title: The specialty of the treating physician affects the likelihood of tumor-free resection margins for basal cell carcinoma: results from a multi-institutional retrospective study.
abstract: BACKGROUND
  Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Surgical experience and physician specialty may affect the outcome quality of surgical excision of BCC.
  
  
  METHODS
  We performed a multicenter retrospective study of BCC excisions submitted to the respective Departments of Pathology at 4 major university medical centers. Our outcome measure was presence of histologic evidence of tumor present in surgical margins of excision specimens (incomplete excision). Clinician experience was defined as the number of excisions that a clinician performed during the study interval. The analytic sample pool included 1459 tumors that met all inclusion and exclusion criteria. Analyses included univariate and multivariate techniques involving the entire sample and separate subsample analyses that excluded 2 outlying dermatologists.
  
  
  RESULTS
  Tumor was present at the surgical margins in 243 (16.6%) of 1459 specimens. A patient's sex, age, and tumor size were not significantly related to the presence of tumor in the surgical margin. Physician experience did not demonstrate a significant difference either in the entire sample (P <.09) or in the subsample analysis (P >.30). Tumors of the head and neck were more likely to be incompletely excised than truncal tumors in all the analyses (P <.03). Compared with dermatologists, otolaryngologists (P <.02) and plastic surgeons (P <.008) were more likely to incompletely excise tumors; however, subsample analysis for plastic surgeons found only a trend toward significance (P <.10). Dermatologists and general surgeons did not differ in the likelihood of performing an incomplete excision (P >.4).
  
  
  CONCLUSIONS
  The physician specialty may affect the quality of care in the surgical management of BCC.
authors.affiliation: Westwood-Squibb Center for Dermatology Research and the Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: S R
authors.initials: SR
authors.lastname: Feldman
authors.forename: J O
authors.initials: JO
authors.lastname: Barlow
authors.forename: B
authors.initials: B
authors.lastname: Zheng
authors.forename: H B
authors.initials: HB
authors.lastname: Hahn
authors.forename: T Y
authors.initials: TY
authors.lastname: Chuang
authors.forename: K S
authors.initials: KS
authors.lastname: Draft
authors.forename: L E
authors.initials: LE
authors.lastname: Golitz
authors.forename: E
authors.initials: E
authors.lastname: Wu
authors.forename: A S
authors.initials: AS
authors.lastname: Katz
authors.forename: J C
authors.initials: JC
authors.lastname: Maize
authors.forename: T
authors.initials: T
authors.lastname: Knapp
authors.forename: B
authors.initials: B
authors.lastname: Leshin
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D018365:Neoplasm, Residual; D016017:Odds Ratio; D011787:Quality of Health Care; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D013038:Specialization