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A Histologically Controlled Pilot Study

Klaus Sellheyer, MD; Wilma F. Bergfeld, MD

Arch Dermatol. 2006;142:455-459.

Objective  To compare differences in biopsy techniques of actinic keratoses between dermatologists and plastic surgeons.

Design  Blinded, comparative, retrospective study.

Setting  Dermatopathology laboratory at a major academic medical center with referral of outside cases.

Intervention  We reexamined the histopathologic slides of 405 actinic keratosis biopsy specimens obtained by plastic surgeons and dermatologists from January 1, 1992, through May 31, 2002. We were specifically interested in the type of biopsy technique (shave, punch, or excisional biopsy) used for the surgical management of actinic keratoses by both groups of physicians. We also recorded the clinical diagnoses rendered on the dermatopathology request form and compared them with the histopathologic diagnoses.

Results  Excisional biopsies were performed by plastic surgeons in 50.0% of the cases, compared with only 1.4% by dermatologists. In contrast, shave biopsies of actinic keratoses were performed by plastic surgeons in only 32.4% of the cases, compared with 89.4% by dermatologists. Only 1 (0.5%) of the 198 dermatopathology request forms submitted by the plastic surgeons mentioned actinic keratosis, compared with 82 (39.6%) of 207 histopathologic evaluation requests submitted by dermatologists.

Conclusions  The predominance of excisional biopsies of actinic keratoses by plastic surgeons may be related to a different ability in the clinical recognition of actinic keratoses compared with that of dermatologists. The surgical approach of dermatologists to shave diagnostically uncertain cutaneous lesions is less invasive than that of plastic surgeons and is more likely to achieve a better cosmetic outcome.

Author Affiliations: Department of Anatomic Pathology, Section of Dermatopathology, The Cleveland Clinic Foundation, Cleveland, Ohio.

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RELATED LETTER

To Perform a Biopsy or Excise Suspected Actinic Keratoses: Another View
Lawrence M. Lieblich
Arch Dermatol. 2006;142(10):1363-1364.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

To perform a biopsy or excise suspected actinic keratoses: another view.
Lieblich
Arch Dermatol 2006;142:1363-1364.
FULL TEXT