key: cord-0869936-e9tsedi1
authors: Roseleur, J.; Gonzalez‐Chica, D.A.; Emery, J.; Stocks, N.P.
title: Skin checks and skin cancer diagnosis in Australian general practice before and during the COVID pandemic, 2011‐2020
date: 2021-05-19
journal: Br J Dermatol
DOI: 10.1111/bjd.20494
sha: f09663d2a64795997152abb96c25dd7631115723
doc_id: 869936
cord_uid: e9tsedi1

Reports from several European countries suggest COVID‐19 had a profound impact on referral for cancer diagnoses. A Dutch study using their National Cancer Registry reported that skin cancer diagnosis reduced by 60% six weeks after the first confirmed case of COVID‐19 was identified in that country, while for other cancer types, this reduction was 26%.(1) In the United Kingdom, reductions of 56% for referrals of all skin cancers and 53% in diagnoses for skin cancers were reported(2), with similar results found in one Australian state.(3)

these years; 58.8% females, mean age 53.5±19.3 years ) within MedicineInsight were used to identify consultations where skin checks were recorded, or a diagnosis of skin cancer was recorded as a diagnosis or encounter reason. We excluded all patients with a diagnosis of skin cancer (i.e. melanoma, basal cell carcinoma (BCC), squamous cell carcinoma (SCC) or nonspecified skin cancer) in the preceding 12 months and thus restricted our analysis to those considered 'at risk' of skin cancer. The proportion of recorded skin checks with a positive reported skin cancer diagnosis (i.e. reported skin cancer diagnosis within six months of skin check) was then estimated. The prevalence of recorded skin checks (per 1,000 patients), reported skin cancer diagnosis (per 1,000 patients) and proportion of skin checks that led to a subsequent cancer diagnosis (%) were analysed quarterly (age and sex-adjusted). MBS data related to claims for skin lesion removals (i.e. items 31356-31376) were extracted for 2017-2020 only, as data were unavailable for previous years. 6 MedicineInsight data was analysed in Stata 16.0, using the "variance covariance (vce) cluster" method, with practices as clusters.

Between January 2011 and September 2020, a total of 67,933 recorded skin screening checks and 28,762 records of new skin cancer diagnosis (12.7% melanoma, 43.3% BCC, 38.2% SCC, 5.8% non-specified skin cancer) were identified. Figure 1A reflects the seasonal pattern of recorded skin cancer diagnosis: higher rates in quarter one of each year (i.e. summer in the southern hemisphere), decreasing in quarters two and three. The peak of any skin cancer diagnosis in quarter one of 2020 (6.9 per 1,000 adults) was 20% lower than the prevalence observed in the same quarter in three previous years (8.6 per 1,000 adults), and remained lower in quarter two of 2020. A similar pattern was observed for BCC and SCC, with a greater reduction for melanoma (32%). Figure 1B shows that, compared to previous years, the expected peak of screening checks in quarter one of 2020 did not occur. A 29% decrease in the rate of skin checks was identified in the second quarter of 2020 compared to the second quarter of 2019, which coincided with 14% fewer MBS claims for skin lesion removals than the same period the previous year. Nonetheless, the proportion of patients with a recorded skin cancer diagnosis after screening remained steady in 2020.

The reduction in skin checks performed by general practitioners in Australia could account for the reduction in melanoma notifications, and by extrapolation the reductions noted in England. 2

This article is protected by copyright. All rights reserved In Australia, these checks peak in the late summer months, but COVID-related changes affected this pattern in 2020, reducing skin cancer diagnosis. Apart from the personal impact, delayed diagnosis can have a profound impact on health cost, as the average annual cost of melanoma increases from AU$1681 per patient for stage 0/I/II to AU$115,109 for stage III unresectable/IV. 7 Although the total number of general practice consultations in Australia remained steady in 2020, it rapidly switched from face-to-face to telephone consultations 4 -an approach that may be permanent because telehealth is now government-funded. Therefore, the potential negative impact of telehealth on skin cancer diagnosis requires monitoring, as poor image quality of pictures obtained by patients 8 and missed opportunistic skin checks during face-to-face consultations for another reason can undermine the identification of malignant lesions.

Dermatologists and general practitioners should work together to ensure adequate case finding and opportunistic skin cancer screening. 

Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands

Reduction in skin cancer diagnosis, and overall cancer referrals, during the COVID-19 pandemic

Decline in cancer pathology notifications during the 2020 COVID-19-related restrictions in Victoria

Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic

Data Resource Profile: MedicineInsight, an Australian national primary health care database

Estimated Healthcare Costs of Melanoma in

Australia Over 3 Years Post-Diagnosis. Applied Health Economics and Health Policy

Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies

We are grateful to the general practices and general practitioners that