title: A multistep approach to improving biopsy site identification in dermatology: physician, staff, and patient roles based on a Delphi consensus.
abstract: OBJECTIVE
  Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery.
  
  
  OBJECTIVE
  To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology.
  
  
  METHODS
  Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations.
  
  
  RESULTS
  In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions.
  
  
  CONCLUSIONS
  When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.
authors.forename: Murad
authors.initials: M
authors.lastname: Alam
authors.forename: Andy
authors.initials: A
authors.lastname: Lee
authors.forename: Omar A
authors.initials: OA
authors.lastname: Ibrahimi
authors.forename: Natalie
authors.initials: N
authors.lastname: Kim
authors.forename: Jeremy
authors.initials: J
authors.lastname: Bordeaux
authors.forename: Karen
authors.initials: K
authors.lastname: Chen
authors.forename: Scott
authors.initials: S
authors.lastname: Dinehart
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: C William
authors.initials: CW
authors.lastname: Hanke
authors.forename: George J
authors.initials: GJ
authors.lastname: Hruza
authors.forename: Kishwer S
authors.initials: KS
authors.lastname: Nehal
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Olbricht
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Orringer
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Rohrer
authors.forename: Noah S
authors.initials: NS
authors.lastname: Scheinfeld
authors.forename: Chrysalyne D
authors.initials: CD
authors.lastname: Schmults
authors.forename: John M
authors.initials: JM
authors.lastname: Strasswimmer
authors.forename: James S
authors.initials: JS
authors.lastname: Taylor
authors.forename: Simon
authors.initials: S
authors.lastname: Yoo
authors.forename: Michael
authors.initials: M
authors.lastname: Nodzenski
authors.forename: Emily
authors.initials: E
authors.lastname: Poon
authors.forename: Todd
authors.initials: T
authors.lastname: Cartee
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D032921:Consensus; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D062109:Dermatologic Surgical Procedures / Q000592:standards / Q000639:trends; D003880:Dermatology / Q000592:standards / Q000639:trends; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D010358:Patient Participation; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome