How dermatologic surgeons decide to proceed with surgery for nonmelanoma skin cancer when site identification is initially uncertain: A nationwide, multicenter, prospective study - 18/12/24

Doi : 10.1016/j.jaad.2024.08.073

Areeba Ahmed, MD ^a, Amanda Maisel-Campbell, MD ^a,^b, Victoria J. Shi, BS ^a, Eric Koza, BS ^a, Melissa Ma, BS ^a, Misha Haq, BS ^a, Umer Nadir, BS ^a, Michael D. Yi, BS ^a, Loma Dave, BS ^a, Farhana Ikmal Hisham, MA ^a, Katherine A. Lin, BS ^a, Sarah A. Ibrahim, MD ^a, Bianca Y. Kang, MD ^a, McKenzie A. Dirr, BA, BS ^a, Juliet L. Aylward, MD ^c, Omar Bari, MD ^d,^e, Hamza Bhatti, DO ^f,^g, Diana Bolotin, MD, PhD ^h, Basil S. Cherpelis, MD ⁱ, Joel L. Cohen, MD ^j,^k, Sean Condon, MD ^l,^m, Sheila Farhang, MD ^i,ⁿ, Bahar Firoz, MD, MPH ^f, Algin B. Garrett, MD ^o, Roy G. Geronemus, MD ^p,^q, Nicholas J. Golda, MD ^r, Dyann Helming, BS ^r, Tatyana R. Humphreys, MD ^s,^t, Eva A. Hurst, MD ^u,^v, Oren H. Jacobson, BS ^w,^x, S. Brian Jiang, MD ^d, Pritesh S. Karia, PhD, MPH ^y, Arash Kimyai-Asadi, MD ^z, David J. Kouba, MD ^aa,^ab, M. Laurin Council, MD ^u, Marilyn Le, BA ^s, Deborah F. MacFarlane, MD ^ac, Ian A. Maher, MD ^ad,^ae, Stanley J. Miller, MD ^af, Eduardo K. Moioli, MD, PhD ^h, Meghan Morrow, MD ^a, Julia Neckman, MD ^q,^ag, Timothy Pearson, MD ^l,^ah, Samuel R. Peterson, MD ^ai, Christine Poblete-Lopez, MD ^l, Chad L. Prather, MD ^aj, Jennifer S. Ranario, MD ^ac, Ashley G. Rubin, MD ^d,^ak, Chrysalyne D. Schmults, MD ^y, Andrew M. Swanson, MD ^c, Christopher Urban, MD ^u,^al, Y. Gloria Xu, MD, PhD ^c, Ross Pearlman, MD ^a, Simon Yoo, MD ^a, Vishnu Harikumar, MD ^a, Alexandra Weil, BS ^a, Matthew Schaeffer, MD ^a, Sanjana Iyengar, MD ^a, Emily Poon, PhD ^a, Brian A. Cahn, MD ^am, Murad Alam, MD, MSCI, MBA ^a,^⁎
^a Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
^b Department of Dermatology, Columbia University Medical Center, New York, New York
^c Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
^d Mohs and Dermatologic Surgery Center, University of California, San Diego, California
^e Division of Dermatology, University of California, Los Angeles, California
^f Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
^g The Skin Institute of South Florida, Coral Springs, Florida
^h Section of Dermatology, University of Chicago, Chicago, Illinois
ⁱ Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa, Florida
^j AboutSkin Dermatology, Denver, Colorado
^k Department of Dermatology, University of California Irvine, Irvine, California
^l Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
^m The Center for Dermatology Care, Thousand Oaks, California
ⁿ Avant Dermatology and Aesthetics, Tucson, Arizona
^o Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
^p Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York
^q Laser and Skin Surgery Center of New York, New York, New York
^r Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri
^s Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania
^t Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
^u Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
^v Distinctive Dermatology, Fairview Heights, Illinois
^w Revere Health Central Utah Mohs, Provo, Utah
^x St George's University School of Medicine, Grenada, West Indies
^y Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
^z DermSurgery Associates, Houston, Texas
^aa Wayne State University School of Medicine, Detroit, Michigan
^ab Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio
^ac Department of Dermatology, Baylor College of Medicine, Houston, Texas
^ad Department of Dermatology, St Louis University, St Louis, Missouri
^ae Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
^af Towson Dermatology, Towson, Maryland
^ag Metroderm, Atlanta, Georgia
^ah Anne Arundel Dermatology, Berlin, Maryland
^ai California Skin Institute, Newport Beach, California
^aj Dermasurgery Center, Baton Rouge, Louisiana
^ak Bernardo Dermatology Medical Group, Poway, California
^al Carolina Mountain Dermatology, Arden, North Carolina
^am Department of Dermatology, University of Illinois-Chicago, Chicago, Illinois

^∗Correspondence to: Murad Alam, MD, MSCI, MBA, Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair St, Suite 1600, Chicago, IL 60611.Department of DermatologyFeinberg School of MedicineNorthwestern University676 N Saint Clair StSuite 1600ChicagoIL60611

Abstract

Background

Few studies show how dermatologic surgeons manage problems with site identification.

Objective

To estimate frequency and characterize management of skin cancer treated by surgery when the anatomic location of the tumor is in question.

Methods

Nationwide, prospective, multisite cohort study.

Results

Among 17,076 cases at 22 centers, 98 (0.60%) were lesions in question for which site identification was initially uncertain, with these more often in patients who were male, older, and biopsied more than 30 days ago. Surgeons employed on average 5.0 (95% CI: 4.61-5.39) additional techniques to confirm the site location, with common approaches including: re-checking available documentation (90 lesions, 92%); performing an expanded physical examination (89 lesions, 91%); and asking the patient to point using a mirror (61 lesions, 62%). In 15%, photographs were requested from the biopsying provider, and also in 15%, frozen section biopsies were obtained. In 10%, the referring physician was contacted. Eventually, surgeons succeeded in definitively identifying 82% (80 of 98) of initially uncertain sites, with the remaining 18% (18 of 98) postponed. Most postponed surgeries were at non-facial sites.

Limitations

Sites were academic centers.

Conclusions

When the anatomic location of the tumor is uncertain, dermatologic surgeons use multiple methods to identify the site, and sometimes cases are postponed.

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Key words : cutaneous surgery, dermbase, lesion in question, Mohs micrographic surgery, skin cancer, uncertain lesion location

Abbreviations used : IQR, LIQ

Plan

Introduction

Methods

Results

Patient characteristics

Reason for questioning anatomic location of lesion

Documentation provided for identification of tumor site on day of surgery

Approaches used to ascertain correct site on day of surgery

Discussion

	Funding sources: None.
	Patient consent: Not applicable for recognizable or identifiable patient information in our publication. Consent for participation was obtained by the authors prior to enrollment in the study.
	IRB approval status: Study procedures were performed under the authorization of 2 expedited Northwestern University Institutional Review Board (IRB) protocols, which collectively authorized data collection and managed transmittal of de-identified data across institutions to enable analysis. All data collected were de-identified, and informed consent was waived per IRB direction.

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Vol 92 - N° 1

P. 85-91 - janvier 2025 Retour au numéro

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How dermatologic surgeons decide to proceed with surgery for nonmelanoma skin cancer when site identification is initially uncertain: A nationwide, multicenter, prospective study - 18/12/24

Abstract

Background

Objective

Methods

Results

Limitations

Conclusions

Plan

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