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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
Abstract
Background

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

Objective

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.

Methods

This was a prospective observational cohort study.

Results

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).

Limitations

This was a single-site observational study.

Conclusion

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.



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