Delivering value in dermatology: Insights from skin cancer detection in routine clinical visits

doi:10.1016/j.jaad.2014.10.030

Journal of the American Academy of Dermatology

Volume 72, Issue 2, February 2015, Pages 310-313

Preliminary findings of this study were presented in abstract form at the International Investigative Dermatology 2013 meeting in Edinburgh, Scotland on May 8-11, 2013.

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Background

There are increasing demands to demonstrate and report on outcomes in dermatology. Skin cancer diagnosis through skin examination has been well studied, and is promising as a value-delivering intervention.

Objective

This study seeks to identify the rate of skin cancer diagnosis during routine visits to a large tertiary dermatology clinic.

Methods

Medical records of patients presenting for routine dermatologic care at Massachusetts General Hospital between March 28 and September 28, 2012, were retrospectively reviewed. All patients given a diagnosis of nonmelanoma skin cancer (NMSC) confirmed on biopsy specimen were identified. Billing data were used to identify the total number of patients evaluated during the study period.

Results

NMSC was diagnosed in 1266 skin biopsy specimens from 1047 (7.0%) of the 14,829 patients who presented for routine care. In all, 55% of patients with NMSC were men (mean age 70 years). Chief symptoms of patients with NMSC included general dermatologic concerns (37%), routine cancer screening (43%), and specific lesion(s) of concern (19%).

Limitations

Retrospective design and restriction to a single institution may limit the generalizability of our findings.

Conclusion

The incidence of NMSC in routine dermatology is high; these findings validate the value of care provided by dermatologists and highlight the likely increasing need for their diagnostic skills as the population ages in the United States.

Section snippets

Methods

This study was approved by the Massachusetts General Hospital Institutional Review Board. Medical records of patients presenting for routine dermatologic care between March 28 and September 28, 2012, at the Massachusetts General Hospital, a busy multiprovider urban practice setting, were retrospectively reviewed. All patients given a diagnosis of NMSC histopathologically confirmed by skin biopsy specimen were identified. Demographic information was abstracted from patient medical records, and

Results

In all, 14,829 patients (42% male, mean age 51.1 years) were evaluated for routine care among 27 medical dermatology providers. NMSC was detected in 1266 (32%) of the 4217 total skin biopsy specimens during the study period.

The incidence of NMSC was 7.1%, diagnosed in 1047 of 14,829 unique patients who presented for care. The NMSC subpopulation consisted of patients evaluated for general dermatologic issues, specific lesions of concern, and routine skin cancer screening examinations. Of the

Discussion

Skin examination is highly accurate when performed by dermatologists (sensitivity 93.3%, specificity 97.8%), mirroring the efficacy of other routinely used cancer screening modalities.⁷ Given that the skin cancer burden is substantial with 3.5 million cases of NMSC and 76,000 cases of melanoma expected to be discovered in 2014 and that dermatologists are in short supply, determining the best way to detect these cancers is important.4, 8

In this study a sizeable proportion of routine dermatology

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Incidental Skin Cancer Detection in a Hospital Department: A Prospective Study
2020, Actas Dermo-Sifiliograficas
El cáncer de piel es un motivo frecuente de derivación a dermatología, pero también puede ser un hallazgo incidental durante la exploración por otro motivo de consulta. El objetivo del estudio fue comparar las características de las lesiones diagnosticadas de un cáncer cutáneo de forma incidental y compararlas con aquellas que constituían el motivo de derivación con pacientes diagnosticados de cáncer de piel (carcinoma espinocelular, carcinoma basocelular y melanoma) durante un año en una consulta de dermatología. Se recogieron diferentes variables y se realizó el análisis estadístico mediante la prueba de la Ji cuadrado de Pearson comparando el grupo en el que el diagnóstico era el motivo de derivación frente al grupo en el que el diagnóstico fue hallazgo incidental.
Se recogieron datos de 433 pacientes, con una mediana de edad de 72 años, con 233 (51,3%) pacientes del sexo femenino y un predominio de fototipos II y III. El carcinoma basocelular fue en todos los análisis la neoplasia más frecuente, representando un 68,4% (296/433). Un 26% de los tumores cutáneos malignos diagnosticados no estaban relacionados con el motivo de derivación. El análisis estadístico demostró que las diagnosticadas de forma incidental estaban localizadas en zonas no visibles, tenían un menor tamaño y menor tiempo de evolución.
La alta tasa de cáncer de piel diagnosticado de forma incidental por el dermatólogo resalta la necesidad de realizar exploraciones exhaustivas a nuestros pacientes para facilitar la detección temprana y el tratamiento precoz.
Skin cancer is a common cause for referral to dermatology, but it may also be an incidental finding during examination of patients referred for other reasons. The objective of the study was to compare the characteristics of skin cancer lesions (squamous skin carcinoma, basal cell carcinoma, melanoma) diagnosed at a dermatology department over 1 year between patients referred for suspected skin cancer and those referred for another reason but in whom skin cancer was detected as an incidental finding. Pearson's χ² test was used to compare different study variables between the 2 groups.
Data were collected from 433 patients with a mean age of 72 years; 233 (51.3%) of the patients were female. The most common skin types were Fitzpatrick types II and III. Basal cell carcinoma was the most frequent cancer in all the analyses and accounted for 68.4% of all cancers diagnosed (296/433). Twenty-six percent of the malignant skin tumors were detected incidentally. Statistical analysis revealed that these tumors tended to be located in nonvisible areas and were smaller and of more recent onset than tumors initially suspected to be malignant.
The high rate of skin cancer diagnosed incidentally by dermatologists highlights the need to carry out thorough examinations of patients in order to facilitate early detection and treatment.
The impact of the COVID-19 pandemic on keratinocyte carcinoma in the Netherlands: Trends in diagnoses and magnitude of diagnostic delays
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Development and Validation of a Simple Model to Predict the Risk of Nonmelanoma Skin Cancer on Screening Total Body Skin Examination
2022, Dermatology Research and Practice
Dermatology in the aging man
2020, Design and Implementation of the Modern Men's Health Center: A Multidisciplinary Approach
Modelling the value of risk-stratified skin cancer screening of asymptomatic patients by dermatologists
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A Systematic Review on Smartphone Skin Cancer Apps: Coherent Taxonomy, Motivations, Open Challenges and Recommendations, and New Research Direction
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: Funding sources: None.

: Conflicts of interest: None declared.

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Original articleDelivering value in dermatology: Insights from skin cancer detection in routine clinical visits

Background

Objective

Methods

Results

Limitations

Conclusion

Section snippets

Methods

Results

Discussion

J Am Acad Dermatol

J Am Acad Dermatol

Why patients visit their doctors: assessing the most prevalent conditions in a defined American population

Mayo Clin Proc

Screening for skin cancer: an update of the evidence for the US Preventive Services Task Force

Ann Intern Med

Original article
Delivering value in dermatology: Insights from skin cancer detection in routine clinical visits