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Study Shows Dermatologists Are Best at Removing Skin Cancers

Patients with a common form of skin cancer known as basal cell carcinoma stand a better chance of being cured by seeing a dermatologist rather than any other type of physician.

That''s the conclusion of a pilot study by the Westwood- Squibb Center for Dermatology Research at the Wake Forest University Baptist Medical Center. The results of the study were presented today during the annual meeting of the Society for Investigative Dermatology in Chicago.

The findings come as agencies and state legislatures across the country are considering measures to regulate in-office surgery that could have the practical effect of prohibiting most dermatologists from removing basil cell carcinomas in their offices.

Over a 66-month period, the study found that dermatologists removed all traces of cancer in 93 percent of the tumors they removed. Non-dermatologists removed all traces of cancer in 62 percent of the tumors they removed. The study looked at removal of a total of 1,557 tumors.

This difference can have long-term consequences. Previous research has shown that when basil cell carcinomas are not completely removed the first time, recurrent tumors are harder to eradicate.

Alan Fleischer, M.D., the lead investigator of the study and associate professor of dermatology, said that the results are "frightful." "I assumed going into this that surgeons and dermatologists were equally effective in their cure rates."

Given the findings, the investigators have initiated efforts to conduct a broader study to confirm the results.

The study took into account the relative skill of individual physicians. It also looked to see if other specialties, such as surgeons, disproportionately were assigned the more difficult cases.

In both cases, there was no change from the overall results, said Steve Feldman, M.D, a co-investigator and the director of the Westwood-Squibb Center.

The study did find differences based on the sex and age of the patient and the tumor location. "Those things are beyond the patient''s control," said Feldman, associate professor of dermatology. "The only thing patients have control over is what doctor they go to, and patients should be aware that not all doctors have equal expertise in curing skin cancer."

Nationwide, more than 1.3 million people had basil cell carcinomas removed in 1994.

The center undertook the study to determine the impact of regulatory changes that would prohibit doctors from performing outpatient surgery in offices unless they have hospital admitting privileges. Because dermatology is almost exclusively an outpatient practice, Feldman said, most dermatologists do not have hospital privileges.

"The side effect of this policy is to exclude dermatologists from performing those procedures in which they have the greatest expertise."

This policy has already been passed in Florida. It is pending before the medical boards in 11 other states, including California, Arizona, New York, New Jersey and Massachusetts.

Of the 1,557 cases the study looked at, dermatologists treated 1,200, and completely removed all traces of cancer cells in 93 percent of the cases. Plastic surgeons accounted for 239 cases and had a success rate of 62 percent. General surgeons treated 55 cases and had a success rate of 71 percent, and otolaryngologists treated 46 cases and had a 46 percent success rate. Four other specialties (family medicine, internal medicine, ophthalmology and orthopedic surgery) accounted for the other 17 cases.

This distribution of cases is similar to national statistics, and it explains the difference in outcomes, Fleischer said.

"Removing skin cancers is what dermatologists do," he said, "and this experience leads to better outcomes. We don''t need regulations that will block patients from this care."

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