Aim: Outpatient dermatological procedures are becoming increasingly popular for managing various multiple dermatological conditions, most important of which are skin cancers. Common intra- and post-op complications encountered include infections, bleeding, wound dehiscence, pain, tissue necrosis, hypertrophic/keloid scarring and anaesthetic complications. We aim to evaluate the current practice of outpatient dermatological procedures at Monash Health, Melbourne Victoria and demonstrate its safety in the Australian context based on the rates of adverse events.
Methods: This is a retrospective audit of patients who received treatment from Monash Health dermatology procedures outpatient clinic from June 2018 to May 2024. Cases are included if the procedure was performed to investigate and manage lesions clinically suspicious for in-situ or invasive malignancies, or to treat biopsy-proven malignancies. Patient demographics, details of procedures and the follow-up outcomes and complications are recorded. Adverse events are defined as: infection, bleeding, pain/paraesthesia, tissue necrosis, anaesthetic complications, hypertrophic/keloid scarring, incomplete excision, and major complications requiring patients to be hospitalized, resuscitated or resulted in death. Descriptive statistics have been used for analysis.
Results: 344 procedures from 129 patients (92 males, 37 females) were identified on the department’s procedures outpatient clinic database. Excisions were most commonly performed [181/344 (52.6%)] along with shave, punch, incisional biopsies and curettage. 97/129 (75.2%) of patients had relevant comorbidities including transplant recipients, diabetes and anticoagulation. The overall rate of adverse events was 24/344 (6.98%). The most common adverse event was infection (10/24), followed by incomplete excision (7/24), dehiscence (3/24), pain/paraesthesia (2/24) and bleeding (2/24). There was no major complication requiring hospitalization. Secondary plastic surgery referrals were made for 5.81% of procedures - reasons being incomplete excision, difficult location requiring flaps or grafts or large excision size.
Conclusions: Outpatient dermatological procedures are a safe and effective option for managing skin cancers in a tertiary hospital setting.