Early skin cancer more accurately diagnosed by dermatologist than other providers

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PITTSBURGH, April 18, 2018 – Physician assistants (PAs) are increasingly used in dermatology practices to cut costs and improve access to care, but are more likely than dermatologists to perform unnecessary skin biopsies to check for cancer, while being less likely to accurately diagnose early stage skin cancers, according to new research conducted by the University of Pittsburgh School of Medicine.

The results of the study, led by Laura Ferris, M.D., Ph.D., associate professor, University of Pittsburgh, Department of Dermatology, are published today in JAMA Dermatology.

"Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for training of PAs and other non-physician practitioners in dermatology," said Ferris. "Currently there is no formal training or certification program in dermatology for PAs or other advanced practice providers."

Ferris suggests that the study findings also should be considered when evaluating cost of care. PAs typically have lower salaries than physicians and health systems are increasingly shifting patient care responsibilities to such advanced practice providers in an effort to control costs.

"In the age of cost-conscious medicine, it's important to consider more than just a clinician's salary," said Ferris. "Missed diagnoses or unnecessary biopsies of benign lesions should be factored into decisions about the scope of a practice, hiring decisions, supervision of providers and patient decisions about who provides their dermatologic care."

The study examined the medical records of 33,647 skin cancer screening examinations in 20,270 unique patients who underwent screening at UPMC-affiliated dermatology offices from 2011 through 2015. Ferris and her team found that the lower detection rate among PAs was only for melanoma in situ, or early stage skin cancer, and that PAs and dermatologists had similar detection rates for invasive melanomas and nonmelanoma skin cancers, which often are more clinically obvious.

In addition, the study found that, for every case of melanoma diagnosed, PAs needed to biopsy more than 39 pigmented lesions and dermatologists needed to biopsy slightly more than 25 such lesions. In other words, for every suspected case of melanoma, PAs' suspicions were correct one out of every 39 times, compared to one out of 25 for dermatologists.

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Additional researchers on this study include Alyce M. Anderson, Ph.D., and Melissa I. Saul, M.S., of Pitt; Martha Matsumoto, M.D., of UPMC; and Aaron M. Seacrest, M.D., Ph.D., of the University of Utah.

This study was supported by National Institutes of Health grants 1TL1R001858-01 and 2P50CA121973-06.

About the University of Pittsburgh School of Medicine

As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.

About UPMC

A $16 billion world-renowned health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. UPMC provides more than $900 million a year in benefits to its communities, including more care to the region's most vulnerable citizens than any other health care institution. The largest nongovernmental employer in Pennsylvania, UPMC integrates 80,000 employees, more than 30 hospitals, 600 doctors' offices and outpatient sites, and a 3.4 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. As UPMC works in close collaboration with the University of Pittsburgh Schools of the Health Sciences, U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America's Best Hospitals. UPMC Enterprises functions as the innovation and commercialization arm of UPMC, and UPMC International provides hands-on health care and management services with partners on four continents. For more information, go to UPMC.com.

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http://dx.doi.org/10.1001/jamadermatol.2018.0212

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