‘Follow the Money’ in Extreme Skin Cancer Care
PSP: Plastic Surgery Practice
Dermatologists may be tempted to overtreat patients with minor skin cancers such as basal cell carcinomas, or prescribe patented drugs offering no advantage to generics, because these approaches benefit them financially, according to a symposium focusing on controversies in dermatology.
Financial ties between dermatologists and pharmaceutical companies are rife in the specialty, but these relationships inevitably promote using more costly procedures and less-optimal drugs than are warranted, said
Tamar Nijsten, MD, PhD, from Erasmus Medical Centerin Rotterdam, the Netherlands.
“I like games, but often if I don’t understand what’s going on in a game, I follow the principle of ‘follow the money,’ ”
Dr Nijstensaid. “We’ve seen a rise in every [ultraviolet]-related type of skin cancer. For physicians, it’s very profitable because we do procedures, and procedures cost money.”
Dr Nijsten’s remarks were part of a presentation entitled “Inconvenient Truths in Skin Cancer Care,” given here at the 26th
European Academy of Dermatologyand Venereology (EADV) Congress.
As chair of the European Dermato-Epidemiology Network, Dr Nijsten’s research has largely focused on the epidemiology and related aspects of different skin diseases, but with an emphasis on skin cancer.
Dermatologists often default to expensive Mohs micrographic surgery to treat primary basal cell carcinomas in particular, he said, despite evidence that a specific lesion is nonaggressive. Instead, curettage, excision, cryotherapy, or even topical creams should be considered before resorting to Mohs.
Guidelines such as those issued by the
American Academy of Dermatologyas part of the Choosing Wisely campaign to reduce unnecessary healthcare attempt to lead dermatologists to this conclusion, he said. One American Academy of Dermatologystatement specifically cautions, “Do not treat uncomplicated, non-melanoma skin cancer less than 1 cm in size on the trunk and extremities with Mohs micrographic surgery.”