Skin Cancer Early Detection and Prevention for the Primary Care Physician: Assessing and Changing Physicians' Knowledge, Attitudes, and Behaviors

Context: Skin Cancer is of growing public health concern. The incidence and mortality of skin cancer continues to rise. The morbidity and mortality from skin cancer is directly proportional to the depth of invasion of the tumor. Primary care physicians are in an optimum position to diagnose skin cancer due to their frequent exposure to patients. However, it is not clear if primary care physicians have adequate knowledge or diagnostic ability to detect skin cancer. Additionally it is not clear if primary care physicians are screening or counseling high-risk patients. Objectives: To assess primary care physicians' knowledge, attitudes, and behavior concerning early detection and prevention of skin cancer, and to assess changes in primary care physicians' knowledge, attitudes, and behavior following implementation of a brief educational intervention developed by the authors. Design: Prospective Randomized Controlled Trial Setting and Participants: Family medicine and internal medicine residency programs (9 total) in academic and community based settings were randomized to control or intervention groups. Participants from both groups (174 total) completed an initial survey to assess baseline knowledge, attitudes, and behavior with regards to early detection and prevention of skin cancer. The control groups attended their normal conference while the intervention groups attended a skin cancer education module. The same survey was completed again at 2-4 weeks follow up by 88 of the original 174 participants. Of the 88 participants who completed both surveys, 43 were in the intervention group and 45 were in the control group. Baseline and follow up surveys were analyzed. Intervention: 1-hour educational presentation covering skin cancer epidemiology, diagnosis, decision-making, screening, and counseling. A copy of the presentation and additional educational materials provided to participants can be found in appendix 1. Main Outcome Measures: Participant survey responses at baseline and follow-up. The survey found in appendix 2 tested skin cancer knowledge, diagnostic ability, attitudes, and behavior. Results: The baseline survey revealed primary care physicians' deficiencies in general skin cancer knowledge and diagnostic ability. 28% knew the lifetime risk of melanoma for someone in the year 2000 and 18% correctly identified 3 out of 3 melanomas. 43% knew all four of the ABCD's of melanoma, and 18% listed at least 5 risk factors for skin cancer. Following the educational intervention, participants in the intervention group gained significant knowledge and diagnostic ability. Participants in the intervention group scored significantly better on: 3 of 6 general skin cancer knowledge questions, listing the ABCDs of melanoma, and listing risk factors of melanoma. Participants in the intervention group correctly diagnosed 2 of the 3 melanomas more frequently than those in the control group. Primary care physicians in the intervention group reported performing skin cancer preventive or early detection measures with new or high-risk patients more often than those in the control group. Conclusions: Primary care physicians possess inadequate knowledge, diagnostic skills, and preventive behaviors with regards to skin cancer prevention and early detection that can be improved using a brief educational intervention.Master of Public Healt

To scoop or not to scoop: the diagnostic and therapeutic utility of the scoop-shave biopsy for pigmented lesions

BACKGROUND: Concern over transection of melanomas has inhibited many practitioners from using the scoop-shave for removal of pigmented lesions. OBJECTIVE: To assess the safety and efficacy of the scoop-shave for pigmented lesions. MATERIALS AND METHODS: The practitioner\u27s clinical diagnosis, intent (sample or completely remove), and removal technique (excision, punch, shave biopsy, or scoop-shave) were recorded. Pathology results including the status of the peripheral and deep margins were subsequently documented. RESULTS: Over an 8-month period, 333 procedures were performed. Of the 11 melanomas (6 in situ and 5 invasive) removed by the scoop-shave, none had positive deep margins and 6 (2 in situ and 4 invasive) were completely removed. One of the 50 dysplastic nevi removed by scoop-shave had a positive deep margin (moderately dysplastic). Forty-six dysplastic nevi were completely removed by the scoop-shave. When the practitioner\u27s intent was complete removal, the lesion was completely removed 73.1% of the time by scoop-shave, 91% by standard excision, 18.1% by shave biopsy, and 78.6% by punch excision (p \u3c .0001). CONCLUSION: The scoop-shave is a safe and effective technique for diagnosis and treatment of melanocytic lesions

Merkel Cell Carcinoma

XI, 219 p. 86 illus., 74 illus. in color.online r

Squamous cell carcinoma tumor thrombus encountered during Mohs micrographic surgery

We present a unique case of complete vascular occlusion by squamous cell carcinoma (SCC) encountered during Mohs micrographic surgery