Jason P. Lott

Background Little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time. Objectives To evaluate population‐based temporal trends in healthcare utilization following primary melanoma diagnosis. Methods We conducted a before‐and‐after multiple time series study of Medicare beneficiaries aged ≥ 66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results Medicare database. Primary exposure was time from primary melanoma diagnosis at 3–6 months and 6–24 months postdiagnosis. Covariates included tumour‐, patient‐ and geographical‐level characteristics and healthcare utilization in the 6 months before diagnosis. Poisson regression was used to estimate population‐based risk‐adjusted utilization rates for skin biopsies, benign skin excisions, internal medicine office visits and dermatology office visits. Results The study population included 56 254 patients with first diagnoses of primary melanoma. Most patients were ≥ 75 years old (56·8%), male (62·1%), and had in situ melanoma (42·4%) or localized invasive melanoma (45·9%). From 2000 to 2009, risk‐adjusted skin biopsy rates 24 months postdiagnosis increased from 358·3 to 541·3 per 1000 person‐years (P < 0·001), and dermatology visits increased from 989·0 to 1535·6 per 1000 person‐years (P < 0·001). Benign excisions and internal medicine visits remained stable. In 2000, risk‐adjusted skin biopsy rates 6 months postdiagnosis increased by 208·5 relative to the 6 months before diagnosis (148·7 vs. 357·2) compared with an observed absolute increase of 272·5 (290·9 vs. 563·1) in 2009. Trends in dermatology visits were similar. Conclusions Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population.

The Centers for Medicare and Medicaid Services (CMS) have prioritized the objective of optimizing quality healthcare though quality improvement initiatives, yet research on dermatology-specific QI programs and their perceptions among dermatology residents remains limited. We explore residents’ opinions of a dermatology-specific QI scholarly project curriculum implemented at University of Colorado Denver (UCD) in 2010 and also evaluate residents’ attitudes regarding the value of this curriculum in aiding them to meet ACGME core competencies.

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Digital whole slide imaging (WSI) is an emerging technology for pathology interpretation, with specific challenges for dermatopathology, yet little is known about pathologists’ practice patterns or perceptions regarding WSI for interpretation of melanocytic lesions. A national sample of pathologists (N = 207) was recruited from 864 invited pathologists from ten US states (CA, CT, HI, IA, KY, LA, NJ, NM, UT, and WA). Pathologists who had interpreted melanocytic lesions in the past year were surveyed in this cross-sectional study. The survey included questions on pathologists’ experience, WSI practice patterns and perceptions using a 6-point Likert scale. Agreement was summarized with descriptive statistics to characterize pathologists’ use and perceptions of WSI. The majority of participating pathologists were between 40 and 59 years of age (62 %) and not affiliated with an academic medical center (71 %). Use of WSI was seen more often among dermatopathologists and participants affiliated with an academic medical center. Experience with WSI was reported by 41 %, with the most common type of use being for education and testing (CME, board exams, and teaching in general, 71 %), and clinical use at tumor boards and conferences (44 %). Most respondents (77 %) agreed that accurate diagnoses can be made with this technology, and 59 % agreed that benefits of WSI outweigh concerns. However, 78 % of pathologists reported that digital slides are too slow for routine clinical interpretation. The respondents were equally split as to whether they would like to adopt WSI (49 %) or not (51 %). The majority of pathologists who interpret melanocytic lesions do not use WSI, but among pathologists who do, use is largely for CME, licensure/board exams, and teaching. Positive perceptions regarding WSI slightly outweigh negative perceptions. Understanding practice patterns with WSI as dissemination advances may facilitate concordance of perceptions with adoption of the technology.

Melanoma is a leading cause of new cancer diagnoses in the United States, accounting for most skin cancer–related deaths.¹ Although surgical excision is the primary therapy for melanoma, few studies have examined delay in undergoing this procedure.^2-6 Surgical delay may result in increased morbidity and mortality for other malignant neoplasms,^7-9 including cancers of the lung,^7-10 rectum,^7,11 breast,^7,9,12-14 and bladder,^8,9,15,16 but little association has been shown between delay of surgery for melanoma and survival.^2,3,6,17