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Dermatologists perform fewest biopsies to diagnose skin cancer

For all skin cancers and nonmelanoma skin cancer, dermatologists performed the fewest number of biopsies to diagnose one skin cancer compared with other types of clinicians, including primary care.

“The American Academy of Dermatology’s Burden of Skin Disease Report demonstrated that there are far too few board-certified dermatologists to manage all patients with skin disease, and primary care physicians are often at the frontline of skin cancer screening,” Ashley Privalle, MD, of the department of dermatology at University of Wisconsin-Madison and Mayo Clinic, and colleagues wrote.

The utilization of biopsy was compared among dermatologists, dermatology advanced practice professionals (APPs), primary care physicians (PCPs) and other non-dermatology clinicians in the retrospective study at a single academic tertiary medical center. Twenty-two dermatology physicians submitted skin biopsies along with six dermatology APPs, 127 non-dermatology PCPs and 46 non-dermatology specialists.

A total of 2,364 patients with 3,306 biopsies were included, of which 882 nonmelanoma skin cancers and 79 melanomas were diagnosed. Dermatology performed the most biopsies (2,507, 75.8%), followed by family medicine (558, 16.9%), internal medicine (110, 3.3%), plastic surgery (102, 3.1%), general surgery (16, 0.5%), otolaryngology (six, 0.2%), gynecology (five, 0.2%) and other specialties (two, 0.1%).

Researchers calculated the number needed to biopsy (NNB) by dividing the total number of biopsied lesions by the number of histologically proven skin cancers. The NNB for all clinicians and all skin cancers was 3.59 (3.37-3.81). Nonmelanoma skin cancer had a NNB of 2.23 (2.13-2.34), and melanoma had a NNB of 19.25 (15.34-23.15).

The NNB rate was the lowest for dermatology MDs at 2.82 (2.61-3.03), followed by dermatology APPs at 4.69 (3.99-5.39), non-dermatology PCPs at 4.55 (3.82-5.28) and other non-dermatology physicians at 6.55 (3.84-9.26) (P < .001).

For dermatology MDs, the NNB was significantly lower in those with more years of experience.

“This suggests that the dermatologist’s clinical diagnostic ability and thus, biopsy utilization, improves with experience. Interestingly, years of experience had no significant impact on the NNB of melanoma, which again may be due to a small number of biopsies performed. ... Skin cancer screenings and diagnosis by primary care physicians or dermatology APPs may increase access to dermatologic care. However, patient burden and overall costs must be considered,” the researchers wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.