Biopsy Accuracy

The skin biopsy is a crucial dermatologic procedure, gaining significance in the diagnosis of skin cancer amid rising global rates.  As medical costs rise, the accuracy of skin biopsies becomes an increasingly vital metric for ensuring value-based care.  Historical skin biopsy evaluation measures, such as number needed to biopsy, excise, and treat, as well as malignancy ratios, have become fraught with inconsistencies and confusion over time. In addition, each equation taken individually does not comprehensively evaluate a clinician’s diagnostic accuracy. Therefore, a more precise methodology combining the strengths of these individual measures is needed to assist clinicians and provide important feedback on how effective their biopsies really are. To address this issue, we are evaluating a new, more comprehensive, easily replicable, and standardized biopsy performance methodology. This approach aims to offer clinicians valuable insights into their diagnostic accuracy, initially focusing on skin cancer but with broader applicability. 

Reporting Recurrences of Keratinocyte Carcinomas

Keratinocyte Carcinomas (KCs), composed of basal cell carcinoma and squamous cell carcinoma, are the most common cancer in the United States, with an estimated annual incidence of 4 million and rising. The lack of standardized protocol for notifying dermatologic surgeons and dermatology providers of recurrent KCs has resulted in limited evidence on the frequency of such reporting. Before establishing protocols and performance metrics, it is crucial to assess the perceptions and current practices of dermatology providers and skin surgeons in communications about recurrent KCs. Standardizing communication for recurrent KCs can foster greater understanding of recurrences in KCs, thereby improving quality of care and providing valuable data for improved knowledge on prognosis and risk factors associated with higher-risk skin cancers.

Melanoma Synoptic Reports

For the Melanoma Synoptic Report project, we aim to ensure that patients diagnosed with melanoma receive appropriate care. We are in the process of formulating a simple measure (joint project between dermatology and surgical oncology) that evaluates whether the operating surgeon reported on the following, as required by national guidelines:

1. Operation performed with curative intent
2. Original thickness of the lesion
3. Clinical margins width taken from edge of lesion or biopsy site
4. Depth of excision

Evaluation of Advanced Skin Cancer Risk in the United States, A National County Level Geospatial Risk Analysis

The objective of this retrospective study is to identify the populations of patients in the United States that are at greatest risk for advanced stage skin cancer. We will be using skin cancer, US census, and public health larger public domain data sources to perform multivariate and geospatial analysis to identify at-risk populations. By identifying these at-risk populations and examining access-to-care risk factors and how they relate geographically, we hope to better focus care on identified high-risk populations. The intent is to eventually create an open-source database with geospatial mapping capability for population health researchers. (Current Lifespan IRB approved project)

Predictive Modeling of Advanced Skin Cancer Risk in Rhode Island, A Geospatial Risk Analysis

The objective of this retrospective study is to identify the populations of patients in Rhode Island that are at greatest risk for advanced stage skin cancer. By examining the Rhode Island standard skin cancer patient factors, along with access-to-care risk factors and how they relate geographically, we hope to better focus care on identified high-risk populations. In addition, through this population-level data analysis, an opportunity also arises to identify where data gaps exist that could be addressed. It is intended that this study will also enhance the institution’s clinical research infrastructure by supporting the development of a high quality, sustainable, and relevant database in a common cancer. (Current Lifespan IRB approved project, see attached data registry development proposal that is undergoing review by the Lifespan Information Technology Department)

Development of a Department of Defense Melanoma Prognostic Risk Index and Performance Measurement Driven Melanoma Disease Registry Plan

This retrospective study is a DoD-wide research initiative to comprehensively assess potential influencing risk factors in patients, affiliated with the Department of Defense, that have been diagnosed with melanoma, with a focus on the risk for melanoma on fighter pilots. A more granular subgroup analysis will also be performed on patients that had their tissue samples evaluated at Naval Medical Center San Diego, San Antonio Military Medical Center, Walter Reed Military Medical Center, or the Joint Pathology Center. The design of the proposed study is two-pronged, consisting of an epidemiologic and geospatial research component to develop a comprehensive prognostic index for melanoma within the DoD and a translational research component to identify the methodology to validate, refine, and clinically apply this data into a future DoD-wide automated melanoma registry that will incorporate tissue banking for genomic analysis and performance metrics to drive care. We intend on this being a long-term joint project between Brown University and the Uniformed Services University of Health Sciences. (We are in the process of submitting for Lifespan IRB approval)