Jessica Witherspoon, Brian De'Ambrosis, Jim Muir, Daniel Kennedy
Aims: To examine the utilisation of the various surgical modalities for skin cancer management across Australia.
To determine if there are differences over time in their usage.
To determine if there are state based differences in utilisation of surgical management.
Methods: This retrospective observational study utilising the Medicare ‘item number’ data base evaluates the relative use of surgical methods in the treatment of skin cancer in Australia. Treatment modalities reviewed include; curettage and electrodessication, simple excision on various body sites with various diameters of surgical defects and Mohs micrographic surgery. The utilisation of each item number between states and over time are compared relative to population and medical services available. Item numbers are reviewed between 2017–2021 since new item numbers were established.
Results: Differences in the usage of item numbers suggests that curettage and cautery is much more widely used in QLD and NSW than elsewhere. Fewer Mohs blocks, which generally corresponds to a smaller surgical defect is much more common in Victoria than elsewhere and has increased substantially in Qld since 2017.
Conclusions: The use of surgical modalities tends to differ between states. These differences may be reflected in the burden of skin disease and the number and type of practitioners providing care. A document outlining appropriate use criteria for Mohs surgery was published in 2012. Considering the variable use of Mohs across Australian states it is likely that there are considerable variations both regionally and between individual practitioners in applying these guidelines. This has the potential to have adverse impacts on both patient outcomes and budget expenditure in skin cancer management.