Validation of Claims Data Algorithms to Identify Nonmelanoma Skin Cancer

Health maintenance organization (HMO) administrative databases have been used as sampling frames for ascertaining nonmelanoma skin cancer (NMSC). However, because of the lack of tumor registry information on these cancers, these ascertainment methods have not been previously validated. NMSC cases arising from patients served by a staff model medical group and diagnosed between 1 January 2007 and 31 December 2008 were identified from claims data using three ascertainment strategies. These claims data cases were then compared with NMSC identified using natural language processing (NLP) of electronic pathology reports (EPRs), and sensitivity, specificity, positive and negative predictive values were calculated. Comparison of claims data–ascertained cases with the NLP demonstrated sensitivities ranging from 48 to 65% and specificities from 85 to 98%, with ICD-9-CM ascertainment demonstrating the highest case sensitivity, although the lowest specificity. HMO health plan claims data had a higher specificity than all-payer claims data. A comparison of EPR and clinic log registry cases showed a sensitivity of 98% and a specificity of 99%. Validation of administrative data to ascertain NMSC demonstrates respectable sensitivity and specificity, although NLP ascertainment was superior. There is a substantial difference in cases identified by NLP compared with claims data, suggesting that formal surveillance efforts should be considered

Relationship of Treatment Delay with Surgical Defect Size from Keratinocyte Carcinoma (Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin)

Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24%). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size (R2=0.39) and were used as control variables. Self-reported delay between initial physician examination and MMS predicted defect size (p=0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3–3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7–8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5–18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5–83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5–15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public

Squamous cell carcinoma originating from cutaneous cysts: The Henry Ford Experience and review of the literature

PURPOSE: Malignant transformation to squamous cell carcinoma (SCC) arising within cutaneous epidermal cysts is a very rare phenomenon. We provide a series of new cases and an overview of the literature. We sought to define the prevalence of and characterize SCC arising within epidermal and pilar cysts. PATIENT AND METHODS: We searched Henry Ford Health System (HFHS) non-melanoma skin cancer (NMSC) registry from 2005 to 2009 to identify cases of SCC arising from epidermal cysts. RESULTS: We identified 1904 cases of epidermal cysts at our institution between 2005 and 2014. Of these, three cases of SCC arose from an epidermal cyst and one case of SCC developed from a pilar cyst. All lesions occurred below the waist with the exception of the pilar cyst on the scalp. CONCLUSIONS: Given the extremely low incidence, propensity of malignant lesions to become symptomatic and efficacy of treatment, we do not recommend routine excision of all epidermal cysts. Instead, we recommend excision and pathology for all symptomatic epidermal cysts, or those that rapidly grow, or do not respond to medical therapy

PS2-27: Identification of Patients With Nonmelanoma Skin Cancer Using HMO Claims Data

Background: Despite the large population affected, the epidemiology of nonmelanoma skin cancer (NMSC) is understudied, and U.S. cancer registries often exclude NMSC. Secondary data analysis has been limited in that squamous cell (SCC) and basal cell carcinoma (BCC) do not have their own unique International Classification of Disease (ICD-9) identifiers. Our aim was to define and compare algorithms for identifying NMSC by secondary analysis using a computerized database of a large health maintenance organization (HMO)

What increased registry outreach may mean for cutaneous melanoma surveillance: impact of changes in Iowa

BACKGROUND: Cutaneous melanoma (CM) is underreported to cancer registries, in part due to insufficient reporting in the nonhospital setting. The objective of this study was to better understand the impact of dermatologist and private pathology laboratory reporting on CM rates. METHODS: We examined the impact of targeted casefinding in private pathology laboratories and dermatology offices by the State Health Registry of Iowa (SHRI) on CM incidence, as well as the characteristics of nonhospital reported cases. RESULTS: Over the 39-year period (1973-2011), 22,541 cases of CM were captured by the SHRI; 16,183 (72%) were invasive melanoma cases and 6,358 (28%) were in situ cases. The incidence of invasive melanoma increased 3.6 fold between the time periods of 1973-1975 and 2009-2011 (6.6 vs. 24 per 100,000 person-years, respectively). If case reporting from private pathology laboratories and dermatology offices was not conducted, the 2009-2011 invasive CM rate would have decreased to 19.1. The ratio of invasive to in situ cases declined from 8:1 from 1973-1987 to less 2:1 from 2007-2011. Age at diagnosis also significantly increased across time periods, while the proportion of females declined. From 2007-2011, the majority (55%) of nonhospital cases were in situ, and 90% of the invasive cases were localized. A higher percentage of urban residents were attributed to nonhospital-based reporting sources compared to hospital-based sources (57% vs 45%, P \u3c .0001) CONCLUSIONS: Electronic health records and incentivized Meaningful Use for reporting may provide an efficient method for nonhospital based providers to easily and accurately report CM cases to registries

Providers\u27 Experiences with a Melanoma Web-Based Course: a Discussion on Barriers and Intentions

Primary care visits provide an opportunity for skin examinations with the potential to reduce melanoma mortality. The INFORMED (INternet curriculum FOR Melanoma Early Detection) Group developed a Web-based curriculum to improve primary care providers\u27 (PCPs\u27) skin cancer detection skills. This study details feedback obtained from participant focus groups, including the feasibility of implementing in other PCP practices. Practicing PCPs at Henry Ford Health System and Kaiser Permanente Northern California completed the curriculum. Feedback sessions were conducted with standardized questions focusing on four domains: (1) overall impressions of the curriculum, (2) recommendations for improvement, (3) current skin examination practices, and (4) suggestions for increasing skin screening by PCPs. Discussions at each site were audio recorded, transcribed verbatim, and de-identified. Providers (N = 54) had a positive impression of the Web-based curriculum, with suggestions to provide offline teaching aids and request assistance. Despite having improved confidence in diagnosing malignant lesions, many providers felt a lack of confidence in performing the screening and time constraints affected their current practices, as did institutional constraints. Providers intended to increase discussion with patients about skin cancer. The accessibility, effectiveness, and popularity of the curriculum indicate potential for implementation in the primary care setting. Participating providers noted that institutional barriers remain which must be addressed for successful dissemination and implementation