According to a study, researchers examine that physician assistant (PAs), perform more skin biopsies per case of skin cancer diagnosed and diagnosis and dermatologists. The study was published in JAMA Dermatology.
Researchers compared the diagnostic accuracy for skin cancer of PAs with that of dermatologists. Medical records were reviewed for 33,647 skin cancer screening examinations in 20,270 unique patients. Advanced practice professionals (APPs), a term referring to nonphysician clinicians including nurse practitioners and physician assistants (PAs), provide an increasing proportion of dermatologic care, with one recent survey finding that 46% of dermatologists employed APPs in 2014.
Advanced practice professionals can help reduce wait times, improve access to dermatology care, and cost less to hire than dermatologists. However, ensuring the quality of care provided by APPs is difficult because there is no formal training or certification program in dermatology for APPs. The researchers found that the number needed to biopsy (NNB) to diagnose one case of skin cancer was 3.9 for PAs and 3.3 for dermatologists (P < 0.001).
Per diagnosed melanoma, the NNB was 39.4 and 25.4 for PAs and dermatologists, respectively (P = 0.007). Compared with those screened by a dermatologist, patients screened by a PA were significantly less likely to be diagnosed with melanoma in situ; for invasive melanoma (0.7 versus 0.8 percent of visits; P = 0.83) and nonmelanoma skin cancer (6.1 versus 6.1 percent of visits; P = 0.98), the differences were not significant.
Visits in which skin cancers are missed and/or biopsies are performed on benign lesions owing to lower diagnostic accuracy are low-value visits and increase the potential harm to patients. This information should be factored into policy decisions about the scope of practice, hiring decisions, supervision of APPs, and patient decisions about who provides their dermatologic care.
Physician assistants performed more skin biopsies to detect melanoma and nonmelanoma skin cancer than did dermatologists. Also, PAs were less likely than dermatologists to diagnose melanoma in situ during a skin cancer screening visit. However, assuming that some fraction of these lesions will progress to ultimately fatal invasive melanoma, early detection and treatment of melanoma at the in situ stage should be beneficial to the patient regarding prognosis and decreased morbidity.