A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by different specialties compared with dermatology

Abstract

Background: With the recent trend for nondermatologists to treat dermatologic disorders, this retrospective biopsy study reviews the accuracy of the clinical diagnosis of physicians of different specialties performing surgical dermatologic procedures.

Objective: We assessed the diagnostic abilities of nondermatologist physicians who performed various types of skin biopsies and compared them with those of dermatologists.

Methods: The clinical diagnoses of family physicians, plastic, general, and orthopedic surgeons, and internists and pediatricians versus dermatologists were correlated with the histopathologic diagnoses. In total, 4451 cases were analyzed.

Results: Dermatologists diagnosed twice the number of neoplastic and cystic skin lesions correctly (75%) than nondermatologists (40%). The clinical diagnosis rendered by family practitioners matched the histopathologic diagnosis in only 26% of neoplastic and cystic skin lesions. Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in the recognition of skin tumors than family physicians, but still had a diagnostic accuracy rate of only 45%. Inflammatory skin diseases were correctly diagnosed in 71% of the cases by dermatologists but in only 34% of the cases by nondermatologists.

Limitations: A limitation of this retrospective, unblinded study is the use of the clinical data from the pathology requisition form as a surrogate for clinical diagnostic accuracy.

Conclusions: The overall accuracy of the clinical diagnosis depends heavily on the clinicopathologic correlation. Without sufficient clinical data, the histopathologic diagnosis will be limited or restricted. This review concludes that without basic dermatology knowledge, clinicopathologic correlation is compromised.