title: Factors associated with the number of lesions excised for each skin cancer: a study of primary care physicians in Queensland, Australia.
abstract: OBJECTIVE
  To assess physician, patient, and skin lesion characteristics that affect the number of benign skin lesions excised by primary care physicians for each skin cancer.
  
  
  METHODS
  Prospective study collecting clinical, patient, and histopathologic details of excisions or biopsies of skin lesions by random samples of primary care physicians.
  
  
  METHODS
  Southeast Queensland involving traditional family medicine physicians (n = 104; response rate, 53.9%) and family medicine physicians working in 27 primary care skin cancer clinics (n = 50; response rate, 75.0%).
  
  
  METHODS
  Of 28 755 skin examinations recorded during the study, 11 403 skin lesions were excised or biopsied; 97.5% of the excised lesions had clinical and histologic diagnoses recorded.
  
  
  METHODS
  Number of lesions needed to excise or biopsy (NNE) for 1 melanoma (pigmented lesions only) and NNE for 1 nonmelanoma skin cancer (nonpigmented lesions only).
  
  
  RESULTS
  The NNE for nonpigmented lesions (n = 8139) was 1.5 (95% confidence interval, 1.4-1.6) and for pigmented lesions (n = 2977) was 19.6 (16.2-22.9). The NNE estimates were up to 8 times lower if the physician thought the lesion was likely to be malignant and up to 2.5 times higher if there was strong patient pressure to excise. The NNE estimates varied by other physician-, patient-, and lesion-related variables.
  
  
  CONCLUSIONS
  Clinical impressions of excised skin lesions were strongly associated with NNE estimates. By focusing on pigmented skin lesions and by addressing the physician- and patient-specific factors identified, the effectiveness of future training for primary care physicians in the clinical management of skin cancer could be improved.
authors.affiliation: Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Queensland, Australia. peterbaade@cancerqld.org.au
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
authors.forename: Philippa H
authors.initials: PH
authors.lastname: Youl
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Del Mar
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
mesh_terms: D000328:Adult; D017677:Age Distribution; D001291:Attitude of Health Personnel; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D016001:Confidence Intervals; D003880:Dermatology / Q000592:standards / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D010821:Physicians, Family / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011320:Primary Health Care / Q000592:standards / Q000639:trends; D011446:Prospective Studies; D011787:Quality of Health Care; D011793:Queensland; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult