SKIN-CANCER DIAGNOSIS IN A PRIMARY-CARE SETTING

Background: Primary care providers are in a good position to detect sk in cancers early, but their current involvement in diagnosis and refer ral of patients with skin cancer is unknown, Some managed care setting s utilize a primary care case manager approach to health care. Objecti ve: The purpose of this study was to assess the incidence and demograp hic 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 c ertified physician assistants within an eastern Washington health main tenance organization and the 69 biopsy specimens obtained by referral specialists and confirmed by pathologic consultation. Results: Interni sts, family physicians, and their physician assistants performed 94.7% of the biopsies on 87% of all malignancies. Dermatologists and surgeo ns performed the rest. Primary care providers and dermatologists detec ted malignant melanomas at a rate comparable to a similar study from B ritish Columbia but lower than other previous investigations. Conclusi on: Melanomas were diagnosed in this managed care system at a rate com parable to a similar system in Canada. Lower rates for other skin canc ers are probably because of methodologic differences from other studie s, but variation in histologic diagnoses between pathologists and diff erences in skin cancer detection cannot be excluded.