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atrial septal defect and 1 infant with persistent patent ductus arteriosus administered propranolol for IH. Our experience indicates that oral propranolol can be administered to infants with asymptomatic cardiac abnormalities. Some researchers propose that echocardiography is unnecessary as a routine screening tool before the initiation of propranolol in the absence of abnormal clinical findings.5 Our results support this recommendation. Hyang-Suk You, MD,a Hoon-Soo Kim, MD,a ByungSoo Kim, MD, PhD,a,b Moon-Bum Kim, MD, PhD,a,b and Hyun-Chang Ko, MDa,c Department of Dermatology, School of Medicine, Pusan National University, Yangsana; Biomedical Research Institute, Pusan National University Hospital, Busanb; and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan,c Korea Funding sources: None. Conflicts of interest: None declared. Correspondence to: Hyun-Chang Ko, MD, Department of Dermatology, School of Medicine, Pusan National University, Geumo-ro 20, Mulgeum-eup, Yangsan, Gyeongsangnam-do 626-770, Korea E-mail: [email protected] REFERENCES 1. Schupp CJ, Kleber JB, Gunther P, Holland-Cunz S. Propranolol therapy in 55 infants with infantile hemangioma: dosage, duration, adverse effects, and outcome. Pediatr Dermatol. 2011;28:640-644. 2. de Graaf M, Breur JM, Raphael MF, Vos M, Breugem CC, Pasmans SG. Adverse effects of propranolol when used in the treatment of hemangiomas: a case series of 28 infants. J Am Acad Dermatol. 2011;65:320-327. 3. Love JN, Sikka N. Are 1-2 tablets dangerous? Beta-blocker exposure in toddlers. J Emerg Med. 2004;26:309-314. 4. Betlloch-Mas I, Martinez-Miravete MT, Lucas-Costa A, Martin de Lara AI, Selva-Otalaurruchi J. Outpatient treatment of infantile hemangiomas with propranolol: a prospective study. Actas Dermosifiliogr. 2012;103:806-815. 5. Drolet BA, Frommelt PC, Chamlin SL, et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2012;131:128-140. http://dx.doi.org/10.1016/j.jaad.2015.01.034
Frequent indoor tanning among New Jersey high school students To the Editor: Indoor tanning among children increases their lifetime risk for developing melanoma by 85%.1 Additionally, individuals who tan indoors 10 or more times have a 34% increased
risk for developing melanoma.2 In this study, we examined the prevalence and correlates of frequent indoor tanning among New Jersey high school students. The data were drawn from the 2012 New Jersey Youth Tobacco Survey, which was completed by 1850 high school students ( grades 9-12) in 27 public schools throughout New Jersey (overall participation rate ¼ 60.3%). Several questions related to indoor tanning were included in the survey, which focused primarily on tobacco-related issues. In 2013, commercial indoor tanning was banned in New Jersey for minors under the age of 17 years. The results of this study provide the necessary basis for assessing the subsequent impact of the ban on indoor tanning rates among minors in New Jersey. Standard parental consent and student assent procedures were used. The study received institutional review board approval. Additional information regarding the study is available elsewhere.3 Participants reported their sex, age, race/ ethnicity, whether they currently smoke (ie, smoked at least 1 cigarette in the past 30 days), and the number of times they tanned indoors in the past year (ie, used a tanning bed or booth with tanning lamps, not including getting a spray-on tan). Students who reported any past-year indoor tanning indicated whether they had done so before a special occasion, before a vacation, and/or to improve their mood. They also reported whether they had used social media related to indoor tanning salons (ie, ‘‘visited, followed, liked, or become a fan of a tanning salon on sites like Facebook, Twitter, or YouTube’’). Finally, they indicated how hard it would be to stop indoor tanning. To take into account the complex sample survey design, the data were analyzed using SUDAAN (RTI International, Research Triangle Park, NC). All percentages were weighted to adjust for probability of selection and nonresponse. Of the 1754 students who answered the question about use of indoor tanning, 8.5% (N ¼ 146) reported indoor tanning in the past year, 38.0% of whom were denoted as frequent indoor tanners (ie, $10 past-year indoor tanning sessions). Descriptive statistics regarding the students who reported past-year indoor tanning are shown in Table I. Results of 2 analyses indicated that students who had tanned indoors in the past year did not differ in age from individuals who had not (P ¼ .076) but the past-year indoor tanners were significantly more likely to be female (66.1% vs 48.4%, P ¼ .0093) and current smokers (25.0% vs 7.4%, P ¼ .0017) and were less likely to be denoted as non-Hispanic other race/ethnicity (4.4% vs 14.4%, P ¼ .0034).
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Table I. Frequent indoor tanning among New Jersey high school students who reported indoor tanning in the past year
Sex Female Male Age, y #15 16 $17 Race/ethnicity Hispanic Non-Hispanic white Non-Hispanic black Non-Hispanic other Smoking status Current smoker Not current smoker Indoor tanned before a special occasion No Yes Indoor tanned before a vacation No Yes Indoor tanned to improve mood No Yes Used social media related to tanning salons No Yes How hard it would be to stop indoor tanning Not at all A little Somewhat/moderately Very
Past-year indoor tanners, %
Prevalence of frequent indoor tanning, % (95% CI)
66.1 33.9
38.5 (28.2-50.0) 38.6 (20.5-60.6)
26.7 29.2 44.1
34.5 (19.8-53.0) 32.0 (18.0-50.1) 45.4 (31.0-60.6)
21.2 64.3 10.1 4.4
29.1 (15.1-48.7) 39.3 (27.2-52.9) * *
25.0 75.0
57.6 (41.1-72.6) 30.4 (21.5-41.1)
P value
.99
.55
.36y
.0038
.14 40.3 59.7
48.0 (30.2-66.3) 31.3 (21.2-43.6) .54
79.2 20.8
39.1 (30.1-48.9) 34.1 (20.0-51.7) .013
89.6 10.4
33.7 (25.2-43.5) 75.2 (45.8-91.6) .0015
59.7 40.3
27.9 (16.1-43.9) 54.6 (45.2-63.8) .018
68.5 8.7 13.1 9.7
28.0 27.7 60.1 90.3
(17.3-41.9) (10.5-55.5) (31.7-83.0) (63.8-98.0)
N ¼ 146 high school students who reported indoor tanning in the past year. All percentages are weighted. P values represent the results of 2 analyses examining the association between the prevalence of frequent indoor tanning and each respective variable among past-year indoor tanners. The data are drawn from the 2012 New Jersey Youth Tobacco Survey. CI, Confidence interval. *Because of high SE ([30% of the estimate), it is not possible to reliably estimate these percentages. y Only students who reported being Hispanic or non-Hispanic white were included in this analysis.
We conducted 2 analyses to examine the association between each study variable and whether students who reported past-year indoor tanning were frequent indoor tanners. As shown in Table I, the prevalence of frequent indoor tanning did not differ according to students’ sex, age, race/ ethnicity (Hispanic vs non-Hispanic white students), and whether they indoor tanned before a special occasion or vacation. However, frequent indoor tanning was significantly more common among indoor tanners who were current smokers, tanned to improve their mood, had used social media related to tanning salons, or indicated it would be very hard to stop indoor tanning. More than one third of the indoor tanning high school students in the current study were frequent tanners who reported that it would be harder for them to stop indoor tanning. Frequent tanners were more likely to have engaged in social media activities related to indoor tanning. Social media may represent a viable mechanism to deliver interventions to reduce indoor tanning among frequent indoor tanners. Such interventions should also address the higher rates at which youths who frequently tan indoors do so to improve their mood. The higher rate of smoking among frequent indoor tanners suggests that they may benefit from interventions that target multiple behavioral risk factors.4 Reducing rates of indoor tanning among US youth is an important public health priority.5 Elliot J. Coups, PhD,a,b,c Jerod L. Stapleton, PhD,a,b,c Christine M. Davis, PhD,c and Cristine D. Delnevo, PhD, MPHa,c Rutgers Cancer Institute of New Jerseya and Department of Medicine, Rutgers Robert Wood Johnson Medical School,b Rutgers, The State University of New Jersey, New Brunswick, and Department of Health Education and Behavioral Science, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscatawayc The 2012 New Jersey Youth Tobacco Survey was funded by a contract from the New Jersey Department of Health to the Center for Tobacco Studies, Rutgers School of Public Health, Rutgers, The State University of New Jersey. Conflicts of interest: None declared. Correspondence to: Elliot J. Coups, PhD, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany St, Room 5567, New Brunswick, NJ 08903 E-mail: [email protected]
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REFERENCES 1. Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Biomarkers Prev. 2010;19:1557-1568. 2. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol. 2014;70:847-857. e1-e18. 3. Davis CM, Delnevo CD, Manderski MT, Hrywna M. The 2012 New Jersey youth tobacco survey: a statewide report. New Brunswick (NJ): Rutgers School of Public Health; 2014. Available from: URL: www.state.nj.us/health/ctcp/research. shtml. Accessed December 19, 2014. 4. Holman DM, Watson M. Correlates of intentional tanning among adolescents in the United States: a systematic review of the literature. J Adolesc Health. 2013;52:S52-S59. 5. US Department of Health and Human Services. The Surgeon General’s call to action to prevent skin cancer. Washington (DC): US Dept of Health and Human Services, Office of the Surgeon General; 2014. Available from: URL: www.surgeongeneral.gov. Accessed December 19, 2014. http://dx.doi.org/10.1016/j.jaad.2015.01.035
Comparison of electronic and handwritten pathology requisition forms for cutaneous melanoma To the Editor: Evaluation of suspicious pigmented lesions involves clinical examination followed by biopsy specimen and histopathological interpretation. Communication of clinical information via the pathology requisition form is crucial to establish pretest probability and, ultimately, render the most accurate diagnosis. Indeed, misdiagnosing melanoma constitutes a significant source of medicolegal risk for pathologists.1 Although dermatologists report that it is important to communicate clinical information to pathologists and very few are concerned that providing this information will bias the pathologist,2 previous
studies have shown that requisition forms for melanocytic lesions frequently omit crucial clinical information. Among 238 melanocytic lesion requisition forms submitted by dermatology residents, 75% omitted all of the ABCDE criteria.3 A study of 100 consecutive biopsy specimens of melanocytic lesions by 60 community dermatologists and 5 mid-level providers revealed that morphological descriptions were absent from 67% of cases, the ABCDE criteria was omitted in 55%, a clinical differential diagnosis was limited to ‘‘r/o atypia or nevus’’ in 39%, and family or personal history was not included in 92%.4 Electronic requisition forms have been proposed as a means of improving the quality of information communicated to pathologists. Kinonen et al5 compared 8545 dermatopathology electronic and handwritten requisition forms to determine the frequency of data entry error. The authors found that, after excluding mislabeling, errors occurred in 94/8545 (1.1%) of handwritten requisitions compared with only 17/2930 (0.6%) of electronic requisitions. We hypothesized that an electronic template requisition form in which clinicians are prompted to include pertinent clinical information regarding melanocytic lesions would improve the quantity and quality of information communicated to pathologists. At our institution, a structured electronic pathology requisition form was implemented in April 2013. We sought to compare the information provided on handwritten and electronic requisition forms for specimens ultimately diagnosed as melanoma. After institutional review board approval, our pathology database was queried for all specimens with a final diagnosis of melanoma between January
Table I. Comparison of handwritten and electronic pathology requisition forms for cutaneous melanoma MD providers PA providers Biopsy specimen type recorded Proportion of lesion removed with biopsy specimen Mean no. of differential diagnosis 6 SD (range) Melanoma not on differential diagnosis Family history Medical history Morphological description Diameter Clinical history of lesion Photograph Skin type/ethnicity Dermoscopy finding MD, Medical doctor; PA, physician assistant; SD, standard deviation.
Handwritten (n = 189)
Computerized (n = 37)
P value
32 7 138 (73%) 28 (14%) 1.73 6 0.84 (0-3) 53 (28%) 6 (3%) 54 (29%) 87 (46%) 24 (13%) 24 (13%) 2 (1%) 20 (11%) 4 (2%)
7 2 37 (100%) 22 (60%) 2.13 6 0.78 (1-3) 8 (22%) 12 (32%) 23 (62%) 27 (73%) 25 (68%) 26 (70%) 3 (8%) 12 (33%) 0 (0%)
\.01 \.01 \.01 .42 \.01 \.01 \.01 \.01 \.01 \.01 \.01 .37
914 Letters
MAY 2015
atrial septal defect and 1 infant with persistent patent ductus arteriosus administered propranolol for IH. Our experience indicates that oral propranolol can be administered to infants with asymptomatic cardiac abnormalities. Some researchers propose that echocardiography is unnecessary as a routine screening tool before the initiation of propranolol in the absence of abnormal clinical findings.5 Our results support this recommendation. Hyang-Suk You, MD,a Hoon-Soo Kim, MD,a ByungSoo Kim, MD, PhD,a,b Moon-Bum Kim, MD, PhD,a,b and Hyun-Chang Ko, MDa,c Department of Dermatology, School of Medicine, Pusan National University, Yangsana; Biomedical Research Institute, Pusan National University Hospital, Busanb; and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan,c Korea Funding sources: None. Conflicts of interest: None declared. Correspondence to: Hyun-Chang Ko, MD, Department of Dermatology, School of Medicine, Pusan National University, Geumo-ro 20, Mulgeum-eup, Yangsan, Gyeongsangnam-do 626-770, Korea E-mail: [email protected] REFERENCES 1. Schupp CJ, Kleber JB, Gunther P, Holland-Cunz S. Propranolol therapy in 55 infants with infantile hemangioma: dosage, duration, adverse effects, and outcome. Pediatr Dermatol. 2011;28:640-644. 2. de Graaf M, Breur JM, Raphael MF, Vos M, Breugem CC, Pasmans SG. Adverse effects of propranolol when used in the treatment of hemangiomas: a case series of 28 infants. J Am Acad Dermatol. 2011;65:320-327. 3. Love JN, Sikka N. Are 1-2 tablets dangerous? Beta-blocker exposure in toddlers. J Emerg Med. 2004;26:309-314. 4. Betlloch-Mas I, Martinez-Miravete MT, Lucas-Costa A, Martin de Lara AI, Selva-Otalaurruchi J. Outpatient treatment of infantile hemangiomas with propranolol: a prospective study. Actas Dermosifiliogr. 2012;103:806-815. 5. Drolet BA, Frommelt PC, Chamlin SL, et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2012;131:128-140. http://dx.doi.org/10.1016/j.jaad.2015.01.034
Frequent indoor tanning among New Jersey high school students To the Editor: Indoor tanning among children increases their lifetime risk for developing melanoma by 85%.1 Additionally, individuals who tan indoors 10 or more times have a 34% increased
risk for developing melanoma.2 In this study, we examined the prevalence and correlates of frequent indoor tanning among New Jersey high school students. The data were drawn from the 2012 New Jersey Youth Tobacco Survey, which was completed by 1850 high school students ( grades 9-12) in 27 public schools throughout New Jersey (overall participation rate ¼ 60.3%). Several questions related to indoor tanning were included in the survey, which focused primarily on tobacco-related issues. In 2013, commercial indoor tanning was banned in New Jersey for minors under the age of 17 years. The results of this study provide the necessary basis for assessing the subsequent impact of the ban on indoor tanning rates among minors in New Jersey. Standard parental consent and student assent procedures were used. The study received institutional review board approval. Additional information regarding the study is available elsewhere.3 Participants reported their sex, age, race/ ethnicity, whether they currently smoke (ie, smoked at least 1 cigarette in the past 30 days), and the number of times they tanned indoors in the past year (ie, used a tanning bed or booth with tanning lamps, not including getting a spray-on tan). Students who reported any past-year indoor tanning indicated whether they had done so before a special occasion, before a vacation, and/or to improve their mood. They also reported whether they had used social media related to indoor tanning salons (ie, ‘‘visited, followed, liked, or become a fan of a tanning salon on sites like Facebook, Twitter, or YouTube’’). Finally, they indicated how hard it would be to stop indoor tanning. To take into account the complex sample survey design, the data were analyzed using SUDAAN (RTI International, Research Triangle Park, NC). All percentages were weighted to adjust for probability of selection and nonresponse. Of the 1754 students who answered the question about use of indoor tanning, 8.5% (N ¼ 146) reported indoor tanning in the past year, 38.0% of whom were denoted as frequent indoor tanners (ie, $10 past-year indoor tanning sessions). Descriptive statistics regarding the students who reported past-year indoor tanning are shown in Table I. Results of 2 analyses indicated that students who had tanned indoors in the past year did not differ in age from individuals who had not (P ¼ .076) but the past-year indoor tanners were significantly more likely to be female (66.1% vs 48.4%, P ¼ .0093) and current smokers (25.0% vs 7.4%, P ¼ .0017) and were less likely to be denoted as non-Hispanic other race/ethnicity (4.4% vs 14.4%, P ¼ .0034).
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Table I. Frequent indoor tanning among New Jersey high school students who reported indoor tanning in the past year
Sex Female Male Age, y #15 16 $17 Race/ethnicity Hispanic Non-Hispanic white Non-Hispanic black Non-Hispanic other Smoking status Current smoker Not current smoker Indoor tanned before a special occasion No Yes Indoor tanned before a vacation No Yes Indoor tanned to improve mood No Yes Used social media related to tanning salons No Yes How hard it would be to stop indoor tanning Not at all A little Somewhat/moderately Very
Past-year indoor tanners, %
Prevalence of frequent indoor tanning, % (95% CI)
66.1 33.9
38.5 (28.2-50.0) 38.6 (20.5-60.6)
26.7 29.2 44.1
34.5 (19.8-53.0) 32.0 (18.0-50.1) 45.4 (31.0-60.6)
21.2 64.3 10.1 4.4
29.1 (15.1-48.7) 39.3 (27.2-52.9) * *
25.0 75.0
57.6 (41.1-72.6) 30.4 (21.5-41.1)
P value
.99
.55
.36y
.0038
.14 40.3 59.7
48.0 (30.2-66.3) 31.3 (21.2-43.6) .54
79.2 20.8
39.1 (30.1-48.9) 34.1 (20.0-51.7) .013
89.6 10.4
33.7 (25.2-43.5) 75.2 (45.8-91.6) .0015
59.7 40.3
27.9 (16.1-43.9) 54.6 (45.2-63.8) .018
68.5 8.7 13.1 9.7
28.0 27.7 60.1 90.3
(17.3-41.9) (10.5-55.5) (31.7-83.0) (63.8-98.0)
N ¼ 146 high school students who reported indoor tanning in the past year. All percentages are weighted. P values represent the results of 2 analyses examining the association between the prevalence of frequent indoor tanning and each respective variable among past-year indoor tanners. The data are drawn from the 2012 New Jersey Youth Tobacco Survey. CI, Confidence interval. *Because of high SE ([30% of the estimate), it is not possible to reliably estimate these percentages. y Only students who reported being Hispanic or non-Hispanic white were included in this analysis.
We conducted 2 analyses to examine the association between each study variable and whether students who reported past-year indoor tanning were frequent indoor tanners. As shown in Table I, the prevalence of frequent indoor tanning did not differ according to students’ sex, age, race/ ethnicity (Hispanic vs non-Hispanic white students), and whether they indoor tanned before a special occasion or vacation. However, frequent indoor tanning was significantly more common among indoor tanners who were current smokers, tanned to improve their mood, had used social media related to tanning salons, or indicated it would be very hard to stop indoor tanning. More than one third of the indoor tanning high school students in the current study were frequent tanners who reported that it would be harder for them to stop indoor tanning. Frequent tanners were more likely to have engaged in social media activities related to indoor tanning. Social media may represent a viable mechanism to deliver interventions to reduce indoor tanning among frequent indoor tanners. Such interventions should also address the higher rates at which youths who frequently tan indoors do so to improve their mood. The higher rate of smoking among frequent indoor tanners suggests that they may benefit from interventions that target multiple behavioral risk factors.4 Reducing rates of indoor tanning among US youth is an important public health priority.5 Elliot J. Coups, PhD,a,b,c Jerod L. Stapleton, PhD,a,b,c Christine M. Davis, PhD,c and Cristine D. Delnevo, PhD, MPHa,c Rutgers Cancer Institute of New Jerseya and Department of Medicine, Rutgers Robert Wood Johnson Medical School,b Rutgers, The State University of New Jersey, New Brunswick, and Department of Health Education and Behavioral Science, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscatawayc The 2012 New Jersey Youth Tobacco Survey was funded by a contract from the New Jersey Department of Health to the Center for Tobacco Studies, Rutgers School of Public Health, Rutgers, The State University of New Jersey. Conflicts of interest: None declared. Correspondence to: Elliot J. Coups, PhD, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany St, Room 5567, New Brunswick, NJ 08903 E-mail: [email protected]
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MAY 2015
REFERENCES 1. Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Biomarkers Prev. 2010;19:1557-1568. 2. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol. 2014;70:847-857. e1-e18. 3. Davis CM, Delnevo CD, Manderski MT, Hrywna M. The 2012 New Jersey youth tobacco survey: a statewide report. New Brunswick (NJ): Rutgers School of Public Health; 2014. Available from: URL: www.state.nj.us/health/ctcp/research. shtml. Accessed December 19, 2014. 4. Holman DM, Watson M. Correlates of intentional tanning among adolescents in the United States: a systematic review of the literature. J Adolesc Health. 2013;52:S52-S59. 5. US Department of Health and Human Services. The Surgeon General’s call to action to prevent skin cancer. Washington (DC): US Dept of Health and Human Services, Office of the Surgeon General; 2014. Available from: URL: www.surgeongeneral.gov. Accessed December 19, 2014. http://dx.doi.org/10.1016/j.jaad.2015.01.035
Comparison of electronic and handwritten pathology requisition forms for cutaneous melanoma To the Editor: Evaluation of suspicious pigmented lesions involves clinical examination followed by biopsy specimen and histopathological interpretation. Communication of clinical information via the pathology requisition form is crucial to establish pretest probability and, ultimately, render the most accurate diagnosis. Indeed, misdiagnosing melanoma constitutes a significant source of medicolegal risk for pathologists.1 Although dermatologists report that it is important to communicate clinical information to pathologists and very few are concerned that providing this information will bias the pathologist,2 previous
studies have shown that requisition forms for melanocytic lesions frequently omit crucial clinical information. Among 238 melanocytic lesion requisition forms submitted by dermatology residents, 75% omitted all of the ABCDE criteria.3 A study of 100 consecutive biopsy specimens of melanocytic lesions by 60 community dermatologists and 5 mid-level providers revealed that morphological descriptions were absent from 67% of cases, the ABCDE criteria was omitted in 55%, a clinical differential diagnosis was limited to ‘‘r/o atypia or nevus’’ in 39%, and family or personal history was not included in 92%.4 Electronic requisition forms have been proposed as a means of improving the quality of information communicated to pathologists. Kinonen et al5 compared 8545 dermatopathology electronic and handwritten requisition forms to determine the frequency of data entry error. The authors found that, after excluding mislabeling, errors occurred in 94/8545 (1.1%) of handwritten requisitions compared with only 17/2930 (0.6%) of electronic requisitions. We hypothesized that an electronic template requisition form in which clinicians are prompted to include pertinent clinical information regarding melanocytic lesions would improve the quantity and quality of information communicated to pathologists. At our institution, a structured electronic pathology requisition form was implemented in April 2013. We sought to compare the information provided on handwritten and electronic requisition forms for specimens ultimately diagnosed as melanoma. After institutional review board approval, our pathology database was queried for all specimens with a final diagnosis of melanoma between January
Table I. Comparison of handwritten and electronic pathology requisition forms for cutaneous melanoma MD providers PA providers Biopsy specimen type recorded Proportion of lesion removed with biopsy specimen Mean no. of differential diagnosis 6 SD (range) Melanoma not on differential diagnosis Family history Medical history Morphological description Diameter Clinical history of lesion Photograph Skin type/ethnicity Dermoscopy finding MD, Medical doctor; PA, physician assistant; SD, standard deviation.
Handwritten (n = 189)
Computerized (n = 37)
P value
32 7 138 (73%) 28 (14%) 1.73 6 0.84 (0-3) 53 (28%) 6 (3%) 54 (29%) 87 (46%) 24 (13%) 24 (13%) 2 (1%) 20 (11%) 4 (2%)
7 2 37 (100%) 22 (60%) 2.13 6 0.78 (1-3) 8 (22%) 12 (32%) 23 (62%) 27 (73%) 25 (68%) 26 (70%) 3 (8%) 12 (33%) 0 (0%)
\.01 \.01 \.01 .42 \.01 \.01 \.01 \.01 \.01 \.01 \.01 .37
