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Should We Leave the Skin Biopsies to the Dermatologists?

Kathryn T. Shahwan, MD1; Alexa B. Kimball, MD, MPH1
[+] Author Affiliations
1Clinical Unit for Research Trials and Outcomes in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
JAMA Dermatol. 2016;152(4):371-372. doi:10.1001/jamadermatol.2015.5051.
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This Viewpoint describes dermatologists’ accuracy at skin cancer diagnosis compared with other health care professionals and hypothesizes that prioritizing biopsies to dermatologists may be a cost-effective strategy.

Skin cancer is the most common type of malignancy in the United States, and its morbidity continues to rise. In recent decades, the establishment of accountable care organizations has shifted the paradigm of physician compensation to a basis in performance measures. Given the profound economic burden of skin cancer, the accuracy of its diagnosis has the potential to be a useful performance measure. One way to evaluate diagnostic accuracy is to calculate the number needed to biopsy (NNB), or the number of biopsies needed to detect 1 skin cancer.

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Calculating Total Cost per Skin Cancer Diagnosis

The total cost per skin cancer diagnosis can be calculated by multiplying the cost of a visit and biopsy by the NNB. This tool can be used to compare cost savings with improvement in the NNB, either between physician types or before and after an intervention. NNB indicates number needed to biopsy; PCP, primary care physician.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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