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

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: GP's 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 20414 (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.