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Comment & Response |

A Closer Inspection of the Number Needed to Biopsy—Reply

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, Massachusetts
JAMA Dermatol. 2016;152(8):953. doi:10.1001/jamadermatol.2016.0937.
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In Reply We would like to thank Marchetti and colleagues for their insightful comments on our article. They point out that number needed to biopsy (NNB) is influenced by clinicians’ thresholds to biopsy as well as disease prevalence. This is an important concept because dermatology clinics are certainly enriched with patients at higher risk of skin cancer.

Still, the effect of skill on the NNB cannot be discounted. Skin cancer clinics in Australia staffed by general practitioners are also enriched with patients at greater risk, yet their NNBs for melanoma detection are similar to those seen in general primary care clinics.13 In addition, there can be wide variation in NNB within a single practice, as demonstrated by Wilson et al.4


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August 1, 2016
Michael A. Marchetti, MD; Stephen W. Dusza, DrPH; Allan C. Halpern, MD
1Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Dermatol. 2016;152(8):952-953. doi:10.1001/jamadermatol.2016.0936.
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