title: Delivering value in dermatology: insights from skin cancer detection in routine clinical visits.
abstract: BACKGROUND
  There are increasing demands to demonstrate and report on outcomes in dermatology. Skin cancer diagnosis through skin examination has been well studied, and is promising as a value-delivering intervention.
  
  
  OBJECTIVE
  This study seeks to identify the rate of skin cancer diagnosis during routine visits to a large tertiary dermatology clinic.
  
  
  METHODS
  Medical records of patients presenting for routine dermatologic care at Massachusetts General Hospital between March 28 and September 28, 2012, were retrospectively reviewed. All patients given a diagnosis of nonmelanoma skin cancer (NMSC) confirmed on biopsy specimen were identified. Billing data were used to identify the total number of patients evaluated during the study period.
  
  
  RESULTS
  NMSC was diagnosed in 1266 skin biopsy specimens from 1047 (7.0%) of the 14,829 patients who presented for routine care. In all, 55% of patients with NMSC were men (mean age 70 years). Chief symptoms of patients with NMSC included general dermatologic concerns (37%), routine cancer screening (43%), and specific lesion(s) of concern (19%).
  
  
  CONCLUSIONS
  Retrospective design and restriction to a single institution may limit the generalizability of our findings.
  
  
  CONCLUSIONS
  The incidence of NMSC in routine dermatology is high; these findings validate the value of care provided by dermatologists and highlight the likely increasing need for their diagnostic skills as the population ages in the United States.
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Monica
authors.initials: M
authors.lastname: Enamandram
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Duncan
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: Harvardskinstudies@partners.org.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Kimball
mesh_terms: D000368:Aged; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology; D003880:Dermatology / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008404:Massachusetts / Q000453:epidemiology; D063868:Patient Outcome Assessment; D058996:Quality Improvement / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D063128:Tertiary Health Care / Q000706:statistics & numerical data*
keywords: basal cell carcinoma; nonmelanoma skin cancer; quality improvement; screening; skin cancer incidence; squamous cell carcinoma; value in health care delivery