Worried about that spot on your skin? A new study finds that dermatologists are more likely than physician assistants (PAs) to accurately diagnose some skin cancers. PAs are increasingly used in dermatology practices to cut costs and improve access to care, but according to research published in JAMA Dermatology, PAs are more likely than dermatologists to perform unnecessary skin biopsies to check for cancer, and less likely to accurately diagnose melanoma skin cancer at its earliest stage.
Laura Ferris, MD, PhD, and her team at the University of Pittsburgh examined the medical records of 33,647 skin cancer screening examinations in 20,270 patients who underwent screening at UPMC-affiliated dermatology offices from 2011 through 2015. Ferris and her team found that while PAs and dermatologists had similar detection rates for advanced melanomas and non-melanoma cancers, PAs were less likely to diagnose melanoma in situ. Melanoma in situ is the very earliest stage of the sometimes deadly form of skin cancer called melanoma; if caught early, most patients diagnosed with melanoma in situ can be cured with surgery alone.
In addition, the study found that for every case of melanoma diagnosed, PAs needed to biopsy more than 39 moles and dermatologists needed to biopsy slightly more than 25 such lesions. In other words, for every suspected case of melanoma, PAs’ suspicions were correct one out of every 39 times, compared to one out of 25 for dermatologists.
“Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for training of PAs and other non-physician practitioners in dermatology,” said Dr. Ferris. “Currently there is no formal training or certification program in dermatology for PAs or other advanced practice providers.” Dr. Ferris further points out that the issues of missed diagnoses and unnecessary biopsies should be an important consideration for physicians when hiring staff and for patients when choosing dermatologic care.
Interested in learning about other dermatology research studies? Visit our Skin, Hair, and Nails studies page.