Weinstein David A, Konda Sasank, Coldiron Brett M
*Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida; †TriHealth Good Samaritan Hospital, Cincinnati, Ohio; ‡University of Chicago Pritzker School of Medicine, Chicago, Illinois; §Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, Ohio; and ‖The Skin Cancer Center, Cincinnati, Ohio.
Dermatol Surg. 2017 Nov;43(11):1348-1357. doi: 10.1097/DSS.0000000000001188.
Skin biopsies are essential to establish a diagnosis in many skin diseases. Utilization has been increasing rapidly and represents a significant health care cost. There are no benchmarks or baselines to guide the practice of skin biopsies.
To create a reference data set of biopsy behavior among dermatologists.
Five hundred eighty-eight dermatologists belonging to the American Dermatological Association (ADA) were surveyed. Two hundred eighty-seven responded with 128 of those providing biopsy data.
The mean percentage of biopsies that were malignant was 44.5%. This varied by subspecialty with a mean of 41.7%, 57.4%, and 4.1% of biopsies performed by general dermatologists, Mohs micrographic surgeons, and pediatric dermatologists, respectively. By category or diagnosis, the biopsies were 22.7% basal cell carcinoma, 12.0% SCC, 10.2% benign neoplasms, 10.0% nevi, 8.0% actinic keratosis, 7.6% seborrheic keratosis, 7.5% inflammatory disorders, 6.1% SCC in situ, 5.3% dysplastic nevus, 5.1% benign skin, 1.5% melanoma in situ, 1.4% melanoma, 0.9% lentigines, 0.8% other malignancies, 0.6% infectious, 0.2% not otherwise specified, and 0.1% atypical lesions. There was a statistically significant difference in biopsy results between different dermatological subspecialties.
These results should help elucidate dermatologic practice patterns and thus create opportunities to improve dermatologic care and reduce health care costs.
皮肤活检对于许多皮肤病的诊断至关重要。其使用量一直在迅速增加，且代表着一项重大的医疗保健成本。目前尚无基准或基线来指导皮肤活检的实践。
创建皮肤科医生活检行为的参考数据集。
对588名美国皮肤病学会（ADA）的皮肤科医生进行了调查。287人做出回应，其中128人提供了活检数据。
活检为恶性的平均百分比为44.5%。这因亚专业而异，普通皮肤科医生、莫氏显微外科医生和儿科皮肤科医生进行的活检中，恶性的平均比例分别为41.7%、57.4%和4.1%。按类别或诊断划分，活检结果为基底细胞癌占22.7%，鳞状细胞癌占12.0%，良性肿瘤占10.2%，痣占10.0%，光化性角化病占8.0%，脂溢性角化病占7.6%，炎症性疾病占7.5%，原位鳞状细胞癌占6.1%，发育异常痣占5.3%，良性皮肤病变占5.1%，原位黑色素瘤占1.5%，黑色素瘤占1.4%，雀斑样痣占0.9%，其他恶性肿瘤占0.8%，感染性病变占0.6%，未另作说明的占0.2%，非典型病变占0.1%。不同皮肤科亚专业之间的活检结果存在统计学上的显著差异。
这些结果应有助于阐明皮肤科的实践模式，从而创造改善皮肤科护理和降低医疗保健成本的机会。
