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Invited Commentary | Practice Gaps

Immediate Curettage and Electrodesiccation Following Biopsy of Suspected Basal Cell Carcinoma at Initial Visit

Fiona Zwald, MD1
[+] Author Affiliations
1Mohs Micrographic Surgery, Transplant Dermatology, Department of Dermatology, Emory University, Atlanta, Georgia
JAMA Dermatol. 2013;149(8):981. doi:10.1001/jamadermatol.2013.4463.
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This retrospective medical chart review attempts to establish the clinical value of performing a biopsy and treating a lesion suspected to be a basal cell carcinoma (BCC) with curettage and electrodesiccation (C & D) at first visit. The positive predictive value was 84% for lesions confirmed to be BCC on histologic confirmation. The success rate, defined as the proportion of lesions that were treated appropriately, was 95.8%.

This study suggests that dermatologists are extremely accurate about clinically diagnosing lesions that are appropriately treated by same-day electrodesiccation and curettage. Diagnosis and treatment of BCC at the same office visit would improve clinical efficiency and practice outcomes. This would also allow for improved patient access to dermatological care, as appointment times would be more available for patients with suspicious lesions. The practice gap identified herein may be the predilection for practicing dermatologists to suspect skin cancer, biopsy it only, and then perform C & D at a later date. Many patients may not necessarily require surgical excision or Mohs micrographic surgery for treatment of all BCC lesions. This practice gap may exist because of current reimbursement strategies (ie, fee for service model; eg, the health care provider performs a skin biopsy at initial office visit to be followed by a procedure only at a subsequent office visit).

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