New clinic on the block
It used to be that we'd get our skin checked by a GP, or a specialist such as a dermatologist if there was major cause for concern. Then skin cancer clinics started popping up around Australia, dedicated to checking and treating skin cancer. They are generally easier to get into than a dermatologist, often cheaper (especially those that bulk bill), and have lots of whiz-bang technology that your local doctor probably doesn't. But amid all this, there were reports about unnecessary procedures and poor quality of work. So we ask the question, are skin cancer clinics just suffering a PR problem, or should we be wary?
We wade into a few of the studies that have been done around skin cancer clinics, and find a range of conclusions. But first, let's take a closer look at how clinics operate.
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 removal. Many clinics offer the latest digital technology to assist in examining skin spots, and some even have the facilities to store images of your spots for future comparison.
Although 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 others that are part of large corporate chains. The Cancer Council of NSW says clinics are usually operated by GPs with an interest in skin cancer, and some are operated by dermatologists with specialist training in this area. However, there are no particular requirements for further training or certification of the doctors who work in a skin cancer clinic.
Skin clinics and the doctors working in them have received some bad press in the past 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.
So are you better off seeing your GP for a skin check, and giving skin cancer clinics a miss?
Reports of over-servicing 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.
However, subsequent research from Queensland 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 in 2007 found that GPs and skin cancer clinic doctors diagnose skin cancer with similar accuracy. It also 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. Bear in mind, though, that any equipment is simply a tool that assists in making a diagnosis — the quality of the diagnosis still depends on the experience and skills of the doctor.
In 2012, the Skin Cancer College Australasia was formed from an amalgamation of the Skin Cancer College of Australia and New Zealand, the Australasian College of Skin Cancer Medicine and the Skin Cancer Collegiate Association of New Zealand. Its website states that the College "has evolved in response to the recognised need for primary care practitioners to have ready access to high quality skin cancer training".
The College offers several certificate and diploma courses as well as workshops and other continuing professional development for doctors wishing to specialise in skin cancer diagnosis and treatment.
The College website also offers users to search for a doctor who has been trained and tested (by the College) on their knowledge and skills in skin cancer diagnosis and treatment.
What to ask at your skin cancer clinic visit
Cancer Council NSW offers the following advice on what you should be asking a skin clinic, and what information you should leave with. (Please note: the Cancer Council does not operate or endorse any particular skin clinic.)
- What are the qualifications, skills and experience of the person who will examine you? The Skin Cancer College Australasia website lists the skin cancer education and training opportunities available to Australian doctors — does your practitioner have certificates for any of these?
- Is the person a member or fellow of any professional association relevant to skin cancer (such as the Australasian College of Dermatologists)?
- 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.
- Is there a fee for storing 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.
- Information about skin cancer, prevention and sun protection.
- Information about checking your own skin.
- Written results of any tests you have.
- A record of your diagnosis and treatment (should be sent to your GP).
- A reminder letter should be sent for future check-ups.