Outpatient surgical management of head and neck keratinocyte cancers in a regional centre: an updated analysis of costs and outcomes

Background: Australia has the highest global incidence of keratinocyte cancer. Surgically managing keratinocyte cancers in regional Australia presents geographic and economic challenges, which necessitate cost-effective resource allocation. Previous work has outlined the cost benefit for outpatient day surgical excision of head and neck skin lesions that can be closed primarily. We expand on this analysis with the inclusion of graft and local flap reconstructions.

Methods: A retrospective analysis was completed in a single regional centre across 24 months from July 2022 to June 2024. Patient demographics, lesion characteristics, margin status, cost comparison, and complication rates were recorded.

Results: There were 256 excisions for proven or suspected keratinocyte cancers. Basal cell carcinomas comprised 73.1% of lesions, squamous cell carcinoma for 21.9% of lesions, and intra-epidermal carcinoma for 5.1%. Lesion defects were closed primarily in 63.8% while 23.0% underwent full thickness graft reconstruction and 13.2% required local flaps. Involved margins were reported in 8.1% of excisions. Follow-up wound review was undertaken in primary care for 26.1% of all lesion excisions. Average indicative costs were three-to-four times higher for procedures performed in theatre compared to the outpatient setting, and these savings were greatest for graft and local flap reconstructions. There were 20 recorded complications including 16 partial or complete graft failures and one partial flap failure.

Conclusion: This study demonstrates further cost effectiveness for graft and local flap reconstruction of head and neck skin excisions under local anaesthetic in the regional outpatient setting, while maintaining low complication and incomplete excision rates.