Basal cell carcinomas made up the majority (56.8%) of NMSC problems managed: squamous cell carcinoma accounted for onethird, and skin carcinomas unspecified made up about 10% of these conditions.
The management rate of NMSCs rose significantly through age groups and was highest among patients aged 75 years and over. The management rate was significantly higher for males than for females. Significantly higher rates of NMSC management were found among patients with Commonwealth healthcare cards (HCC), compared with non-HCC holders; patients from an English speaking background (ESB) compared with those from a non-English speaking background (NESB); and non-Indigenous patients compared with Indigenous Australian patients. Figure 1 shows the management rates in each specific group.
Figure 1. Management rate of nonmelanoma skin cancers within patient groups
Management of NMSCs
A high percentage (54%) of NMSCs were new presentations. Rates of prescribed, advised or supplied medications were low compared with the BEACH average of 69 per 100 problems. Pathology ordering rates were also lower than average, and imaging orders were rarely recorded. On the other hand, procedural treatments were recorded at much higher rates than the BEACH average of 11.1 per 100 problems, as were specialist referrals, which have an average rate of 5.6 in total BEACH data. Details of management for NMSCs are shown in Table 1.
Table 1. Management of nonmelanoma skin cancers
| Management type | Rate per 100 NMSC problems managed (n=966) |
|---|
| Medications |
6.7 |
| Imiquimod |
0.9 |
| Cephalexin |
0.9 |
| Fluorouracil |
0.7 |
| Procedures |
51.9 |
| Excision/biopsy |
38.8 |
| Repair/suture |
8.0 |
| Specialist referrals |
22.4 |
| Dermatologist |
9.2 |
| Plastic surgeon |
5.3 |
| Pathology tests |
21.1 |
| Histology, skin |
20.8 |
| Imaging orders |
0.4 |
Conflict of interest: none declared.
Acknowledgements
The authors thank the GP participants in BEACH and all members of the BEACH team. Funding contributors to BEACH from April 2010 to March 2011: Australian Government Department of Health and Ageing; AstraZeneca Pty Ltd (Australia); Bayer Australia Ltd; CSL Ltd; Glaxo SmithKline Australia Pty Ltd; Merck, Sharp and Dohme (Australia) Pty Ltd; Novartis Pharmaceuticals Australia Pty Ltd; Pfizer Australia; Sanofi–Aventis Australia Pty Ltd.