School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Acad Dermatol. 2018 Jan;78(1):47-53. doi: 10.1016/j.jaad.2017.09.031. Epub 2017 Sep 22.
Analyses of skin cancer procedures adjusted for population changes are needed.
To describe trends in skin cancer-related biopsies and procedures in Medicare beneficiaries.
An ecological study of Medicare claims for skin biopsies and skin cancer procedures in 2000 to 2015.
Biopsies increased 142%, and skin cancer procedures increased 56%. Mohs micrographic surgery (MMS) utilization increased on the head/neck, hands/feet, and genitalia (increasing from 11% to 27% of all treatment procedures) but was low on the trunk/extremities (increasing from 1% to 4%). Adjusted for increased Medicare enrollment (+36%) between 2000 and 2015, the number of biopsies and MMS procedures performed per 1000 beneficiaries increased (from 56 to 99 and from 5 to 15, respectively), whereas the number of excisions and destructions changed minimally (from 18 to 16 and from 19 to 18, respectively). Growth in biopsies and MMS procedures slowed between each time period studied: 4.3 additional biopsies per year and 0.9 additional MMS procedures per year per 1000 beneficiaries between 2000 and 2007, 2.2 and 0.5 more between 2008 and 2011, and 0.5 and 0.3 more between 2012 and 2015, respectively.
Medicare claims-level data do not provide patient-level or nonsurgical treatment information.
The increased number of skin cancer procedures performed was largely the result of Medicare population growth over time. MMS utilization increased primarily on high- and medium-risk and functionally and cosmetically significant locations where tissue sparing and maximizing cure are critical.
需要对针对人口变化进行调整的皮肤癌手术分析。
描述医疗保险受益人的皮肤癌相关活检和手术趋势。
对 2000 年至 2015 年医疗保险皮肤活检和皮肤癌手术的索赔进行了生态研究。
活检增加了 142%，皮肤癌手术增加了 56%。Mohs 显微手术（MMS）的使用率在头/颈、手/脚和生殖器（从所有治疗程序的 11%增加到 27%）增加，但在躯干/四肢（从 1%增加到 4%）较低。根据 2000 年至 2015 年间医疗保险参保人数（增加 36%）的调整，每 1000 名受益人的活检和 MMS 程序数量有所增加（分别从 56 增加到 99 和从 5 增加到 15），而切除和破坏的数量变化不大（分别从 18 增加到 16 和从 19 增加到 18）。在研究的每个时间段，活检和 MMS 手术的增长都有所放缓：2000 年至 2007 年，每 1000 名受益人的活检每年增加 4.3 例，MMS 手术每年增加 0.9 例；2008 年至 2011 年，活检每年增加 2.2 例，MMS 手术每年增加 0.5 例；2012 年至 2015 年，活检每年增加 0.5 例，MMS 手术每年增加 0.3 例。
医疗保险索赔数据不提供患者水平或非手术治疗信息。
随着时间的推移，进行的皮肤癌手术数量的增加主要是医疗保险人口增长的结果。MMS 的使用率主要在高风险和中风险以及功能和美容意义重大的部位增加，在这些部位，保留组织和最大限度地提高治愈率至关重要。
