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Skin cancer diagnosis in a primary care setting
P E Boiko1, T D Koepsell, E B Larson
1Department of Family Medicine, University of Washington, Seattle, 98125, USA.
Journal of the American Academy of Dermatology
|April 1, 1996
Summary
Primary care providers are key in early skin cancer detection. This study found their involvement in diagnosis and referral within a managed care setting yielded melanoma rates comparable to Canadian data.
Area of Science:
- Oncology
- Dermatology
- Primary Care Medicine
Background:
- Primary care providers (PCPs) are well-positioned for early skin cancer detection.
- The extent of PCP involvement in skin cancer diagnosis and referral is not well-established.
- Managed care settings often employ a primary care case manager approach.
Purpose of the Study:
- To evaluate the incidence of skin cancer within a managed care population.
- To identify demographic associations of skin cancer in this population.
- To assess the role of primary care providers in skin cancer diagnosis and referral.
Main Methods:
- Analysis of 1215 skin biopsy specimens from PCPs (family physicians, internists, physician assistants) in a health maintenance organization.
- Inclusion of 69 biopsy specimens from referral specialists, confirmed by pathology.
- Comparison of detection rates with previous studies.
Main Results:
- PCPs performed 94.7% of biopsies for 87% of malignancies.
- Dermatologists and surgeons performed the remaining biopsies.
- Malignant melanoma detection rates by PCPs and dermatologists were comparable to a British Columbia study, but lower than other investigations.
Conclusions:
- Melanoma diagnosis rates in this managed care system align with those in a similar Canadian system.
- Lower rates for other skin cancers may stem from methodological differences or variations in histologic diagnosis and detection.
- Further research is needed to clarify diagnostic variations and detection capabilities.