Skin Cancer Checks and Excisions

Skin cancer checks are performed at Barton Lane Practice by general practitioners with a special interest in skin cancer management. 

Cancer checks can be performed in either a general consulting room or a procedure room. A doctor may recommend having a specific appointment to allow sufficient time and a specific room to access lighting or equipment. 

After introductions, skin cancer checks start with a discussion of the patient’s concern, skin cancer risk, previous cancers, and other health-related matters. 

Patients are encouraged to point out skin areas they are concerned about. In addition to looking at those areas, a full head-to-toe skin check is generally recommended as skin cancer can occur anywhere on the body. 

Doctors differ in how the skin check is performed. It may be done sitting, standing, laying down or a combination of the above. They may use special lights or tools such as a dermatoscope or a camera. 

Generally, the patient is exposed to their underwear allowing the skin to be accurately inspected. The rooms are private, and the consultations (including any photos) are confidential. A chaperone can be provided if that makes the experience more comfortable. 

The doctor may recommend and perform swabs, fungal scrapings or take small skin biopsies. Cryotherapy with liquid nitrogen is frequently used to freeze various skin lesions. If more complex procedures are required, such as a skin excision, you will be asked to rebook for a time when the correct equipment, staff and time is available. 

The doctor will recommend skin care advice including sun protection and advise when you should attend your next skin check. Regular self-examination is encouraged. If you notice a lesion changing or otherwise of concern, you should have that reviewed sooner. 

Skin checks have a time-based consultation fee. There may be additional fees for biopsies or extensive cryotherapy. 

Skin excisions are performed to remove a part of the skin that is thought to be diseased. This may be as a diagnostic step (to work out what the lesion is) or as a therapeutic step (to remove the lesion with the goal of cure). 

Various techniques can be used but the most common methods are punch biopsies (using a small circular device 2-8mm) and excisional biopsies (with scalpel and suture.) These procedures can take 15-45 minutes. 

Antiseptics are used to clean the skin. Local anaesthetic is used to numb the skin, reducing any discomfort. Dressings are applied once the procedure is complete. The sample that is removed is sent to a pathology laboratory for formal diagnosis. 

If sutures are used, you will be asked to see the nurse to have these removed in 5-14 days. Pathology results take approximately 5-10 days to become available and are normally discussed when the sutures are removed. Further management is sometimes required. 

The fees for skin cancer excisions are complex and are a frequent area of confusion. The Medicare rebate depends on the location of the lesion, the severity of the lesion, the size of the lesion, and the number of excisions performed. There are quite a few variables, and some are not known until after the pathology results become available. There are also two fees – one to the practice, and one to the doctor. 

Although there can be variability in the Medicare rebate, at Barton Lane Practice we have focused on predictable out-of-pocket expenses. 

1. The Facility Fee.  
In 2023 the Facility Fee is $50. This is paid to the practice to help cover the expenses such as nursing time and consumables such as local anaesthetic and suture material. 

2. The Procedure Fee.
   In 2023 the out-of-pocket procedure fee is $90 for the first lesion, $45 for the second lesion, and $22.5 for any subsequent lesion. This 100%, 50%, 25%, … pattern is also true for the Medicare rebates which reduce in value at the same rate.

Example 1: 
A lesion is removed from the back. It proves to be a small skin cancer <15mm. This lesion would be charged as $232.25. (The patient receives $142.25 from Medicare, leaving an out-of-pocket expense of $90.) This is in addition to the Facility Fee. 

Example 2: 
Two lesions are removed from the back. One proves to be a medium skin cancer 15-30mm, and the other although appearing suspicious was benign on pathology and was small <15mm. 

The first lesion would be charged at $281.95. (The patient receives $191.95 from Medicare leaving an out-of-pocket expense of $90.) The second lesion would be charge at $87.95 (half of the single lesion rates of $85.85 and $45.) The total fee would be $369.90 with a $135 out-of-pocket expense in addition to the Facility Fee. 

 An estimation of fees can be provided prior to any procedure however it can only be an estimate until the pathology results are available.