title: Skin biopsy utilization and melanoma incidence among Medicare beneficiaries.
abstract: BACKGROUND
  Melanoma incidence has increased in recent decades in the U.S.A. Uncertainty remains regarding how much of this increase is attributable to greater melanoma screening activities, potential detection bias and overdiagnosis.
  
  
  OBJECTIVE
  To use a cross-sectional ecological analysis to evaluate the relationship between skin biopsy and melanoma incidence rates over a more recent time period than prior reports.
  
  
  METHODS
  Examination of the association of biopsy rates and melanoma incidence (invasive and in situ) in SEER-Medicare data (including 10 states) for 2002-2009.
  
  
  RESULTS
  The skin biopsy rate increased by approximately 50% (6% per year) throughout this 8-year period, from 7012 biopsies per 100 000 persons in 2002 to 10 528 biopsies per 100 000 persons in 2009. The overall melanoma incidence rate increased approximately 4% (< 1% per year) over the same time period. The incidence of melanoma in situ increased approximately 10% (1% per year), while the incidence of invasive melanoma increased from 2002 to 2005 then decreased from 2006 to 2009. Regression models estimated that, on average, for every 1000 skin biopsies performed, an additional 5·2 (95% confidence interval 4·1-6·3) cases of melanoma in situ were diagnosed and 8·1 (95% confidence interval 6·7-9·5) cases of invasive melanoma were diagnosed. When considering individual states, some demonstrated a positive association between biopsy rate and invasive melanoma incidence, others an inverse association, and still others a more complex pattern.
  
  
  CONCLUSIONS
  Increased skin biopsies over time are associated with increased diagnosis of in situ melanoma, but the association with invasive melanoma is more complex.
authors.affiliation: Center for Dermatoepidemiology, US Department of Veterans Affairs Medical Center, Providence, RI, U.S.A.|Department of Dermatology, Rhode Island Hospital, Providence, RI, U.S.A.|Departments of Dermatology and Epidemiology, Brown University, Providence, RI, U.S.A.
authors.forename: M A
authors.initials: MA
authors.lastname: Weinstock
authors.affiliation: Cornell Scott-Hill Health Center, New Haven, CT, U.S.A.
authors.forename: J P
authors.initials: JP
authors.lastname: Lott
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Norris Cotton Cancer Center, Lebanon, NH, U.S.A.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: L J
authors.initials: LJ
authors.lastname: Titus
authors.affiliation: Norris Cotton Cancer Center, Lebanon, NH, U.S.A.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.|Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: T
authors.initials: T
authors.lastname: Onega
authors.affiliation: Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health & Science University, Portland, OR, U.S.A.|Providence Cancer Center, Providence Health and Services, Portland, OR, U.S.A.
authors.forename: H D
authors.initials: HD
authors.lastname: Nelson
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: L
authors.initials: L
authors.lastname: Pearson
authors.affiliation: Department of Medicine, Division of Dermatology, University of Washington School of Medicine, Seattle, WA, U.S.A.|Dermatopathology Northwest, Bellevue, WA, U.S.A.
authors.forename: M
authors.initials: M
authors.lastname: Piepkorn
authors.affiliation: Department of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France.
authors.forename: R L
authors.initials: RL
authors.lastname: Barnhill
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, U.S.A.
authors.forename: J G
authors.initials: JG
authors.lastname: Elmore
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.|Norris Cotton Cancer Center, Lebanon, NH, U.S.A.|Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: A N A
authors.initials: ANA
authors.lastname: Tosteson
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology*; D012044:Regression Analysis; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014481:United States / Q000453:epidemiology