Investigating the utility of primary care skin cancer clinics in Queensland

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Skin cancer is the most common cancer in Australia, with an estimated 375,000 people being treated for some skin cancer in Australia in 2002, and 1462 dying from the disease (mainly from melanoma) in 2001. Australia has the highest rate of skin cancer, both melanoma and non-melanoma is the world. However, if detected early, skin cancer is curable, and the focus of current treatment programs internationally is to detect the disease before it progresses to an advanced stage. A large proportion of skin cancers are first detected by the non-medical community. However, due to the two-tiered medical system in Australia, a person first seeks medical opinion from a general practitioner (GP), who acts as a gatekeeper for further treatment from a specialist. Therefore the ability of GPs to be able to discern which lesions require further treatment is crucial, both for the patient, and the financial burden on the health system. A recent development has been the establishment of dedicated primary skin care clinics, which offer open access consultations to the community for the diagnosis and treatment of skin cancers and pigmented lesions. The emergence of these clinics has created much debate in the medical media. Concern has been expressed about the skills of practitioners in these clinics, whilst others argue that sub-specialisation in primary care will lead to improvements in the management of patients. As there is currently no data on the volume, casemix and diagnostic accuracy of these clinics it is difficult to assess the diagnostic ability of skin cancer clinics. This will be the first project to quantify the role of skin clinics in the diagnosis of skin cancer in the community, and in particular their case volume, casemix and diagnostic accuracy, and assess these measures in relation to a comparable sample of general practitioners. Queensland is an ideal location for a study of this type due to its high incidence of both types of skin cancer.