Utilization and outcomes of skin biopsies for cutaneous malignancies

Skin cancer is the most common malignancy in humans. Recent evidence suggests that increasing skin
cancer diagnoses may in fact be the result of increasing skin biopsy utilization, financial incentivization,
and/or heightened diagnostic scrutiny. Unfortunately, population-based estimates of skin biopsy utilization
and associated histopathologic outcomes have not been performed. We do not know how skin biopsy rates
are changing over time, how many biopsies are performed for skin cancer, or what fraction results in skin
cancer. We also do not know which biopsies result in “precursor” skin cancer lesions that may be subject to
over-diagnosis and lead to unnecessary future procedural utilization and cancer surveillance. The Specific
Aims of this project are: (1) to determine temporal trends and patterns of skin biopsy utilization and
histopathologic outcomes for suspected skin cancer by patient and provider characteristics; and (2) to gather
data on dermatopathology resources and infrastructure across all CRN sites to support larger studies and
build capacity for skin cancer research within the CRN. Aim 1 of this study will be conducted at Group Health
and will examine temporal trends in skin biopsy utilization among enrollees ages ?18 years from January 1,
2004 to December 31, 2012. Regression-based modeling will be used to evaluate the relationship between
patient- and provider-level characteristics and age-adjusted rates of skin biopsy utilization. Natural language
processing will be used to identify and classify “reason for biopsy” (clinical indication for biopsy, including
suspected skin cancer) and histopathologic outcomes from digital dermatopathology records. Patterns of
association and temporal trends in “reason for skin biopsy” and histopathologic outcomes will be analyzed
from January 1, 2007 to December 31, 2012 using regression-based modeling. Aim 2 will be conducted
through a survey of all participating CRN sites to characterize site-specific dermatopathology resources and
capabilities, including which sites have “in-house” dermatopathology services, number/characteristics of
dermatopathologists, yearly volume and age-adjusted rates of skin biopsies, availability and accessibility of
digital dermatopathology reports, and extent of missing histopathologic data.

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