GPs did 51.1% of excisions in 2001, increasing to 54.4% in 2005, representing a higher mean annual rate increase than in specialists (P = 0.003). Nationally, melanoma excisions increased from 20 414 (2001) to 25 580 (2005); GPs did 34.3% of excisions in 2001, increasing to 35.8% in 2005 — a similar mean annual rate increase to that in specialists (P = 0.25). Total flap repairs increased from 58 550 (2001) to 80 742 (2005); GPs did 21.3% of flap repairs in 2001, increasing to 26.9% in 2005 — a similar mean annual rate increase to that in specialists (P = 0.83). Nationally, the excision to flap ratio for GPs fell from 14 : 1 (2001) to 12 : 1 (2005); in Queensland the ratio fell from 14 : 1 to 9 : 1 over the same period. Conclusion: GPs excise the majority of skin cancers, and the proportion excised by GPs is increasing. GPs are increasingly using skin flaps for repair, suggesting substantial changes to patterns of treatment, especially in Queensland.

Choosing to biopsy or refer suspicious melanocytic lesions in general practice

“…Finally, in seven scenarios (2%) skin flaps were chosen with excision biopsies. Researchers have identified an increasing trend in general practice towards the use of flaps, particularly in skin cancer clinics [3]. Performing flaps without a histological confirmation of margins can confuse re-excision because the remaining margins have been altered, requiring more extensive and complex definitive excision.…”

“…The general practitioner (GP) is the first point of medical contact for the majority of patients who have suspicious skin lesions in Australia [2,3]. Previous research has explored the initial step in the diagnostic process – the assessment of skin lesions presented by patients [4,5].…”

Prevention of surgical site infection in lower limb skin lesion excisions with single dose oral antibiotic prophylaxis: a prospective randomised placebo-controlled double-blind trial

“…The majority of skin cancers are treated by surgical excision3 4 which is increasingly being performed in outpatient and primary care settings 5 6. As the majority of skin cancer surgery takes place in general practice in Australia,5 it is important to study infection rates in this setting.…”

“…The majority of skin cancers are treated by surgical excision3 4 which is increasingly being performed in outpatient and primary care settings 5 6. As the majority of skin cancer surgery takes place in general practice in Australia,5 it is important to study infection rates in this setting. Skin lesion excisions form a large proportion of a typical Australian general practitioner's (GPs) workload, and this proportion is even greater for Queensland GPs, given that this State has the highest incidence of skin cancer 6.…”

Basic Plastic Surgery Skills Training Program on Inanimate Bench Models during Medical Graduation

“…Recently there has been tremendous growth of ambulatory surgical procedures that general practitioners need to perform in order to treat cutaneous lesions [1–3]. In this context, as a large percentage of medical students do not acquire basic surgical skills during their training [4] and most of the general practitioners that perform ambulatory surgeries received no formal surgical training [5], it is necessary to establish a training program to teach and refine the basic surgical skills related to plastic surgery (e.g., to biopsy a cutaneous lesion and to reconstruct the defect by the rotation of a surgical flap) that are essential to perform these ambulatory surgical procedures during medical education [4–6].…”