The carbon footprint of surgical and non-surgical skin cancer appointments

BACKGROUND: The carbon emissions of the healthcare sector are large and there is a growing literature dedicated to estimating the carbon footprint of healthcare activities. The carbon footprint of dermatology services is of particular interest in Australia due to the high burden of melanoma and non-melanoma skin cancer and the geographically dispersed population. OBJECTIVES: The goal of this study was to estimate the carbon emissions of an appointment for dermoscopy guided full skin examination, total body photography, and the excision of a lesion suspicious for melanoma or other skin cancers for patients attending specialist dermatology clinics in Sydney, Australia. METHODS: The carbon footprint of each appointment type was estimated in kilograms carbon dioxide equivalent (CO2-e) using process-based life cycle assessment. We included patient transport, single-use equipment, reusable equipment requiring treatment, and energy. Each appointment type was investigated as a mutually exclusive event. RESULTS: Total carbon emissions were 11.11 kg CO2-e (95% CI 1.93-55.53) for a full skin examination, 10.75 kg CO2-e (95% CI 1.60-54.54) for total body photography, and 12.21 kg CO2-e (95% CI 2.92-61.58) for the excision of a lesion suspicious for melanoma. Patient transport was responsible for 10.72 kg CO2-e for each appointment type. CONCLUSIONS: Carbon emissions associated with dermoscopy guided full skin examination, total body photography, and the excision of a lesion suspicious for melanoma or other skin cancers were similar and largely driven by patient transport. Efforts to reduce emissions related to skin cancer care should focus on reducing the need for patients to attend the clinic, where it is clinically safe to do so.