Performance of skin biopsies by general practitioners

Abstract

Objective: To evaluate and appraise skin biopsies performed by general practitioners and compare their performance with that of hospital doctors.

Design: Retrospective analysis of histology records.

Setting: University hospital.

Subjects: Records of 292 skin biopsy specimens obtained by general practitioners and 324 specimens obtained by general and plastic surgeons.

Main outcome measures: Clinical and pathological diagnoses and completeness of excision.

Results: The number of specimens received from hospital surgeons and general practitioners increased over the study period; the proportion of specimens from general practitioners rose from 17/1268 (1.3%) in 1984 to 201/2387 (8.7%) in 1990. The range of diagnoses was similar among hospital and general practitioner cases, although malignancy was commoner in hospital cases (63/324 (19%) v 14/292 (5%) in general practitioner cases; chi 2 = 28, p less than 0.00001). Completeness of excision was less common among general practitioners than hospital surgeons (150/233 (3/15 malignant) v 195/232 (57/63); chi 2 = 22, p less than 0.00001).

Conclusions: The increase in minor surgery has implications for the staffing and finance of histopathology departments. General practitioners must be given proper training in performing skin biopsies, and all specimens should be sent for examination.