Decreasing pediatric skin biopsy rates of lesions that were pigmented in a large health system
J Invest Dermatol
Pediatric melanoma is difficult to clinically detect, which can delay diagnosis. Diagnostic tools, such as dermatoscopes, have evolved, improving evaluation and management of pigmented lesions. We sought to quantify biopsy rates of pigmented lesions and assess clinical suspicion in pediatric patients in a large US health system to assess changes over time. We identified a cohort of patients ages 0-18 years who underwent biopsies of skin lesions in 2004, 2007 and 2010. Using electronic data from a large health plan, biopsy rates for incident pigmented lesions and confidence intervals were calculated. Differential diagnoses recorded by clinicians at time of biopsy were used to classify lesions into categories of low, intermediate, high or unknown clinical suspicion. Kappa coefficients were calculated to compare histology with clinical suspicion. We identified 251 health plan pediatric patients for biopsy rate calculation. Biopsy rates of lesions that were pigmented declined by 44% from 2004 (182.9/100,000) to 2010 (102.0/100,000). Rates declined more in older children, with a 52.9% decline in preadolescents aged 10-14 years old and 53.3% in adolescents aged 15-18 years old. Biopsies of intermediate clinical suspicion declined by 64.3% during the study period with concurrent improvement in the kappa coefficients between clinical suspicion and histology: 0.04, 0.06 and 0.10 respectfully. Pediatric biopsy rates of lesions that were pigmented declined between 2004 and 2010, especially among preadolescents and adolescents. We theorize that clinicians may be more confident in their differential diagnoses due to improved diagnostic ability or patient reassurance related to the use of dermatoscopes. Findings may refute concerns of an increase in medically unnecessary skin biopsies, at least in the pediatric population. Copyright © 2016 Published by Elsevier Inc.
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