Biopsies of nevi in children and adolescents in the United States, 2009 through 2013.

The increase in incidence and mortality of melanoma over the past 30 years has heightened public and physician awareness. It is suggested that the combination of increasing detection pressure and poor specificity of current diagnostic strategies is driving biopsy rates to alarming levels in younger individuals despite a low risk of melanoma. 1 Nevertheless, the number of nevi biopsied in children and adolescents remains poorly characterized in the United States. Methods | Institutional review board approval and informed consent were waived. No patient identifiable data were used, only statistical data based on the counts and year of diagnoses. All data were accessed and used in compliance with the Health Information Portability and Accountability Act of 1996 (HIPAA), and any regulation promulgated thereunder, to include the Privacy Rule, Title 45 of the Code of Federal Regulations , Part 160 and Subparts A and E of Part 164. To estimate the number of nevus biopsies in children and adolescents aged 19 years or younger in the United States during 2009 through 2013, we conducted analyses using (1) a large regional private dermatopathology laboratory database, the Pinkus Dermato-pathology Laboratory database, and (2) a large commercial health insurance administrative claims database, the Health-Core Integrated Research Database (HIRD). Surgical specimens used for pathologic analysis from the dermatopathology database were categorized by histopatho-logic diagnosis of (1) melanoma, (2) nevi (ie, acquired, congenital , blue, Spitz nevi), or (3) all other diagnoses, and age categories (0-9, 10-14, 15-19 years). We identified all patients in HIRD with at least 1 Current Procedural Terminology code for excision, shave removal, or biopsy (referred to collectively as " biopsies "). Only the first biopsy in the calendar year counted for each individual. Multiple biopsies for the same individual that spanned calendar years were counted as distinct biopsies. Total biopsy counts were reduced by 41.9% on the basis of data from the dermatopathol-ogy database to account for the number of biopsies expected for diagnoses other than nevi (such as warts and rashes) (see Results). We then calculated rates of biopsies in the HIRD population and applied them to 2010 US Census data to estimate age-specific and sex-specific biopsy counts extrapolated to the US population. 2 We used age-specific and sex-specific melanoma incidence rates from the Surveillance, Epidemiology, and End Results Program 2006-2010 (SEER) 3 and applied them to extrapolated biopsy rates to quantify the expected number of mela-nomas. We calculated the number …