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      Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System

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          Abstract

          <div class="section"> <a class="named-anchor" id="ab-doi180006-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e315">Question</h5> <p id="d5523492e317">Are physician assistants and dermatologists equally accurate in diagnosing skin cancer in patients undergoing screening? </p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e320">Findings</h5> <p id="d5523492e322">In this medical record review of 33 647 skin cancer screening examinations in 20 270 unique patients, physician assistants needed to biopsy 39.4 pigmented lesions and dermatologists needed to biopsy 25.4 pigmented lesions to diagnose 1 case of melanoma. Patients screened by a physician assistant were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ. </p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e325">Meaning</h5> <p id="d5523492e327">Compared with dermatologists, physician assistants have lower diagnostic accuracy for melanoma. </p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e331">Importance</h5> <p id="d5523492e333">Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied. </p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e336">Objective</h5> <p id="d5523492e338">To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists.</p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e341">Design, Setting, and Participants</h5> <p id="d5523492e343">Medical record review of 33 647 skin cancer screening examinations in 20 270 unique patients who underwent screening at University of Pittsburgh Medical Center–affiliated dermatology offices from January 1, 2011, to December 31, 2015. <i>International Classification of Diseases, Ninth Revision</i> code V76.43 and <i>International Classification of Diseases and Related Health Problems, Tenth Revision </i> code Z12.83 were used to identify pathology reports from skin cancer screening examinations by dermatologists and PAs. </p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e352">Exposure</h5> <p id="d5523492e354">Examination performed by a PA or dermatologist.</p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e357">Main Outcomes and Measures</h5> <p id="d5523492e359">Number needed to biopsy (NNB) to diagnose skin cancer (nonmelanoma, invasive melanoma, or in situ melanoma). </p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e362">Results</h5> <p id="d5523492e364">Of 20 270 unique patients, 12 722 (62.8%) were female, mean (SD) age at the first visit was 52.7 (17.4) years, and 19 515 patients (96.3%) self-reported their race/ethnicity as non-Hispanic white. To diagnose 1 case of skin cancer, the NNB was 3.9 for PAs and 3.3 for dermatologists ( <i>P</i> &lt; .001). Per diagnosed melanoma, the NNB was 39.4 for PAs and 25.4 for dermatologists ( <i>P</i> = .007). Patients screened by a PA were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ (0.2% vs 0.4% of visits, <i>P</i> = .04), but differences were not significant for invasive melanoma (0.2% vs 0.2% of visits, <i>P</i> &gt; .99) or nonmelanoma skin cancer (6.1% vs 6.1% of visits, <i>P</i> = .98). </p> </div><div class="section"> <a class="named-anchor" id="ab-doi180006-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d5523492e382">Conclusions and Relevance</h5> <p id="d5523492e384">Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for the training, appropriate scope of practice, and supervision of PAs and other nonphysician practitioners in dermatology. </p> </div><p class="first" id="d5523492e387">This medical record review evaluates biopsy reports from skin cancer screening examinations to compare dermatologist vs physician assistant accuracy in diagnosing skin cancer in a large health care system. </p>

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          Melanoma treatment costs: a systematic review of the literature, 1990-2011.

          Melanoma is the most deadly form of skin cancer and an important public health concern. Given the substantial health burden associated with melanoma, it is important to examine the economic costs associated with its treatment. The purpose of the current study was to systematically review the literature on the direct medical care costs of melanoma.
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            Dermatology Practice Consolidation Fueled by Private Equity Investment

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              Frequency of excisions and yields of malignant skin tumors in a population-based screening intervention of 360,288 whole-body examinations.

              To explore the frequency of excisions and yields of histopathologically confirmed skin cancer.
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                Author and article information

                Journal
                JAMA Dermatology
                JAMA Dermatol
                American Medical Association (AMA)
                2168-6068
                May 01 2018
                May 01 2018
                : 154
                : 5
                : 569
                Affiliations
                [1 ]Medical student, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
                [2 ]Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
                [3 ]Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
                [4 ]Department of Dermatology, University of Utah, Salt Lake City
                [5 ]Department of Population Health Sciences, University of Utah, Salt Lake City
                Article
                10.1001/jamadermatol.2018.0212
                6128496
                29710082
                eea5cedf-d8a2-4199-8c3b-e74ec2680826
                © 2018
                History

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