Factors associated with biopsy site identification, postponement of surgery, and patient confidence in a dermatologic surgery practice

J Am Acad Dermatol. 2016 Jun;74(6):1185-93. doi: 10.1016/j.jaad.2015.12.019. Epub 2016 Feb 4.


Background: Biopsy site identification is critical to avoid wrong-site surgery and may impact patient-centered outcomes.

Objective: We sought to evaluate risk factors for biopsy site misidentification, postponement of surgery, and patient confidence in surgical site selection and to assess the near-miss rate for wrong-site surgeries.

Methods: This was a prospective observational cohort study.

Results: Near-miss wrong-site surgeries were detected and averted in 1.3% (3 of 239) of patients with biopsy site photographs. Risk factors for biopsy site misidentification by patients were 6 weeks or longer between biopsy and surgery (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.12-4.27; P = .028) and patient inability to see biopsy site (OR 3.95, 95% CI 1.50-10.37; P = .002). Risk factors for physician misidentification were 6 or more weeks between biopsy and surgery (OR 3.68, 95% CI 1.40-9.66; P = .007) and biopsy specimens from multiple sites (OR 4.39, 95% CI 1.67-11.54; P = .003). Postponement of surgery was associated with absence of a biopsy site photograph (OR 12.5, 95% CI 2.79-62.21; P < .001). Patient confidence in surgical site identification was associated with the presence of a biopsy site photograph (OR 5.48, 95% CI 1.96-15.30; P = .001).

Limitations: This was a single-site observational study.

Conclusion: Biopsy site photography is associated with reduced rates of postponed surgeries and improved rates of patient confidence in surgical site selection. Risk factors for biopsy site misidentification should be considered before definitive treatment.

Keywords: Mohs; biopsy; excision; identification; photograph; skin cancer; wrong-site surgery.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Near Miss, Healthcare*
  • Patient Satisfaction
  • Photography*
  • Prospective Studies
  • Risk Factors
  • Skin / pathology*
  • Skin Diseases / pathology*
  • Skin Diseases / surgery*
  • Time Factors
  • Young Adult