Jones T P, Boiko P E, Piepkorn M W
University of Washington School of Medicine, Seattle, USA.
J Am Board Fam Pract. 1996 Nov-Dec;9(6):397-404.
To better understand skin biopsy practice among primary care providers, we sought to describe (1) the type and variability of skin lesions biopsied within a defined population, (2) the providers' previous skin cancer experience in clinical practice, and (3) how providers are alerted to the lesions.
Our study was based upon 1215 skin biopsies done by family physicians, internists, physician assistants, and certified nurse midwives at a health maintenance organization between June 1989 and February 1992. Biopsy reports were reviewed, and providers were both surveyed and interviewed.
There were 1004 benign, 89 premalignant, and 122 malignant skin lesions removed for biopsy by 47 primary care providers. The five most frequent biopsy diagnoses were nevi, seborrheic keratoses, actinic keratoses, cysts, and dermatofibromas. Personal interviews indicated that providers noticed lesions based on their experience with pictures, text descriptions, or variation from expected growth, behavior, or response to treatment. Seventy percent of providers interviewed stated that most often the patient brought the lesion to the attention of the provider.
Among the skin lesions examined by biopsy in this primary care setting, 82.6 percent were benign, 7.3 percent were premalignant, and 10.0 percent were malignant. Worthy educational objectives suggested by this study include (1) meeting primary care providers' need for information about early detection of skin cancers, (2) increasing provider access to visual dermatology resources, and (3) increasing patient awareness of skin cancers.
为了更好地了解初级保健提供者的皮肤活检实践情况,我们试图描述:(1)特定人群中接受活检的皮肤病变的类型和变异性;(2)提供者在临床实践中既往的皮肤癌诊疗经验;(3)提供者如何发现这些病变。
我们的研究基于1989年6月至1992年2月期间,一家健康维护组织的家庭医生、内科医生、医师助理和认证护士助产士所进行的1215例皮肤活检。对活检报告进行了审查,并对提供者进行了调查和访谈。
47名初级保健提供者共切除了1004例良性、89例癌前病变和122例恶性皮肤病变进行活检。最常见的五种活检诊断为痣、脂溢性角化病、光化性角化病、囊肿和皮肤纤维瘤。个人访谈表明,提供者根据他们对图片、文字描述的经验,或病变与预期生长、行为或对治疗反应的差异来发现病变。70%接受访谈的提供者表示,大多数情况下是患者将病变提请提供者注意。
在这个初级保健机构接受活检检查的皮肤病变中,82.6%为良性,7.3%为癌前病变,10.0%为恶性。本研究提出的有价值的教育目标包括:(1)满足初级保健提供者对皮肤癌早期检测信息的需求;(2)增加提供者获取皮肤病视觉资源的机会;(3)提高患者对皮肤癌的认识。