Purpose Queensland has the highest rate of skin cancer in the world with 770,000 new cases of Non-Melanoma Skin Cancer and 12,000 of Melanoma diagnosed each year. Rockhampton is a farming town of 80,000, situated 600km north of Brisbane. Historically serviced by visiting Plastic Surgeons, limited public access means there is only one Plastics PHO available. We aim to audit the skin cancer burden and review the registrar experience in rural Queensland. Methodology: Retrospective audit of a single Plastic Surgery PHO over 6 months, 6th August 2018 - 3rd February 2019. ORMIS database and ICD10 codes were used to collect all patients. Inclusion criteria included any patient who had a skin cancer removed during the period. Excision of non-cancerous lumps were not included. The type, number and method of reconstruction for each skin cancer was recorded and close or involved margins. Results: 105 lesions were excised over 6 months, with 3 involved (2.9%) and 2 close (1.9%) margins. Lesions excised included; 11 benign, 11 IEC, 57 BCC, 21 SCC and 5 Melanoma. Reconstructions included; 59 direct closures, 13 FTSG, 8 SSG and 22 local flaps. Local flaps included; 5 Rhomboid, 3 V-Y, 3 Local rotation, 3 A-T, 2 Nasalis, 2 Hatchet, 2 Cervicofacial, 1 Nasolabial and 1 Bilobe. Conclusions: Rockhampton has a significant skin cancer burden, particularly BCC. There is excellent operative experience for a Plastics PHO with varying pathology. As skin cancer numbers increase, there continues to be an ongoing need for specialist Plastic Surgeons in rural areas.