In the April issue of the ARCHIVES, Sellheyer and Bergfeld1 provided a variety of possible explanations for why the plastic surgeons in their pilot study performed so many more excisional biopsies for actinic keratoses than did the dermatologists. The authors consider such possibilities as different abilities in the clinical recognition of actinic keratoses, different perceptions as to which procedure leads to the best clinical outcome, and systematic differences and expectations in the types of patients consulting each specialty. All of these reasons probably play some role. However, I suspect that financial considerations play a significant and perhaps dominant role in explaining these differences.
Lieblich LM. To Perform a Biopsy or Excise Suspected Actinic Keratoses: Another View. Arch Dermatol. 2006;142(10):1361-1375. doi:10.1001/archderm.142.10.1363