Skin cancer clinics investigation

Skin clinics claim to help identify and treat skin cancers. How good are they?
 
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  • Updated:18 Jan 2008
 

01 .Introduction

In brief

  • Research has shown that GPs and skin cancer clinic doctors diagnose skin cancer with similar accuracy.
  • If you go to a skin clinic, make sure you’re informed about the doctor, the costs and any tests or procedures recommended.
  • If you’re in any doubt about a diagnosis or recommended procedure, get a second opinion.

Given the prevalence of skin cancer and the increasing profile of these clinics in Australia, it’s not surprising there’s a huge demand for information about this industry — in the last financial year The Cancer Council NSW received 3974 calls about skin cancer to its helpline, 2251 (57%) of which were specifically about skin cancer clinics.

Please note: this information was current as of January 2008 but is still a useful guide today.

What are skin cancer clinics?

  • Skin cancer clinics provide a convenient one-stop shop for skin checks and a variety of procedures, including biopsies and skin cancer removals.
  • Many clinics offer the latest digital technology to assist in examining skin spots. Some even have the facilities to store images of your spots for future comparison.
  • While many services, including the initial consultation, are usually bulk-billed, you’ll pay for some procedures, such as biopsies.
  • There are no regulations about who can set up these clinics — they range from small, independent operations to those that are part of large corporate chains.
  • Contrary to popular belief, doctors working in skin cancer clinics aren’t usually specialists — they’re primarily GPs. And there are no particular requirements for training or certification of the doctors who work there.
  • Skin clinics and the doctors working in them have received some bad press in the last few years, with concerns raised about the type and quality of work performed within the clinics, and suggestions that they’re carrying out procedures on patients that aren’t medically necessary, simply to maximise income.

To make our own assessment, we sent a shadow shopper to various skin cancer clinics to see what experiences she had. See Our shadow shop for details.

 
 

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Our shadow shopper

Tiina, aged 60, has fair skin, light auburn hair and blue eyes, so is a prime candidate for skin cancer. Prior to the clinic visits her skin was independently assessed by three specialists and, fortunately for her, given the all-clear.

Tiina has a number of benign (non-cancerous) spots on her skin (age spots and sun-induced freckles, for example) and several skin tags (harmless skin growths) but nothing of any cause for concern, according to our experts.

Tiina visited 27 skin cancer clinics in NSW and Queensland. Following each visit she completed a survey giving details of the questions asked, method of skin assessment, equipment used, and any recommendations for procedures, tests or skin care advice given. CHOICE's expert specialists then assessed the completed surveys.

The good news

According to our experts, most of the consultations were undertaken appropriately.

The doctors didn’t misrepresent themselves as being skin specialists — although when asked, over half said they had years of experience or a 'special interest' in skin cancer.

In most cases the consultation process was conducted appropriately and thoroughly, with the doctors asking Tiina for her history — has she ever had sunburn, is there a family or personal history of skin cancer, has she noticed any changes to her skin, for example.

Tiina was given a full body examination (removing all clothing except her underwear) in all but one of the 27 skin cancer clinics.

The bad news

Doctors at three clinics recommended a biopsy — the removal of a sample of tissue for diagnosis — of a spot on Tiina’s cheek, which our experts thought was unnecessary. At one clinic, the doctor suggested the 'suspicious' skin lesion "could be solar keratosis, BCC [basal cell carcinoma], intraepidermal carcinoma or HMF [Hutchinson melanotic freckle]".

These diagnoses range from relatively harmless to quite serious. In his review of this visit, one expert’s response was: "This doctor has given a rather wide-ranging diagnosis despite his use of a dermatoscope ... After making this statement he didn’t suggest a second opinion from a specialist and was willing to wait a year to review the patient, despite his uncertainty."

In two cases Tiina was told the biopsy wouldn’t result in scarring, which our experts disputed. "Advice about biopsy leaving no scarring is quite incorrect," said one.

One clinic recommended the removal of a skin tag on Tiina’s neck without explaining why. After requesting a written report to take away with her so she could consider the procedure, Tiina was ushered out of the consulting room.

Our experts all disagreed with this outcome. As one summed it up, "It is preferable to discuss the diagnosis and ask if the patient wants any benign lesions (such as a skin tag) removed. It would be important to discuss the pros and cons of different techniques of doing so, including cost, time to heal, side effects of treated versus untreated condition."

The majority of clinic doctors that gave advice on how often Tiina should have her skin checked said she should return to the clinic yearly, as a matter of course. Given that Tiina’s skin was fine, our specialists thought this unnecessary, and that instead she should have been advised to return only if she noticed any changes in her skin.

Most surprisingly, only one of the 27 clinics visited gave Tiina advice on skin/sun protection (and this was merely to wear a hat). As one of our experts said, "Given [Tiina’s] pale skin, advice should have been given on sun protection measures such as wearing a hat, long-sleeved clothing and sunscreen products."

03.Questions to ask clinics

 

If you do decide to visit a skin clinic, make sure you're well informed about what to expect and what questions to ask. The following tips from the Cancer Council NSW show you how. (Please note: The Cancer Council does not operate or endorse any particular skin clinic).

The practitioner

Ask about the qualifications, skills and experience of the person who will examine you. The Skin Cancer Society of Australia and New Zealand website lists the skin cancer education and training opportunities available to Australian doctors — does your practitioner have certificates for any of these?

Ask whether the person is a member or fellow of any professional association relevant to skin cancer (such as the Australasian College of Dermatologists).

The costs

Ask what costs are involved, not just for the initial consultation but for any follow-up treatment you may require. Some clinics promote bulk-billing, but sometimes just for the initial consultation. Certain procedures — a biopsy or spot removal, for example — often involve extra charges.

Many clinics use technology that involves computer-assisted scanning and store images of your spots for future comparison. Ask if there’s a fee for storing the images and for follow-up appointments. 

Information and follow-up

The following information should be provided to you before and after your visit to a skin cancer clinic. If it isn't, make sure you ask.

  • You should get information about skin cancer, prevention and sun protection.
  • Information about checking your own skin should be provided.
  • You should receive written results of any tests you have.
  • A record of your diagnosis and treatment should be sent to your GP.
  • You should be sent a reminder letter about future check-ups.

04.Are you better off with a GP

 

So are you better off seeing your GP for a skin check, and giving skin cancer clinics a miss? Here are some things to consider:

  • Reports of overservicing in skin cancer clinics can certainly be alarming. Australian researchers in 2006 found that doctors in skin cancer clinics were cutting out almost 29 moles for every melanoma they picked up.
  • They were also performing expensive and over-complicated skin flap repairs — where nearby skin is moved to cover the area where a lesion was cut out — at up to three times the rate of dermatologists and specialist surgeons.
  • Research from Queensland published later that year, however, found that skin clinic doctors have a high success rate at identifying a wide range of benign skin markings, and moderate to high success identifying cancer.
  • Another Australian study published last year found that GPs and skin cancer clinic doctors diagnose skin cancer with similar accuracy.
  • The same study found that skin clinic doctors are more likely than regular GPs to have had additional training in skin cancer, conduct whole-body skin examinations and use specialised equipment such as computer imaging to assist their diagnosis. Any equipment is simply a tool that assists in making a diagnosis, however — the quality of the diagnosis still depends on the experience and skills of the doctor.

As part of a move to raise academic standards and boost credibility, the Skin Cancer Society of Australia and New Zealand, formed in 2005, now offers a Certificate of Skin Cancer Medicine requiring doctors to demonstrate their knowledge and skills in the area.

From Feburary 2008, doctors who obtain the Certificate will be entitled to apply for skin cancer practice accreditation, which requires them to also have good practice systems in place. It may be a year or two, however, before the first doctors receive accreditation, and their details are made publicly available.

CHOICE verdict

When you visit a skin cancer clinic it’s more than likely you’ll receive competent diagnosis and treatment. But as our shadow shop shows, the outcome of a consultation and information given can vary. Use our checklist as a guide to choosing a clinic and what questions to ask. And if you’re not sure of a procedure or diagnosis, get a second opinion.

CHOICE would like the industry to push ahead with self-regulation, to ensure that doctors who choose to work specifically in the area of skin cancer provide the highest standards of clinical care. Meaningful accreditation of skin cancer doctors (not just the clinics) that reflects minimum standards of skin cancer education, skills, training and a code of conduct is vital.