The Accuracy of Self-Reported Skin Cancer Diagnosis: Room for Improvement


    loading  Checking for direct PDF access through Ovid

Excerpt

It is not uncommon for patients with skin cancer to be referred to a separate practice or facility for Mohs micrographic surgery. In our experience, many patients with skin cancer referred for surgical treatment are unaware of their diagnosis or provide an inaccurate diagnosis. Many Mohs micrographic surgery practices (including ours) will triage patients when scheduling based on the nature of their disease. For example, a patient with a melanoma will be triaged to a sooner appointment date than a patient with a basal cell carcinoma (BCC). Of course rapid transfer of information between the biopsying physician and the treating physician is ideal; however, it is also important for the patient to understand what urgency is required for treatment and any associated morbidity or mortality.The objective of our study was to determine the accuracy of self-reported diagnosis versus true histopathologic diagnosis of patients with skin cancer who called our dermatologic surgery center to schedule Mohs surgery. We hypothesized that a significant number of patients (20%) would be unable to accurately report their skin cancer diagnosis. We postulated that patients with a previous history of skin cancer and those with melanoma would both be more likely to accurately report their diagnosis than those with a first time diagnosis and those with nonmelanoma skin cancer (NMSC), respectively.All patients ≥18 years of age who called to schedule surgical treatment of malignant melanoma (MM), squamous cell carcinoma (SCC), or BCC were included. Patients were excluded if they did not meet criteria, had been diagnosed with multiple skin cancers simultaneously, were diagnosed in our office, or had a representative (e.g., spouse) call on their behalf. During phone interview, patients were asked to report the diagnosis given to them by their dermatologist and whether it was their first skin cancer. Reported diagnosis was then compared with the histopathologic report for accuracy. Chi-square tests, logistic regression, and descriptive analysis with CIs were used for data analysis.In this study, 302 patients with 317 skin cancers called to schedule surgical excision. Twelve patients had multiple skin cancers diagnosed simultaneously and were excluded from data analysis. Of the remaining 290 patients (121 BCC, 88 SCC, and 81 MM), 19% (n = 55) were unable to accurately report their skin cancer diagnosis (CI: 14.6%–24%). Most of the patients (97%, n = 280) had a previous history of skin cancer. Among those with a previous history, there was no significant difference between accuracy and inaccuracy (p = .9) of self-reported diagnosis. Patients with MM were more likely to accurately report their diagnosis (90%) than patients with NMSC. This was significantly more accurate when compared with SCC (67%, p < .001) but not significantly more accurate when compared with patients with BCC (85.1%, p = .298).This study supports our hypothesis that a significant number (19%) of patients cannot accurately recall their skin cancer diagnosis. Although we had postulated that patients with a previous history of skin cancer would be more likely to accurately recall their diagnosis, our study did not support this. Perhaps multiple previous skin cancers create apathy or confusion in recalling subsequent diagnoses.As predicted, patients with MM were most likely to accurately report their diagnosis. As MM portends a potentially more significant mortality risk requiring urgent treatment, this observation might reflect the more extensive counseling patients already receive with the diagnosis of MM compared with those with NMSC. Notably, 10% of patients with MM could not accurately recall the diagnosis, which could result in delayed scheduling and treatment.

    loading  Loading Related Articles