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Australian-first study reveals full scope of GP skin cancer care

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Older, male and living in outer regional/remote or disadvantaged areas – that is the average profile of an Australian patient visiting their GP for skin cancer-related issues, according to new research.
 
The cross-sectional survey, published in BMJ Open, is the first study to measure the full scope of skin-cancer related conditions being managed in general practice in Australia.
 
Participants were patients aged 15 years or older who had a skin cancer-related condition managed by GPs in the Bettering the Evaluation And Care of Health (BEACH) study between April 2000 and March 2016.
 
During this period, 15,678 GPs recorded 1,370,826 patient encounters, of which skin cancer-related conditions were managed 65,411 times – or at a rate of 47.72 per 1000 encounters. Skin cancer-related conditions accounted for 3% of all issues managed.
 
Dr Jeremy Hudson, Chair of RACGP Specific Interests Dermatology, told newsGP he is not surprised by these findings.
 
‘Australia is recognised internationally as having the “gold standard” for skin cancer screening and detection, and the majority of this is led by skilled GPs,’ he said.
 
‘We have the highest disease burden of skin cancer in the world, and GPs remain a proven reliable, cost effective, and accessible means of screening and management.
 
‘There has also been the increasing visibility of skin cancer GPs to the general public. The number of skin cancers is predicted to vastly increase by 2030 with an ageing Gen X, and it is nationally recognised that GPs will shoulder the majority of this clinical responsibility.’
 
The study shows that rates of skin cancer-related conditions increased over time, and management rates varied considerably across different patient sub-groups, with overall rates higher for patients who were older, male and living in outer regional/remote regions or more disadvantaged areas.
 
The ‘sample of general practice clinical activity encounters’ indicates that a broad range of skin cancer-related conditions are managed, with highest to lowest frequency being:

• solar keratosis
• keratinocyte cancer
• other skin lesion
• nevi
• skin check
• benign skin neoplasm
• melanoma.

The type of consultation also varied by age-group, with young adults more likely to be seen in general practice for a mole check or skin check, whereas for older age groups were more often seen for established skin cancers or their early precursors on sun-damaged skin.
 
According to the study authors, their findings demonstrate ‘the spectrum and burden’ of skin cancer-related conditions managed in general practice, which they hope can further guide education, policy and interventions to optimise skin cancer prevention and management.
 
‘Skin-cancer related conditions come in a broad spectrum, and each case is different,’ the paper’s senior author Professor Anne Cust said.
 
‘But our study gives doctors and policymakers a better understanding of who is being affected by these skin cancer related conditions, where they are being treated, and where we can direct resources and education programs.
 
‘It’s vital that we get the right resources to where they’re needed most, especially in regional and rural areas where skin cancer incidence is very high and access to specialist care is more limited.’
 
While Dr Hudson agrees, he said GPs first need to be confident in their knowledge, skills and capacity to undertake appropriate management roles in the area of skin cancer.
 
‘Australian GPs practice in a broad range of interests, capabilities, and geographical locations,’ he said.
 
‘Any education and intervention needs to firstly be about a basic clinical standard for all GPs being able to do a full skin check with a dermatoscope.
 
‘The second aspect needs to be recognising and supporting individual GPs in developing their education and providing resources. 
 
‘All peak bodies currently recognise that GPs play a critical role in skin cancer management, but this needs to translate to increased support for GPs who are doing a great job but are time poor, clinically burdened, and running practices on the smell of an oily rag.’
 
The RACGP offers a Certificate of Primary Care Dermatology for GPs and GPs in training.
 
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GP visits preventive health skin cancer skin checks

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