Skin cancer diagnosis in a primary care setting

Background: Primary care providers are in a good position to detect skin cancers early, but their current involvement in diagnosis and referral of patients with skin cancer is unknown, Some managed care settings utilize a primary care case manager approach to health care. Objective: The purpose of this study was to assess the incidence and demographic associations of skin cancer in a managed care population served by primary care providers. Methods: This study analyzed 1215 skin biopsy specimens obtained by family physicians, internists, and supervised certified physician assistants within an eastern Washington health maintenance organization and the 69 biopsy specimens obtained by referral specialists and confirmed by pathologic consultation. Results: Internists, family physicians, and their physician assistants performed 94.7% of the biopsies on 87% of all malignancies. Dermatologists and surgeons performed the rest. Primary care providers and dermatologists detected malignant melanomas at a rate comparable to a similar study from British Columbia but lower than other previous investigations. Conclusion: Melanomas were diagnosed in this managed care system at a rate comparable to a similar system in Canada. Lower rates for other skin cancers are probably because of methodologic differences from other studies, but variation in histologic diagnoses between pathologists and differences in skin cancer detection cannot be excluded.