Retrospective analysis of nail biopsies performed using the Medicare Provider Utilization and Payment Database 2012 to 2017

Abstract

Subungual melanoma (SUM) is subset of acral melanoma that develops within the nail unit and is associated with a poor prognosis. Nail biopsy is the only way to definitively diagnosis SUM. Our objectives were to analyze the Medicare database for nail biopsy utilization and to compare the annual nail biopsy rate with the estimated incidence of SUM in the United States. A retrospective study on nail biopsy data was performed using the Medicare Provider Utilization and Payment Database 2012 to 2017. The number of nail biopsies performed per 100 000 people was compared to SUM incidence per 100 000 people. Podiatrists, dermatologists, other physicians, and NP/PAs respectively performed 12.12, 0.42, 0.08, 0.07 nail biopsies per 100 000 people annually. Dermatologists performed adequate nail biopsies to cover the minimum (0.7%), but not the maximum (3.5%) estimated incidence of SUM. Only 0.28% and 1.01% of general dermatologists and Mohs surgeons, respectively, performed nail biopsies in 19/50 (38.00%) states and 69/929 (7.42%) zip codes. Limitations of our study were that nail biopsies on patients less than 65 years, and those with no or commercial health insurance were not analyzed. In sum, very few dermatologists performed nail biopsies in the Medicare database. Increased efforts are needed to educate dermatologists on nail surgery.

Early Malignant Melanoma Detection, Especially in Persons with Pigmented Skin

“…However, none of these articles referenced patients with Fitzpatrick skin type 5 or 6 (Supplemental Table 2, http://links.lww.com/NSW/A126). 5,14–24 Subsequent searches that were meant to narrow the search to specific articles on melanoma in the lower extremity in persons with Fitzpatrick skin type 5 or 6 yielded zero results. These searches were performed using the terms “melanoma,” “Fitzpatrick skin type,” and “podia*.”…”

Assessment of comprehensiveness of Medicare Part B provider-level data sets within dermatology

“…They have recently been utilized to assess dermatologist density, biopsy and procedure rates, patch testing utilization, nail procedure utilization, dermatopathologist practice patterns, and more. [3][4][5][6] These datasets appear most comprehensive in assessing dermatology services in aggregate and among speci c high-volume procedure groups (e.g., biopsies, Mohs micrographic surgery).…”

Slow Mohs micrographic surgery for nail apparatus melanoma in situ

“…In our study, nail avulsion was conducted before surgery to fully expose the nail matrix, nail bed, and hyponychium, and then an excisional biopsy was performed on all suspicious skin lesions. From our perspective, pathological serial sections are necessary to avoid misdiagnosis and to determine the depth of the tumor, 7,30,39 as it has been recently proven by researchers that a complete biopsy would help improve the diagnostic rate of NAM 40,41 . We do not preserve nail plates while performing a biopsy because it could affect the tissue preparation process in the subsequent procedure.…”