‘Eye-watering’ skin cancer burden laid bare

GPs are being urged to refresh their training in skin cancer diagnosis and management, as the ‘enormous scale’ of skin cancer care in Queensland has been revealed in new research.
 
Published in the Australian and New Zealand Journal of Public Health, the eight-year study followed 40,338 Queenslanders aged 40–69, tracking the number, types and costs of skin cancer services used.
 
The QSkin Study – the world’s largest cohort study focused on skin cancer – used data from the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS) and Queensland hospital admissions between 2011–22.

The results show that at an average of 8.5 years follow-up, 71% of participants had more than 245,000 skin cancer services.
 
This came at a cost of approximately $43.1 million to the government, accounting for 2.4% of all direct health service costs.
 
Researchers estimate this equates to Queenslanders aged 40–69 attending around 1.49 million skin cancer appointments and procedures each year.
 
Data also reveals that just over half of participants had one or more skin biopsies, and 36% had one or more non-melanoma skin cancers removed.
 
About one-third had a mole or spot excised to rule out melanoma, with 5% of those resulting in a melanoma being removed. Around 8% were admitted to hospital to have their skin cancers treated.
 
Senior author Professor David Whiteman from QIMR Berghofer labelled the findings ‘astonishing’, saying the ‘great tragedy is that skin cancer is largely a preventable disease’.
 
‘These figures highlight the frankly incredible burden of skin cancer in this part of the world,’ he said.
 
‘The study also highlights the exceptionally high cost of excisions for non-melanoma skin cancers – 44% of government costs and 41% of out-of-pocket costs were for non-melanoma cancer excisions.’
 
Dr Tracey Purnell, RACGP Specific Interests Dermatology Chair, said there is a high burden of skin cancer in Australia and GPs have a role in educating patients.
 
‘When I’m doing a skin check, I see my role as also pointing out to patients that while it’s great that they have come to get their skin checked, what’s more important is actually what happens once they leave the practice – what they do every day as opposed to what they do every year or two by coming to get a skin check,’ she told newsGP.
 
‘Having resources in the practice that can reinforce the behaviours recommended in the “slip, slop, slap, seek and slide” campaign is helpful, such as pamphlets and other material in a practice to back up that messaging.
 
‘GPs need to make sure that every consult for a skin cancer-related issue, be it a spot of concern or someone presenting for a checkup, includes reinforcement of those prevention behaviours.’
 
It’s also important to understand what might be stopping patients from properly using their prevention strategies, Dr Purnell said.
 
‘Using the skills that we have as GPs, we’re trained in motivational interviewing techniques, which is about trying to get people to change their behaviours,’ she said.
 
‘If I ask, “do you wear sunscreen”, and the patient says “no, I don’t like sunscreen”, then I need to find out the barriers to them using sunscreen then try to help them find a product that might work better for them.
 
‘For instance, if someone says, it stings when it gets in my eyes, you could suggest that they use a mineral-based sunscreen that has a pH that isn’t going to sting when it gets into their eyes.
 
‘So, be aware of what products are on the market so that you are able to make suggestions for patients to find products that work for them.’
 
Dr Purnell also urges GPs to look into upskilling in dermoscopy, which could help in better identifying melanomas.
 
‘As a skin cancer GP educator, I would encourage GPs who are doing this sort of work to look at dermoscopy courses that are available and just encourage them to keep sharpening their dermoscopy skills so that they’re not removing as many benign things to rule out melanomas,’ she said.
 
The study has prompted experts to call for a much greater investment in prevention strategies to protect public health and ease pressure on high-demand health services.
 
Adjunct Professor Terry Slevin, Public Health Association of Australia CEO, described the study’s findings as ‘eye watering’. 
 
‘Skin cancer prevention is a flagship example of underinvestment in preventive health,’ he said.
 
‘Despite studies like this, we continue to miss the chance to prevent disease, and we pay the price.
 
‘Skin cancer prevention works. Preventive health works. It saves money, prevents disease and premature deaths.’
 
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dermatology prevention Queensland skin cancer