Skin biopsy indications in primary care practice: a population-based study

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.