Factors associated with the number of lesions excised for each skin cancer: A study of primary care physicians in Queensland, Australia

Baade, Peter D., Youl, Philippa H., Janda, Monika, Whiteman, David C., Del Mar, Christopher B. and Aitken, Joanne F. (2008) Factors associated with the number of lesions excised for each skin cancer: A study of primary care physicians in Queensland, Australia. Archives of Dermatology, 144 11: 1468-1476. doi:10.1001/archderm.144.11.1468

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Author Baade, Peter D.
Youl, Philippa H.
Janda, Monika
Whiteman, David C.
Del Mar, Christopher B.
Aitken, Joanne F.
Title Factors associated with the number of lesions excised for each skin cancer: A study of primary care physicians in Queensland, Australia
Journal name Archives of Dermatology   Check publisher's open access policy
ISSN 0003-987X
1538-3652
Publication date 2008
Year available 2008
Sub-type Article (original research)
DOI 10.1001/archderm.144.11.1468
Open Access Status File (Publisher version)
Volume 144
Issue 11
Start page 1468
End page 1476
Total pages 9
Editor June K. Robinson
Catherine D. DeAngelis
Place of publication Chicago, IL, United States
Publisher American Medical Association
Collection year 2009
Language eng
Subject C1
920102 Cancer and Related Disorders
111717 Primary Health Care
Abstract Objective: To assess physician, patient, and skin lesion characteristics that affect the number of benign skin lesions excised by primary care physicians for each skin cancer. Design: Prospective study collecting clinical, patient, and histopathologic details of excisions or biopsies of skin lesions by random samples of primary care physicians. Setting: Southeast Queensland involving traditional family medicine physicians (n=104; response rate,53.9%) and family medicine physicians working in 27 primary care skin cancer clinics (n=50; response rate,75.0%). Participants: Of 28 755 skin examinations recorded during the study, 11 403 skin lesions were excised or biopsied; 97.5% of the excised lesions had clinical and histologic diagnoses recorded. Main Outcome Measures: Number of lesions needed to excise or biopsy (NNE) for 1 melanoma (pigmented lesions only) and NNE for 1 nonmelanoma skin cancer (nonpigmented lesions only). Results: The NNE for nonpigmented lesions (n=8139) was 1.5 (95% confidence interval, 1.4-1.6) and for pigmented lesions (n=2977) was 19.6 (16.2-22.9). TheNNE estimates were up to 8 times lower if the physician thought the lesion was likely to be malignant and up to 2.5 times higher if there was strong patient pressure to excise. The NNE estimates varied by other physician-, patient-, and lesion-related variables. Conclusions: Clinical impressions of excised skin lesions were strongly associated with NNE estimates. By focusing on pigmented skin lesions and by addressing the physician- and patient-specific factors identified,the effectiveness of future training for primary care physicians in the clinical management of skin cancer could be improved.
Q-Index Code C1
Q-Index Status Confirmed Code

 
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Created: Mon, 30 Mar 2009, 15:27:17 EST by Cathy Swart on behalf of School of Public Health