Over the past decade, the SCARD Skin Cancer Surgical Audit system has played a pivotal role in tracking and improving skin cancer diagnosis and treatment in Australia. As we look back on the data from 2015 to 2024, several key trends emerge that highlight both advancements and ongoing challenges in the field.
Growth in Participation
The number of participating doctors has consistently fluctuated, peaking in some years and declining in others. For instance, participation reached 436 doctors in 2019 but fell to 315 in 2024. Patient numbers followed similar trends, with over 76,000 patients recorded in 2023 compared to just over 60,000 in 2024. These shifts may reflect broader changes in healthcare delivery or system accessibility.
Changes in Lesion Analysis
The SCARD database processed over a million lesions during this period, showing:
- New vs. Previously Biopsied Lesions: The proportion of new lesions consistently dominated the data, with over 80% being new lesions each year.
- Malignancy Rates: The percentage of new lesions tested as malignant varied slightly year-on-year, peaking at 63.94% in 2021 and showing a slight decline to 62.45% in 2024.
- Lesions Tested Per Melanoma: This metric, which reflects the number needed to test (NNT) to find one melanoma, improved from 5.22 in 2015 to 3.82 in 2023, indicating enhanced diagnostic focus.
Advances in Diagnostic Sensitivity and Predictive Value
Diagnostic sensitivity for melanomas improved from 69.18% in 2015 to 77.56% in 2024. This improvement is a testament to advancements in diagnostic techniques and practitioner training. Sensitivity for non-melanoma skin cancers (NMSC) consistently exceeded 95%.
Positive predictive value (PPV) for melanomas, however, showed variability. In 2015, the PPV stood at 41.17%, improving to 46.01% in 2022 but declining slightly to 37.59% in 2024. This fluctuation underscores the ongoing challenge of accurately diagnosing rarer and more aggressive melanomas, which often require additional diagnostic scrutiny.
Shifts in Histological Diagnoses
Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) remained the most diagnosed lesions throughout the decade, with the ratio of BCC to melanoma stabilizing around 8:1 in recent years. Among BCC subtypes:
- Superficial BCCs: These declined slightly in proportion, indicating either improved early interventions or a shift in biopsy focus.
- Nodular BCCs: This subtype consistently remained the most prevalent, reflecting its common presentation in clinical settings.
Meanwhile, invasive melanomas presented a persistent challenge. Although the number of melanomas detected remained relatively stable, the proportion of invasive melanomas >1mm in depth showed limited improvement in surgical margin adequacy, remaining a critical area for focused care.
Evolving Surgical Management
Surgical procedures showed remarkable consistency in some areas but significant changes in others:
- Ellipse Excision: This remained the most common definitive surgical management, accounting for 85-90% of procedures for benign and malignant conditions.
- Complex Closures: The proportion of complex closures varied, reaching 11.70% in 2015 but dropping to around 10.52% in 2024.
- Non-Surgical Management: Methods like liquid nitrogen freeze-thaw and topical treatments like Imiquimod saw limited but steady use.
Challenges in Margins and Advanced Cases
The adequacy of surgical margins improved for many conditions. For instance, BCC margin adequacy rose from 85.34% in 2015 to 89.80% in 2024. However, invasive melanomas larger than 1mm consistently posed challenges, with margin adequacy declining in some years.
Looking Ahead
As SCARD enters its next decade, the data underscores the importance of continuous improvement. By expanding participation, refining diagnostic tools, and focusing on the adequacy of treatment for high-risk lesions, the SCARD database can further enhance outcomes for patients across Australia.
This decade-long review highlights the power of data-driven decision-making and collaboration among healthcare professionals. Together, we can look forward to another decade of innovation and improved care.
References
SCARD reports server (https://report.scard.co/) analysis for 2015 – 2024 @ 20th January 2025
