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Assessing Skin Biopsy Rates for Histologic Findings Indicative of Nonpathological Cutaneous Disease

Solomon, James A., MD, PhD*,†,‡,§; Oswalt, Michael, AS*,†; Nodzenski, Michael, MA; Glener, Julie, MD; Schaeffer, Matthew R., BA; Cartee, Todd V., MD; Maher, Ian A., MD**; Sobanko, Joseph F., MD††; Waldman, Abigail, MD; Yoo, Simon S., MD; Lewis, Suzanna, MD; Barr, Morgan, MD§; Marous, Molly, BS‡‡; Sledge, Brigitte, BS‡‡; Duke, Jodi Kay, MPH§§; Armstrong, April W., MD, MPH‡‡; Poon, Emily, PhD; Veledar, Emir, PhD║║,¶¶; Dellavalle, Robert P., MD, PhD, MSPH‡‡,***,†††; Alam, Murad, MD, MSCI, MBA║,‡‡‡,§§§

doi: 10.1097/DSS.0000000000001865
Original Article

BACKGROUND Recent increase in skin biopsies has been attributed to an epidemic of skin cancer. This may be avoidable, with potential savings.

OBJECTIVE To determine whether the increase in skin biopsies is attributable to increasing frequency of biopsies associated with histology lacking pathological cutaneous disease. Pathological cutaneous disease was defined as (1) a malignancy, precancerous lesion, or lesion of uncertain behavior; or (2) disease symptomatic or associated with adverse quality of life impact.

PATIENTS AND METHODS Retrospective cohort study, 2006 to 2013 of dermatology practice serving Florida and Ohio. Data were a consecutive sample of skin biopsies for diagnosis of dermatologic disease.

RESULTS A total of 267,706 biopsies by an average of 52 providers per month from January 06 to December 13 were analyzed. Number of biopsies per visit increased 2% per year (RR: 1.02, CI: 1.00–1.04). Likelihood of biopsy associated with histology indicative of nonpathological cutaneous disease did not increase over time (OR: 0.99, CI: 0.95–1.03, p = .6302).

CONCLUSION Rates of biopsies associated with nonpathological cutaneous disease is not increasing. Overall biopsy rates per visit have gradually increased; this seems attributable to greater rates of detection of pathological dermatologic disease.

*Advanced Dermatology Cosmetic Surgery, Maitland, Florida;

Ameriderm Research, Ormond Beach, Florida;

Department of Dermatology, University of Central Florida College of Medicine, Orlando, Florida;

§Department of Dermatology, University of Illinois College of Medicine, Urbana, Illinois;

Department of Dermatology, Northwestern University, Chicago, Illinois;

Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania;

**Department of Dermatology, Saint Louis University, St. Louis, Missouri;

††Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania;

‡‡Department of Dermatology, University of Colorado School of Medicine, Anschutz Campus, Aurora, Colorado;

§§Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado;

║║Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia;

¶¶Baptist Health South Florida, Miami, Florida;

***Dermatology Service, Department of Veterans Affairs Medical Center, Denver, Colorado;

†††Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado;

‡‡‡Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;

§§§Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Address correspondence and reprint requests to: Murad Alam, MD, Department of Dermatology, Northwestern University, 676 N St. Clair Street, Ste 1600, Chicago, IL 60611, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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