Investigating the utility of primary care skin cancer clinics in Queensland

皮肤癌是澳大利亚最常见的癌症，2002年澳大利亚估计有37.5万人因皮肤癌接受治疗，2001年有1462人死于这种疾病（主要死于黑色素瘤）。澳大利亚的皮肤癌发病率最高，无论是黑色素瘤还是非黑色素瘤都是世界上最高的。然而，如果发现得早，皮肤癌是可以治愈的，目前国际上治疗方案的重点是在疾病发展到晚期之前发现它。很大一部分皮肤癌是由非医学界首先发现的。然而，由于澳大利亚的双层医疗体系，一个人首先要向全科医生（GP）寻求医疗意见，全科医生是专家进一步治疗的把关人。因此，全科医生能够辨别哪些病变需要进一步治疗的能力对于患者和卫生系统的经济负担都至关重要。最近的一项发展是建立了专门的初级皮肤保健诊所，向社区提供诊断和治疗皮肤癌和色素病变的开放咨询。这些诊所的出现在医学媒体上引起了很多争论。人们对这些诊所从业人员的技能表示担忧，而另一些人则认为，初级保健的亚专业化将导致患者管理的改善。由于目前没有这些诊所的数量、病例组合和诊断准确性的数据，因此很难评估皮肤癌诊所的诊断能力。这将是第一个量化皮肤诊所在社区皮肤癌诊断中的作用的项目，特别是它们的病例量、病例组合和诊断准确性，并将这些措施与全科医生的可比样本进行比较。由于两种皮肤癌的高发病率，昆士兰州是进行这类研究的理想地点。

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.