Examination of skin naevi in Australian general practice: Dissonance between care and need?
Over 26 months, 223 general practitioners recorded consultations involving the management of skin naevi and some demographic details of the patients. We used data from the Health Insurance Commission and the Australian Bureau of Statistics to estimate population consultation rates. Of 749,171 consultations, 9,729 involved management of naevi. The annual rate per 1,000 of these consultation was 11.3 (95% CI 11.0-11.6) for males and 17.0 (95% CI 16.6-17.5) for females. The rate was significantly higher in the 15-44 year age group, at 21.8 consultations per 1000 individuals annually, compared to 6.3 for younger ages and 16.0, 16.1 and 8.6 for the 45-64, 65-74 and 75+ age groups respectively. There was a seasonal variation, with rates highest in the hot months (of about 16 annual consultations per 1,000 individuals) and lowest in the cooler months (14 for the two years' cooler seasons sampled). There was a significant variation between the rates of different states and territories, but this did not follow a latitude difference. There is a dissonance between the distribution of melanomas (relatively concentrated among older patients and males) and the general practice management of skin naevi (relatively concentrated among younger patients and females). Although melanomas (particularly those with the poorest prognosis) are relatively concentrated in older men, paradoxically, more skin naevi are managed in general practice among younger and female patients.