1 Iconography
Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text

Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates

Journal of the American Academy of Dermatology
Volume 74, n° 6
pages 1185-1193 (juin 2016)
Doi : 10.1016/j.jaad.2015.12.019
accepted : 8 December 2015
Dermatologic Surgery

Factors associated with biopsy site identification, postponement of surgery, and patient confidence in a dermatologic surgery practice

Junqian Zhang, BS a, Alex Rosen, BA a, Lauren Orenstein, MD b, Abby Van Voorhees, MD c, Christopher J. Miller, MD b, Joseph F. Sobanko, MD b, Thuzar M. Shin, MD, PhD b, Jeremy R. Etzkorn, MD b,
a Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 
b Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 
c Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia 

Reprint requests: Jeremy R. Etzkorn, MD, Department of Dermatology, University of Pennsylvania Health System, 3400 Civic Center Blvd, Philadelphia, PA 19104.Department of DermatologyUniversity of Pennsylvania Health System3400 Civic Center BlvdPhiladelphiaPA 19104

Biopsy site identification is critical to avoid wrong-site surgery and may impact patient-centered outcomes.


We sought to evaluate risk factors for biopsy site misidentification, postponement of surgery, and patient confidence in surgical site selection and to assess the near-miss rate for wrong-site surgeries.


This was a prospective observational cohort study.


Near-miss wrong-site surgeries were detected and averted in 1.3% (3 of 239) of patients with biopsy site photographs. Risk factors for biopsy site misidentification by patients were 6 weeks or longer between biopsy and surgery (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.12-4.27; P  = .028) and patient inability to see biopsy site (OR 3.95, 95% CI 1.50-10.37; P  = .002). Risk factors for physician misidentification were 6 or more weeks between biopsy and surgery (OR 3.68, 95% CI 1.40-9.66; P  = .007) and biopsy specimens from multiple sites (OR 4.39, 95% CI 1.67-11.54; P  = .003). Postponement of surgery was associated with absence of a biopsy site photograph (OR 12.5, 95% CI 2.79-62.21; P  < .001). Patient confidence in surgical site identification was associated with the presence of a biopsy site photograph (OR 5.48, 95% CI 1.96-15.30; P  = .001).


This was a single-site observational study.


Biopsy site photography is associated with reduced rates of postponed surgeries and improved rates of patient confidence in surgical site selection. Risk factors for biopsy site misidentification should be considered before definitive treatment.

The full text of this article is available in PDF format.

Key words : biopsy, excision, identification, Mohs, photograph, skin cancer, wrong-site surgery

 Supported by a Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery (Dr Sobanko).
 Conflicts of interest: None declared.

© 2015  American Academy of Dermatology, Inc.@@#104156@@
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Article Outline
You can move this window by clicking on the headline