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Value of histopathologic analysis of subcutis excisions by general practitioners

Value of histopathologic analysis of subcutis excisions by general practitioners Background: Only around 60% of skin lesions excised by GPs are referred to a pathologist. Clinical diagnoses of skin excisions by GPs may not be very accurate. Subcutis excisions are rarely done by GPs, and there is hence little information in the literature on the histopathological yield of subcutis excisions by GPs with regard to malignancies. The aim of this study was to evaluate the yield of histopathological investigation of a relatively large group of subcutis excisions by GPs, with special emphasis on discrepancies between clinical and histopathological diagnoses of malignancy. Methods: We investigated a series of 90 subcutis excisions, which was derived from a database of consecutive GP submissions from the years 1999–2000 where in the same time period 4595 skin excisions were performed by the same group of GPs. This underlines the apparent reluctance of GPs to perform subcutis excisions. Results: The final diagnosis was benign in 88 cases (97.8%) and malignant in 2 cases (2.2%). Seven cases had no clinical diagnosis, all of which were benign. Of the 83 clinically benign cases, 81 (97.6%) were indeed benign and 2 (2.4%) were malignant: one Merkel cell carcinoma and one dermatofibrosarcoma protuberans. The former was clinically thought to be a lipoma, and the latter a trichilemmal cyst. The dermatofibrosarcoma protuberans presented at the age of 27, and the Merkel cell carcinoma at the age of 60. Both were incompletely removed and required re-excision by a surgical oncologist. Conclusion: Histopathological investigation of subcutis excisions by GPs yields unexpected and rare malignancies in about 2% of cases that may initially be excised inadequately. Based on these data, and because of the relatively rareness of these type of excisions, it could be argued that it may be worthwhile to have all subcutis excisions by GPs routinely investigated by histopathology. Background some lesions. It has been estimated that only around 60% Most general practitioners (GPs) do not submit all their of lesions excised by GPs are referred to a pathologist excisions for histopathological investigation, apparently [1,2]. Studies have shown that clinical diagnoses of skin relying on their clinical assessment of the benign nature of excisions by GPs may not be very accurate. Some studies Page 1 of 4 (page number not for citation purposes) BMC Family Practice 2007, 8:5 http://www.biomedcentral.com/1471-2296/8/5 found a discrepancy rate of at least 30% between clinical noted as well and grouped as benign or malignant. The and histopathological diagnoses by GPs on skin excisions clinical diagnosis status (benign, malignant, unknown) [3,4]. We showed in a previous study that skin excisions was compared with the final diagnosis status. Further, the by GPs harboured about 5% of often unexpected detailed clinical diagnosis was compared with the final (pre)malignancies, and argued that all skin excisions must detailed histopathological diagnosis. therefore be routinely investigated by histopathology in order not to miss serious malignancies [5]. Results As shown in table 1, the most frequent clinical diagnosis Subcutis excisions are rarely done by GPs, and there is was lipoma (n = 51, 56.7%), followed by trichilemmal hence little information in the literature on the his- cyst (n = 24, 26.7%). For seven cases (7.8%), no clinical topathological yield of subcutis excisions by GPs with diagnosis was provided, and no case was suspected to be regard to malignancies (all probably unexpected), let malignant. alone its cost-effectiveness. However, also primary incom- plete excision of a malignancy in a subcutis excision could The final histopathological diagnosis was benign in 88 lead to untreatable local or metastasised recurrences, and cases (97.8%). The most frequent benign diagnoses (table some malignancies require additional treatment besides 2) were lipoma (n = 47, 52.2%), trichilemmal cyst (n = local excision such as Merkel cell carcinoma (sentinel 12, 13.3%), and epidermal cyst (n = 9, 10%), and leiomy- lymph node procedure [6]) or chemotherapy (lympho- oma (n = 4, 4.4%). mas). Two cases (2.2%) were malignant, one Merkel cell carci- The only way to have a primary diagnosis of malignancy, noma and one dermatofibrosarcoma protuberans. Both and to know whether additional treatment is required, is these lesions were incompletely removed and required re- to investigate all subcutis excisions. So, should all subcutis excision by a surgical oncologist. The former was clinically excisions by GPs indeed be histopathologically investi- thought to be lipoma, and the latter a trichilemmal cyst. gated? For skin excisions, it has been argued that this may The dermatofibrosarcoma protuberans presented at the not be worth the large increase in workload and costs [7], age of 27, and the Merkel cell carcinoma at the age of 60. but since subcutis excisions are much less frequently done So, of the 83 clinically benign cases, 81 (97.6%) were by GPs, this argument may be less valid for subcutis exci- indeed benign and 2 (2.4%) were malignant. The seven sions. cases without clinical diagnosis were all benign. The aim of this study was therefore to evaluate the yield of The positive predictive value of the clinical diagnoses histopathological investigation of a relatively large group grouped as benign/malignant was 0% as no lesion was of subcutis excisions by GPs, with special emphasis on clinically suspected to be malignant, and the negative pre- discrepancies between clinical and histopathological dictive value was 97.2%. The detailed clinical diagnosis diagnoses of malignancy. matched with the exact histopathological diagnosis in 60 of the 90 cases, leading to an overall accuracy of the detailed clinical diagnosis of 67%. Methods The SALTRO is a general practice laboratory for clinical chemistry, pathology and haematology in Utrecht, The Discussion Netherlands, serving many GPs in the greater Utrecht Routine histopathological investigation of excisions by region. GPs performing minor surgery submit most of the GPs is controversial. It is well known that most GPs do not resected specimens to the SALTRO for histopathological submit all excisions for histopathological investigation, investigation, which is performed at the Department of apparently relying on their clinical assessment of the Pathology of the VU University Medical Center in Amster- benign nature of some lesions. Some studies reported that dam, The Netherlands. From the years 1999 and 2000, all up to 40% of lesions excised by GPs are not referred to a pathology reports from histological submissions by GPs pathologist [1,2,8]. Several studies have focussed on the to the SALTRO were reviewed. Multiple submissions yield of histopathological investigation of skin excisions under the same entry number were split up so that each by GPs [3-5], some arguing that all skin excisions should resection or biopsy could be analysed separately. This be referred for histopathology in order not to miss serious resulted in 4595 skin excisions (from which the results malignancies [5]. Few data on subcutis excisions are avail- have been reported before [5]) and 90 excisions contain- able, probably at least in part due to the fact that these are ing no skin but only subcutaneous tissue. For each of rarely done by GPs. The aim of this study was to therefore these consecutive "subcutis" entries, the clinical diagnosis evaluate the yield of histopathological investigation in a was noted and grouped as benign, malignant, or relatively large set of subcutis excisions by GPs. unknown. All final histopathological diagnoses were Page 2 of 4 (page number not for citation purposes) BMC Family Practice 2007, 8:5 http://www.biomedcentral.com/1471-2296/8/5 Table 1: Clinical diagnosis of 90 subcutis excisions by general practitioners Frequency (%) Confirmed by histopathology (%) Unknown 7 (7.8%) Trichilemmal cyst 24 (26.7%) 10 (42%) Epidermal cyst 1 (1.1%) 0 (0%) Cyst 2 (2.2%) 0 (0%) Fibroma 2 (2.2%) 0 (0%) Lipoma 51 (56.7%) 41 (80%) Scar 1 (1.1%) 0 (0%) Pilomatricoma 2 (2.2%) 2 (100%) Total 90 We investigated a series of 90 subcutis excisions, which Not diagnosing these malignancies by histopathology was derived from a database where in the same time would later most likely have resulted in serious problems. period 4595 skin excisions were performed by the same group of GPs. This underlines the apparent reluctance of The fact that both malignancies were unexpected (positive GPs to perform subcutis excisions. The most frequent clin- predictive value 0%) indicates that the clinical assessment ical diagnoses were lipoma and trichilemmal cyst. No of subcutis lesions by GPs is not 100% reliable as previ- cases were suspected to be malignant, which is well under- ously shown for skin excisions [5]. This finding is not standable, as such cases would as a rule be referred. In unique for GPs, as even dermatologists face the same 2.2% of excisions, the final histopathological diagnosis problem for skin excisions [3,4], and dermatologists and was malignant. Both these were unexpected, and con- surgeons may well have similar problems with subcutis cerned rare malignancies for which the excision with sub- excisions. sequent histopathology were clinically quite relevant. For the Merkel cell carcinoma, a sentinel node would have On a more detailed level, 60/90 of the clinical diagnoses been indicated [6]. Both malignancies were incompletely were confirmed by histopathology (overall accuracy removed and required re-excision by a surgical oncologist. 67%). The accuracy of the clinically most frequent diagno- sis lipoma was 80% (41/51 cases confirmed by histopa- Table 2: Final histological diagnosis of 90 subcutis excisions by thology), and of the clinically second most frequent general practitioners diagnosis trichilemmal cyst 42% (10/24 confirmed by histopathology). Interestingly, both cases that were clini- Frequency Percentage cally diagnosed as pilomatricoma were indeed as such Benign diagnoses by histopathology. Dermatofibroma 1 1.1 Digital mucinous cyst 1 1.1 In our previous study [5], we showed that age can help to Epidermal cyst 9 10 select those patients at highest risk for unexpected malig- Median raphe cyst 1 1.1 nancies (>40). For subcutis excisions, this cannot be con- Neurofibroma 2 2.2 cluded. One case presented at the age of 27, and the other Trichilemmal cyst 12 13.3 at the age of 60. However, in view of these low numbers, Ganglion 1 1.1 Hemangioma 1 1.1 we have to be careful here. Hydrocystoma 1 1.1 Leiomyoma 4 4.4 The question therefore arises whether all subcutis exci- Lipoma 47 52.2 sions need to be submitted for histopathological evalua- Lymph node 1 1.1 tion. This would obviously ensure detection of all Panniculitis 2 2.2 malignancies, and prevent untreatable recurrences. Natu- Pilomatricoma 2 2.2 rally, this involves costs, but this may be neglected since Giant cell tumor 2 2.2 Schwannoma 1 1.1 the number of subcutis excisions by GPs is quite low in comparison with skin excisions. Overall, there seem to be Malignant many arguments to submit all excised subcutis material Dermatofibrosarcoma protuberans 1 1.1 for histopathological investigation. Merkel cell carcinoma 1 1.1 One drawback to this study is that we are not aware of the Total 90 100.0 submission attitude of the GPs involved in this study for Page 3 of 4 (page number not for citation purposes) BMC Family Practice 2007, 8:5 http://www.biomedcentral.com/1471-2296/8/5 6. Javaheri S, Cruse CW, Stadelman WK, Reintgen DS: Sentinel node subcutis excisions, but we speculate that the percentage of excision for the diagnosis of metastatic neuroendocrine car- submissions for histopathology for subcutis excisions is cinoma of the skin: a case report. Ann Plast Surg 1997, higher than that for skin excisions. 39:299-302. 7. Lowy A, Willis D, Abrams K: Is histological examination of tissue removed by general practitioners always necessary? Before Conclusion and after comparison of detection rates of serious skin lesions. BMJ 1997, 315:406-408. Histopathological investigation of subcutis excisions by 8. Bosch MMC: Klinische diagnoses door de huisarts bij"simpele" GPs yields about 2% of serious and unexpected malignan- huidafwijkingen. Medisch Contact 1996, 51:117-119. cies. This indicates that clinical assessment of subcutis lesions by GPs is insufficiently reliable to allow some sub- Pre-publication history cutis excisions to be kept from histopathological investi- The pre-publication history for this paper can be accessed gation, and that all subcutis excisions by GPs deserve to be here: routinely investigated by histopathology in order not to miss serious malignancies. http://www.biomedcentral.com/1471-2296/8/5/prepub Abbreviations SALTRO: Stichting Artsen Laboratorium en Trombosedi- enst (a general practice laboratory for clinical chemistry, pathology and haematology) VU: Vrije Universiteit (Free University, Amsterdam) GP: general practitioner Competing interests The author(s) declare that they have no competing inter- ests. Authors' contributions PAJB designed the study, did data analysis, and drafted the menuscript WV performed data acquisition and participated in the writing PJvD conceived of the study, participated in its design and coordination, helped in data analysis, and participated in the writing. All authors read and approved the final manuscript. Acknowledgements None References Publish with Bio Med Central and every 1. O'Cathain A, Brazier JE, Milner A, Fall M: The cost-effectiveness of minor surgery in general practice: a prospective comparison scientist can read your work free of charge with hospital practice. Br J Gen Pract 1992, 42:13-17. "BioMed Central will be the most significant development for 2. Lowy A, Brazier J, Fall M, Thomas K, Jones N, Williams B: Quality of disseminating the results of biomedical researc h in our lifetime." minor surgery by general practitioners in 1990 and 1991. Br J Gen Pract 1994, 44:364-365. Sir Paul Nurse, Cancer Research UK 3. Eulderink F: Hoe juist is de klinische diagnose bij huidtumoren verwijderd door een huisarts, chirurg en dermatoloog? Ned Your research papers will be: Tijdschr Geneeskd 1994, 138:1618-1622. available free of charge to the entire biomedical community 4. Federman DG, Concato J, Kirsner RS: Comparison of dermato- peer reviewed and published immediately upon acceptance logic diagnoses by primary care practitioners and dermatol- ogists. A review of the literature. Arch Fam Med 1999, cited in PubMed and archived on PubMed Central 8:170-172. yours — you keep the copyright 5. Buis PAJ, Chorus R, Van Diest PJ: Value of histopathologic analy- sis of skin excisions by general practitioners. BJGP 2005, BioMedcentral Submit your manuscript here: 55:458-460. http://www.biomedcentral.com/info/publishing_adv.asp Page 4 of 4 (page number not for citation purposes) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png BMC Family Practice Springer Journals

Value of histopathologic analysis of subcutis excisions by general practitioners

BMC Family Practice , Volume 8 (1) – Jan 26, 2007

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References (10)

Publisher
Springer Journals
Copyright
Copyright © 2007 by Buis et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1471-2296
DOI
10.1186/1471-2296-8-5
pmid
17257417
Publisher site
See Article on Publisher Site

Abstract

Background: Only around 60% of skin lesions excised by GPs are referred to a pathologist. Clinical diagnoses of skin excisions by GPs may not be very accurate. Subcutis excisions are rarely done by GPs, and there is hence little information in the literature on the histopathological yield of subcutis excisions by GPs with regard to malignancies. The aim of this study was to evaluate the yield of histopathological investigation of a relatively large group of subcutis excisions by GPs, with special emphasis on discrepancies between clinical and histopathological diagnoses of malignancy. Methods: We investigated a series of 90 subcutis excisions, which was derived from a database of consecutive GP submissions from the years 1999–2000 where in the same time period 4595 skin excisions were performed by the same group of GPs. This underlines the apparent reluctance of GPs to perform subcutis excisions. Results: The final diagnosis was benign in 88 cases (97.8%) and malignant in 2 cases (2.2%). Seven cases had no clinical diagnosis, all of which were benign. Of the 83 clinically benign cases, 81 (97.6%) were indeed benign and 2 (2.4%) were malignant: one Merkel cell carcinoma and one dermatofibrosarcoma protuberans. The former was clinically thought to be a lipoma, and the latter a trichilemmal cyst. The dermatofibrosarcoma protuberans presented at the age of 27, and the Merkel cell carcinoma at the age of 60. Both were incompletely removed and required re-excision by a surgical oncologist. Conclusion: Histopathological investigation of subcutis excisions by GPs yields unexpected and rare malignancies in about 2% of cases that may initially be excised inadequately. Based on these data, and because of the relatively rareness of these type of excisions, it could be argued that it may be worthwhile to have all subcutis excisions by GPs routinely investigated by histopathology. Background some lesions. It has been estimated that only around 60% Most general practitioners (GPs) do not submit all their of lesions excised by GPs are referred to a pathologist excisions for histopathological investigation, apparently [1,2]. Studies have shown that clinical diagnoses of skin relying on their clinical assessment of the benign nature of excisions by GPs may not be very accurate. Some studies Page 1 of 4 (page number not for citation purposes) BMC Family Practice 2007, 8:5 http://www.biomedcentral.com/1471-2296/8/5 found a discrepancy rate of at least 30% between clinical noted as well and grouped as benign or malignant. The and histopathological diagnoses by GPs on skin excisions clinical diagnosis status (benign, malignant, unknown) [3,4]. We showed in a previous study that skin excisions was compared with the final diagnosis status. Further, the by GPs harboured about 5% of often unexpected detailed clinical diagnosis was compared with the final (pre)malignancies, and argued that all skin excisions must detailed histopathological diagnosis. therefore be routinely investigated by histopathology in order not to miss serious malignancies [5]. Results As shown in table 1, the most frequent clinical diagnosis Subcutis excisions are rarely done by GPs, and there is was lipoma (n = 51, 56.7%), followed by trichilemmal hence little information in the literature on the his- cyst (n = 24, 26.7%). For seven cases (7.8%), no clinical topathological yield of subcutis excisions by GPs with diagnosis was provided, and no case was suspected to be regard to malignancies (all probably unexpected), let malignant. alone its cost-effectiveness. However, also primary incom- plete excision of a malignancy in a subcutis excision could The final histopathological diagnosis was benign in 88 lead to untreatable local or metastasised recurrences, and cases (97.8%). The most frequent benign diagnoses (table some malignancies require additional treatment besides 2) were lipoma (n = 47, 52.2%), trichilemmal cyst (n = local excision such as Merkel cell carcinoma (sentinel 12, 13.3%), and epidermal cyst (n = 9, 10%), and leiomy- lymph node procedure [6]) or chemotherapy (lympho- oma (n = 4, 4.4%). mas). Two cases (2.2%) were malignant, one Merkel cell carci- The only way to have a primary diagnosis of malignancy, noma and one dermatofibrosarcoma protuberans. Both and to know whether additional treatment is required, is these lesions were incompletely removed and required re- to investigate all subcutis excisions. So, should all subcutis excision by a surgical oncologist. The former was clinically excisions by GPs indeed be histopathologically investi- thought to be lipoma, and the latter a trichilemmal cyst. gated? For skin excisions, it has been argued that this may The dermatofibrosarcoma protuberans presented at the not be worth the large increase in workload and costs [7], age of 27, and the Merkel cell carcinoma at the age of 60. but since subcutis excisions are much less frequently done So, of the 83 clinically benign cases, 81 (97.6%) were by GPs, this argument may be less valid for subcutis exci- indeed benign and 2 (2.4%) were malignant. The seven sions. cases without clinical diagnosis were all benign. The aim of this study was therefore to evaluate the yield of The positive predictive value of the clinical diagnoses histopathological investigation of a relatively large group grouped as benign/malignant was 0% as no lesion was of subcutis excisions by GPs, with special emphasis on clinically suspected to be malignant, and the negative pre- discrepancies between clinical and histopathological dictive value was 97.2%. The detailed clinical diagnosis diagnoses of malignancy. matched with the exact histopathological diagnosis in 60 of the 90 cases, leading to an overall accuracy of the detailed clinical diagnosis of 67%. Methods The SALTRO is a general practice laboratory for clinical chemistry, pathology and haematology in Utrecht, The Discussion Netherlands, serving many GPs in the greater Utrecht Routine histopathological investigation of excisions by region. GPs performing minor surgery submit most of the GPs is controversial. It is well known that most GPs do not resected specimens to the SALTRO for histopathological submit all excisions for histopathological investigation, investigation, which is performed at the Department of apparently relying on their clinical assessment of the Pathology of the VU University Medical Center in Amster- benign nature of some lesions. Some studies reported that dam, The Netherlands. From the years 1999 and 2000, all up to 40% of lesions excised by GPs are not referred to a pathology reports from histological submissions by GPs pathologist [1,2,8]. Several studies have focussed on the to the SALTRO were reviewed. Multiple submissions yield of histopathological investigation of skin excisions under the same entry number were split up so that each by GPs [3-5], some arguing that all skin excisions should resection or biopsy could be analysed separately. This be referred for histopathology in order not to miss serious resulted in 4595 skin excisions (from which the results malignancies [5]. Few data on subcutis excisions are avail- have been reported before [5]) and 90 excisions contain- able, probably at least in part due to the fact that these are ing no skin but only subcutaneous tissue. For each of rarely done by GPs. The aim of this study was to therefore these consecutive "subcutis" entries, the clinical diagnosis evaluate the yield of histopathological investigation in a was noted and grouped as benign, malignant, or relatively large set of subcutis excisions by GPs. unknown. All final histopathological diagnoses were Page 2 of 4 (page number not for citation purposes) BMC Family Practice 2007, 8:5 http://www.biomedcentral.com/1471-2296/8/5 Table 1: Clinical diagnosis of 90 subcutis excisions by general practitioners Frequency (%) Confirmed by histopathology (%) Unknown 7 (7.8%) Trichilemmal cyst 24 (26.7%) 10 (42%) Epidermal cyst 1 (1.1%) 0 (0%) Cyst 2 (2.2%) 0 (0%) Fibroma 2 (2.2%) 0 (0%) Lipoma 51 (56.7%) 41 (80%) Scar 1 (1.1%) 0 (0%) Pilomatricoma 2 (2.2%) 2 (100%) Total 90 We investigated a series of 90 subcutis excisions, which Not diagnosing these malignancies by histopathology was derived from a database where in the same time would later most likely have resulted in serious problems. period 4595 skin excisions were performed by the same group of GPs. This underlines the apparent reluctance of The fact that both malignancies were unexpected (positive GPs to perform subcutis excisions. The most frequent clin- predictive value 0%) indicates that the clinical assessment ical diagnoses were lipoma and trichilemmal cyst. No of subcutis lesions by GPs is not 100% reliable as previ- cases were suspected to be malignant, which is well under- ously shown for skin excisions [5]. This finding is not standable, as such cases would as a rule be referred. In unique for GPs, as even dermatologists face the same 2.2% of excisions, the final histopathological diagnosis problem for skin excisions [3,4], and dermatologists and was malignant. Both these were unexpected, and con- surgeons may well have similar problems with subcutis cerned rare malignancies for which the excision with sub- excisions. sequent histopathology were clinically quite relevant. For the Merkel cell carcinoma, a sentinel node would have On a more detailed level, 60/90 of the clinical diagnoses been indicated [6]. Both malignancies were incompletely were confirmed by histopathology (overall accuracy removed and required re-excision by a surgical oncologist. 67%). The accuracy of the clinically most frequent diagno- sis lipoma was 80% (41/51 cases confirmed by histopa- Table 2: Final histological diagnosis of 90 subcutis excisions by thology), and of the clinically second most frequent general practitioners diagnosis trichilemmal cyst 42% (10/24 confirmed by histopathology). Interestingly, both cases that were clini- Frequency Percentage cally diagnosed as pilomatricoma were indeed as such Benign diagnoses by histopathology. Dermatofibroma 1 1.1 Digital mucinous cyst 1 1.1 In our previous study [5], we showed that age can help to Epidermal cyst 9 10 select those patients at highest risk for unexpected malig- Median raphe cyst 1 1.1 nancies (>40). For subcutis excisions, this cannot be con- Neurofibroma 2 2.2 cluded. One case presented at the age of 27, and the other Trichilemmal cyst 12 13.3 at the age of 60. However, in view of these low numbers, Ganglion 1 1.1 Hemangioma 1 1.1 we have to be careful here. Hydrocystoma 1 1.1 Leiomyoma 4 4.4 The question therefore arises whether all subcutis exci- Lipoma 47 52.2 sions need to be submitted for histopathological evalua- Lymph node 1 1.1 tion. This would obviously ensure detection of all Panniculitis 2 2.2 malignancies, and prevent untreatable recurrences. Natu- Pilomatricoma 2 2.2 rally, this involves costs, but this may be neglected since Giant cell tumor 2 2.2 Schwannoma 1 1.1 the number of subcutis excisions by GPs is quite low in comparison with skin excisions. Overall, there seem to be Malignant many arguments to submit all excised subcutis material Dermatofibrosarcoma protuberans 1 1.1 for histopathological investigation. Merkel cell carcinoma 1 1.1 One drawback to this study is that we are not aware of the Total 90 100.0 submission attitude of the GPs involved in this study for Page 3 of 4 (page number not for citation purposes) BMC Family Practice 2007, 8:5 http://www.biomedcentral.com/1471-2296/8/5 6. Javaheri S, Cruse CW, Stadelman WK, Reintgen DS: Sentinel node subcutis excisions, but we speculate that the percentage of excision for the diagnosis of metastatic neuroendocrine car- submissions for histopathology for subcutis excisions is cinoma of the skin: a case report. Ann Plast Surg 1997, higher than that for skin excisions. 39:299-302. 7. Lowy A, Willis D, Abrams K: Is histological examination of tissue removed by general practitioners always necessary? Before Conclusion and after comparison of detection rates of serious skin lesions. BMJ 1997, 315:406-408. Histopathological investigation of subcutis excisions by 8. Bosch MMC: Klinische diagnoses door de huisarts bij"simpele" GPs yields about 2% of serious and unexpected malignan- huidafwijkingen. Medisch Contact 1996, 51:117-119. cies. This indicates that clinical assessment of subcutis lesions by GPs is insufficiently reliable to allow some sub- Pre-publication history cutis excisions to be kept from histopathological investi- The pre-publication history for this paper can be accessed gation, and that all subcutis excisions by GPs deserve to be here: routinely investigated by histopathology in order not to miss serious malignancies. http://www.biomedcentral.com/1471-2296/8/5/prepub Abbreviations SALTRO: Stichting Artsen Laboratorium en Trombosedi- enst (a general practice laboratory for clinical chemistry, pathology and haematology) VU: Vrije Universiteit (Free University, Amsterdam) GP: general practitioner Competing interests The author(s) declare that they have no competing inter- ests. Authors' contributions PAJB designed the study, did data analysis, and drafted the menuscript WV performed data acquisition and participated in the writing PJvD conceived of the study, participated in its design and coordination, helped in data analysis, and participated in the writing. All authors read and approved the final manuscript. Acknowledgements None References Publish with Bio Med Central and every 1. O'Cathain A, Brazier JE, Milner A, Fall M: The cost-effectiveness of minor surgery in general practice: a prospective comparison scientist can read your work free of charge with hospital practice. Br J Gen Pract 1992, 42:13-17. "BioMed Central will be the most significant development for 2. Lowy A, Brazier J, Fall M, Thomas K, Jones N, Williams B: Quality of disseminating the results of biomedical researc h in our lifetime." minor surgery by general practitioners in 1990 and 1991. Br J Gen Pract 1994, 44:364-365. Sir Paul Nurse, Cancer Research UK 3. Eulderink F: Hoe juist is de klinische diagnose bij huidtumoren verwijderd door een huisarts, chirurg en dermatoloog? Ned Your research papers will be: Tijdschr Geneeskd 1994, 138:1618-1622. available free of charge to the entire biomedical community 4. Federman DG, Concato J, Kirsner RS: Comparison of dermato- peer reviewed and published immediately upon acceptance logic diagnoses by primary care practitioners and dermatol- ogists. A review of the literature. Arch Fam Med 1999, cited in PubMed and archived on PubMed Central 8:170-172. yours — you keep the copyright 5. Buis PAJ, Chorus R, Van Diest PJ: Value of histopathologic analy- sis of skin excisions by general practitioners. BJGP 2005, BioMedcentral Submit your manuscript here: 55:458-460. http://www.biomedcentral.com/info/publishing_adv.asp Page 4 of 4 (page number not for citation purposes)

Journal

BMC Family PracticeSpringer Journals

Published: Jan 26, 2007

There are no references for this article.