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The impact of total body photography on biopsy rate in patients from a pigmented lesion clinic

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Background

Total body cutaneous photography is increasingly being used by dermatologists to monitor patients at risk for the development of melanoma, but limited evidence exists regarding the impact of such photography on melanoma and melanoma-related outcomes.

Objective

We sought to compare biopsy number in patients with multiple atypical nevi in their first year of care at our pigmented lesion clinic (PLC) between those who received total body skin examination alone and those who received total body skin examination and total body digital photography (TBDP). We sought to identify predictors of biopsy number and number of dysplastic nevi diagnosed in patients with multiple atypical nevi.

Methods

A chart review was performed of patients attending the PLC during the years 1998 to 2003 to identify the number of biopsies performed in the first year of care. Patient demographics, melanoma risk factors, and melanoma outcome events were also abstracted from the charts.

Results

The mean number of biopsies performed in patients in their first year of care at the PLC in those who did not receive TBDP was equal to the mean number of biopsies performed in patients who did receive TBDP (0.82 and 0.8, respectively). Linear regression analysis revealed that the interaction term between a lack of both personal history of melanoma and severe dysplastic nevi (−0.930, P = .005) has a significant protective effect on the number of biopsies. Similar regression analysis also showed that the interaction term between a lack of both personal history of melanoma and of severe dysplastic nevi (−1.209, P < .0001), increasing provider experience (−0.047, P = .029), and increased number of biopsies before the initial PLC (−0.028, P = .050) have a statistically significant protective effect on the number of dysplastic nevi diagnosed in the first year of PLC. TBDP did not have an effect on the number of biopsies or on the number of dysplastic nevi diagnosed in the first year of care at the PLC.

Limitations

This study is limited by being retrospective in nature, having a small sample size, and having a short follow-up period.

Conclusion

Overall, this small retrospective study does not provide evidence that would suggest that TBDP changes provider behavior in caring for patients at high risk for melanoma. Rather, our study supports the fact that a patient's positive history of melanoma and a history of severe dysplastic nevi have the most significant impact on provider biopsy behavior, resulting in a lower threshold to biopsy suggestive lesions.

Section snippets

Study population

A chart review was performed of patients who attended our PLC between the years 1998 to 2003. To identify patients who would be eligible for the study, a database of the patients who had attended the PLC between 1998 and 2003 was generated (n = 3632). Patients were considered for the study if they had attended the PLC at least 3 times (n = 946). Patients who met these initial criteria were then stratified into a pre-TBDP group composed of patients who presented to the PLC before December 2000

Results

Table I provides basic demographic information about our patient population and a summary of melanoma risk factors and melanoma outcome events.

The mean age for patients in our population was approximately 36 years, with 55.5% of patients being female. There were no statistically significant differences in age, sex, personal history of melanoma, or family history of melanoma between our patients who received TBDP and those who did not.

There were no statistically significant differences found

Discussion

To our knowledge, this study is one of the first to attempt to objectively evaluate the effect of TBDP used by dermatologists on biopsy rates in patients at increased risk for melanoma. This is an important question that needs to be addressed because, if TBDP is found to be a useful adjunctive screening measure in this patient population, then it has the potential to decrease morbidity, mortality, the cost of care, or a combination of these.

In our study, we were not able to demonstrate that the

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Drs Chen and Veledar are supported in part by a Mentored Patient Oriented Career Development Award (No. K23AR02185-01A1).

Conflicts of interest: None declared.

An abstract of this work was presented at the American Academy of Dermatology Annual Meeting, San Francisco, Calif, on March 4, 2006 and published in the poster abstract edition.

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