title: Is histological examination of tissue removed by general practitioners always necessary? Before and after comparison of detection rates of serious skin lesions.
abstract: OBJECTIVE
  To examine whether histological examination of all tissue removed by general practitioners in minor surgery increases the rate of detection of clinically important skin lesions, and to assess the impact of such a policy on pathologists' workload.
  
  
  METHODS
  Before and after comparison.
  
  
  METHODS
  Stratified random sample of 257 general practitioner partnerships from the catchment areas of 19 English pathology laboratories.
  
  
  METHODS
  Tissue removed in minor surgery by general practitioners during the control period (September 1992 to February 1993) and intervention period (September 1993 to February 1994).
  
  
  METHODS
  General practitioners referred to their local pathology laboratory all solid tissue removed in all minor surgery, irrespective of their previous policy.
  
  
  METHODS
  Numbers of specimens referred for histology by general practitioners during intervention and control periods; numbers of primary malignant melanomas, non-melanoma malignancies, premalignant lesions, and benign lesions.
  
  
  RESULTS
  257/330 partnerships participated (response rate 78%). During the intervention period 5723 specimens were sent, compared with 4430 during the control period. The referral rate increased by an estimated 1.34 specimens per 1000 patient years (95% confidence interval 0.93 to 1.76, P < 0.0001). General practitioners sent 204 specimens that were malignant (including 16 malignant melanomas) in the control period and 188 that were malignant (including 15 malignant melanomas) during the intervention period (change in total number of malignancies, -1.0 per 100,000 patient years (-5.9 to 3.8, non-significant).
  
  
  CONCLUSIONS
  The intervention was associated with a substantial increase in laboratory workload, all of which was accounted for by increases in non-serious lesions. This observation should be taken into account when considering the merits of a policy requiring histological examination in every case.
authors.affiliation: Department of Epidemiology and Public Health, University of Leicester, Faculty of Medicine. agjl1@le.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Lowy
authors.forename: D
authors.initials: D
authors.lastname: Willis
authors.forename: K
authors.initials: K
authors.lastname: Abrams
mesh_terms: D004739:England; D005194:Family Practice; D006801:Humans; D013511:Minor Surgical Procedures; D010818:Practice Patterns, Physicians'; D011230:Precancerous Conditions / Q000473:pathology; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000473:pathology* / Q000601:surgery; D016526:Workload