Years of dermatology experience and geographic region are associated with outlier performance of excision or destruction for nonmelanoma skin cancer

Treatments for nonmelanoma skin cancer (NMSC) include excision (surgical removal) and destruction (cryotherapy or curettage with or without electrodesiccation) in addition to other methods. Although cure rates are similar between excision and destruction for low-risk NMSCs, excision is substantially more expensive. Performing destruction when appropriate can reduce costs while providing comparable cure rate and cosmesis. To identify characteristics associated with exclusive (outlier) performance of excision or destruction for NMSC. The study consisted of malignant excision and destruction procedures submitted by dermatologists to Medicare in 2019. Proportions of services for each method were analyzed with respect to geographic region, years of dermatology experience, median income of the practice zip code, and rural-urban commuting area (RUCA) code. Fewer years of experience predicted a higher proportion of excisions (<i>R</i>² = 0.7, <i>p</i> &lt; .001) and higher odds of outlier excision performance. Outlier performance of excision was associated with practicing in the South, Midwest, and West, whereas outlier performance of destruction was associated with practicing in the Northeast and Midwest. Dermatologists with less experience or in certain geographic regions performed more malignant excision relative to destruction. As the older population of dermatologists retires, the cost of care for NMSC may increase.

非黑色素瘤皮肤癌（nonmelanoma skin cancer, NMSC）的治疗手段除其他方案外，还包括切除术（手术摘除）与破坏疗法——后者涵盖冷冻疗法或刮除术联合或不联合电干燥法。尽管低风险NMSC患者的切除术与破坏疗法治愈率相近，但切除术的成本显著更高。在适宜场景下采用破坏疗法，可在保证相当的治愈率与美容效果的同时降低治疗成本。本研究旨在明确与NMSC切除术或破坏疗法的异常值应用模式相关的特征。
研究数据来源于2019年皮肤科医师提交至美国联邦医疗保险（Medicare）的恶性肿瘤切除术与破坏疗法诊疗操作记录。针对两种诊疗方式的服务占比，本研究分析了其与地理区域、皮肤科从业年限、执业邮政编码对应家庭中位数收入，以及城乡通勤区域（rural-urban commuting area, RUCA）编码的相关性。分析结果显示，从业年限更短的医师，其切除术服务占比更高（R²=0.7，p<0.001），且出现异常值切除术应用模式的概率更高。异常值切除术应用模式与在南部、中西部及西部执业相关，而异常值破坏疗法应用模式则与在东北部及中西部执业相关。
从业年限较短的皮肤科医师，或在特定地理区域执业的医师，相较于破坏疗法，更倾向于采用恶性肿瘤切除术。随着年长一代皮肤科医师退休，NMSC的治疗成本或有所上升。