Higher socioeconomic status of practice location, urban setting, and mean office visit level of service are associated with higher skin closure costs

Excision of skin cancer may involve a closure that can substantially increase the total cost of care. Dermatologist-specific factors may predict closure billing. The objective was to identify characteristics that predict higher-than-expected closure costs following skin cancer excision. The study included general dermatologists who performed malignant excisions and closures in the 2022 United States Medicare population. K-means clustering was performed on each dermatologist's cost difference and their mean size of malignant excisions. Dermatologist characteristics were compared between clusters and effect sizes were calculated to ensure substantial magnitudes of difference. Compared with dermatologists in low-cost clusters, dermatologists in high-cost clusters had higher office visit levels of service (P<0.0001) and practiced in postal codes with higher household incomes (P<0.0001), lower social deprivation scores (P<0.0001), and more urban areas (P<0.0001). For only small excision sizes, the high-cost cluster had more female dermatologists (P<0.0001). General dermatologists who billed for office visits at higher levels or practiced in more urban and affluent areas had higher skin cancer excision closure costs. The dermatologist practice patterns described here may help inform strategies to reduce the cost of surgical care for skin cancer.