Objective:The objective of this study is to define the epidemiology of melanoma in rural communities in southern Queensland. Design: The design used was a 6-year clinical record audit of melanoma cases identified by billing records and electronic clinical records, confirmed and typed with histology. Setting and Participants: This study was based on seven agricultural communities on the Darling Downs with patients presenting to local primary care clinics. Main outcome measures: Outcomes measured were confirmed type, depth and anatomic distribution of melanoma identified at these practices during the study period. Results:The results from 317 cases of melanoma found anatomic distribution was significantly different (χ 2 = 9.6, P < 0.05) to that reported previously from the Queensland Cancer Registry. A high proportion (87%) of melanoma diagnosed by these general practitioners were 1 mm or less when treated. Conclusions: Conclusions drawn from these findings are that melanoma risk is not so much lesser in rural, inland communities compared with coastal and metropolitan regions, but different. Differences may relate to comprehensive data capture available in rural community studies and to different sun exposure and protection behaviours. The higher proportion of melanoma identified at early stages suggests rural primary care is an effective method of secondary prevention. K E Y W O R D Sepidemiology, melanoma, rural

Background and objectiveAs a result of the lack of evidence of reduction in mortality, secondary prevention of melanoma and keratinocyte skin cancers (KSCs) with active screening is not recommended except for individuals at high risk. Limited access to medical professionals for diagnosis and specialised treatment of skin cancers are related to poorer health outcomes for Australians living in rural areas. The aim of this study was to evaluate the secondary prevention of skin cancer in general practice. MethodsA clinical audit of 317 melanomas and 5463 KSCs was conducted, examining the nature of consultation and stage of cancer at diagnosis.

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