Alyce M Anderson1, Martha Matsumoto2, Melissa I Saul3, Aaron M Secrest4,5, Laura K Ferris2. 1. Medical student, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 2. Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania. 3. Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 4. Department of Dermatology, University of Utah, Salt Lake City. 5. Department of Population Health Sciences, University of Utah, Salt Lake City.
Abstract
Importance: Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied. Objective: To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists. Design, Setting, and Participants: Medical record review of 33 647 skin cancer screening examinations in 20 270 unique patients who underwent screening at University of Pittsburgh Medical Center-affiliated dermatology offices from January 1, 2011, to December 31, 2015. International Classification of Diseases, Ninth Revision code V76.43 and International Classification of Diseases and Related Health Problems, Tenth Revision code Z12.83 were used to identify pathology reports from skin cancer screening examinations by dermatologists and PAs. Exposure: Examination performed by a PA or dermatologist. Main Outcomes and Measures: Number needed to biopsy (NNB) to diagnose skin cancer (nonmelanoma, invasive melanoma, or in situ melanoma). Results: Of 20 270 unique patients, 12 722 (62.8%) were female, mean (SD) age at the first visit was 52.7 (17.4) years, and 19 515 patients (96.3%) self-reported their race/ethnicity as non-Hispanic white. To diagnose 1 case of skin cancer, the NNB was 3.9 for PAs and 3.3 for dermatologists (P < .001). Per diagnosed melanoma, the NNB was 39.4 for PAs and 25.4 for dermatologists (P = .007). Patients screened by a PA were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ (1.1% vs 1.8% of visits, P = .02), but differences were not significant for invasive melanoma (0.7% vs 0.8% of visits, P = .83) or nonmelanoma skin cancer (6.1% vs 6.1% of visits, P = .98). Conclusions and Relevance: Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for the training, appropriate scope of practice, and supervision of PAs and other nonphysician practitioners in dermatology.
Importance: Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied. Objective: To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists. Design, Setting, and Participants: Medical record review of 33 647 skin cancer screening examinations in 20 270 unique patients who underwent screening at University of Pittsburgh Medical Center-affiliated dermatology offices from January 1, 2011, to December 31, 2015. International Classification of Diseases, Ninth Revision code V76.43 and International Classification of Diseases and Related Health Problems, Tenth Revision code Z12.83 were used to identify pathology reports from skin cancer screening examinations by dermatologists and PAs. Exposure: Examination performed by a PA or dermatologist. Main Outcomes and Measures: Number needed to biopsy (NNB) to diagnose skin cancer (nonmelanoma, invasive melanoma, or in situ melanoma). Results: Of 20 270 unique patients, 12 722 (62.8%) were female, mean (SD) age at the first visit was 52.7 (17.4) years, and 19 515 patients (96.3%) self-reported their race/ethnicity as non-Hispanic white. To diagnose 1 case of skin cancer, the NNB was 3.9 for PAs and 3.3 for dermatologists (P < .001). Per diagnosed melanoma, the NNB was 39.4 for PAs and 25.4 for dermatologists (P = .007). Patients screened by a PA were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ (1.1% vs 1.8% of visits, P = .02), but differences were not significant for invasive melanoma (0.7% vs 0.8% of visits, P = .83) or nonmelanoma skin cancer (6.1% vs 6.1% of visits, P = .98). Conclusions and Relevance: Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for the training, appropriate scope of practice, and supervision of PAs and other nonphysician practitioners in dermatology.
Authors: Martha Matsumoto; Aaron Secrest; Alyce Anderson; Melissa I Saul; Jonhan Ho; John M Kirkwood; Laura K Ferris Journal: J Am Acad Dermatol Date: 2017-11-24 Impact factor: 11.527
Authors: Annika Waldmann; Sandra Nolte; Alan C Geller; Alexander Katalinic; Martin A Weinstock; Beate Volkmer; Ruediger Greinert; Eckhard W Breitbart Journal: Arch Dermatol Date: 2012-08
Authors: Michael A Marchetti; Ashley Yu; Japbani Nanda; Philipp Tschandl; Harald Kittler; Ashfaq A Marghoob; Allan C Halpern; Stephen W Dusza Journal: J Am Acad Dermatol Date: 2020-04-29 Impact factor: 11.527
Authors: Nicholas D Flint; Michael D Bishop; Tristan C Smart; Jennifer L Strunck; Kenneth M Boucher; Douglas Grossman; Aaron M Secrest Journal: Fam Cancer Date: 2021-01 Impact factor: 2.375
Authors: Ayush Jain; David Way; Vishakha Gupta; Yi Gao; Guilherme de Oliveira Marinho; Jay Hartford; Rory Sayres; Kimberly Kanada; Clara Eng; Kunal Nagpal; Karen B DeSalvo; Greg S Corrado; Lily Peng; Dale R Webster; R Carter Dunn; David Coz; Susan J Huang; Yun Liu; Peggy Bui; Yuan Liu Journal: JAMA Netw Open Date: 2021-04-01
Authors: V Elagin; E Gubarkova; O Garanina; D Davydova; N Orlinskaya; L Matveev; I Klemenova; I Shlivko; M Shirmanova; E Zagaynova Journal: Sci Rep Date: 2021-01-14 Impact factor: 4.379