Skin Cancer Checks and Excisions

What to expect at a skin cancer check 

General practitioners trained in skin cancer management routinely provide skin checks at Tallowwood Health. These checks are best done at a dedicated appointment to allow for time and equipment.  

During the check, the doctor will discuss the patient’s concerns, risk of skin cancer, previous skin-cancers, and other skin-related issues. The patient is encouraged to point out any areas of concern, and a complete head-to-toe skin examination is recommended, as skin cancer can occur anywhere on the body.  

The skin check may be performed while sitting, standing, lying down, or a combination of these positions. The doctor may use specialised lights or tools, such as a dermatoscope or camera, to aid the examination. In stages, the patient is typically asked to be exposed to their underwear for accurate skin inspection. The consultations are confidential, and a chaperone can be requested. 

The doctor may recommend swabs, fungal scrapings, or small skin biopsies if necessary. Cryotherapy with liquid nitrogen is often used to freeze various skin lesions. If more complex procedures are required, such as a skin excision, the patient must rebook when the correct equipment, staff, and time are available. 

The doctor will recommend skin care advice, including sun protection, and advise when the patient should attend their next skin check. Regular self-examination is universally encouraged, with the advice that if a lesion is changing or causing concern, the patient should have it reviewed sooner rather than later. 

Skin checks have a time-based consultation fee, with additional fees for biopsies or extensive cryotherapy.

Skin Biopsies & Excisions 

Skin excisions remove a part of the skin suspected to be diseased. This procedure can be either diagnostic to determine the type of lesion or therapeutic to remove the lesion altogether.  

There are various techniques to perform procedures. The most common methods are punch biopsies (which use a small circular device of 2-8mm) and excisional biopsies (with a scalpel and suture). The procedure takes between 15-45 minutes, depending on the complexity and the number of lesions removed.

It is recommended that you present in comfortable clothes that can be adjusted to allow access to the skin lesion. Generally, regular medications can be continued; however, if you are on blood thinners you should discuss these with the doctor beforehand. You may choose to take simple pain relief, such as panadol, before and/or after the procedure. 

At the start of the procedure, antiseptics are used to clean the skin, followed by the administration of local anaesthetic to numb the skin and reduce discomfort. Once the procedure is complete, dressings are applied. The sample that is removed is sent to a pathology laboratory for a formal diagnosis.  

After the procedure, you should keep the site dry and dressings intact for a number of days. Being careful and keeping the site elevated can reduce swelling and the risk of infection. If sutures are used, the patient is required to see the nurse to have these removed in 5-14 days. Pathology results take approximately 5-10 days to become available and are usually discussed when the sutures are removed. Sometimes, further management is required based on the results. 

Fees

The fees for skin checks are time-based and consistent with general consultation fees at Tallowwood Health. 

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; some are not known until the pathology results become available. Excisions incur two fees – one to the practice and one to the doctor. 

1. The Facility Fee. 
In 2024 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 2024 the out-of-pocket procedure fee is $100 for the first lesion, $50 for the second lesion, and $25 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 $242.25. (The patient receives $142.25 from Medicare, leaving an out-of-pocket expense of $100.) This is in addition to the Facility Fee. 

Lesion 1 
Procedure  fee  $242.25 
Medicare rebate  $142.25 
Out of pocket gap  $100 

Example 2:

Two lesions are removed from the back. One proved 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 $291.95. (The patient receives $191.95 from Medicare leaving an out-of-pocket expense of $100.) The second lesion would be charge at $92.95 (half of the single lesion rates of $85.85 and $50.) The total fee would be $389.90 with a $150 out-of-pocket expense in addition to the Facility Fee.  

Lesion 1  Lesion 2 Total
Procedure fee  $291.95  $92.95 $384.90
Medicare rebate  $191.95  $42.95  $234.90
Out of pocket gap  $100.00 $50.00 $150.00

An estimation of fees can be provided prior to any procedure however it can only be an estimate until the pathology results are available. If you have any questions about pricing, please speak to your doctor or practice management, before the procedure.