Changing Dermatologic Procedural Patterns in the Medicare Population: A National Trend Analysis.

BACKGROUND: Dermatologists are trained in diagnostic and therapeutic procedures for cutaneous lesions, yet comparative trends for basic dermatologic procedures across dermatology providers are lacking at the national level. OBJECTIVE: To trend common dermatologic procedures among general dermatologists, Mohs surgeons, primary care providers or primary care physicians (PCPs), and nonphysician clinicians (NPCs). METHODS: Longitudinal analysis of 2016 to 2021 Medicare Public Use Files. RESULTS: Aggregate dermatologic procedural volume decreased 3.0%. Procedural volume declined among general dermatologists (-11.7%), Mohs surgeons (-16.7%), and PCPs (-41.7%) but increased among NPCs (+57.5%). The proportion of procedures by general dermatologists decreased substantially for premalignant destructions (-6.2%), skin biopsies and shave removals (-4.7%), and malignant excisions (-4.1%) and more notably in counties that were nonmetro (-7.1%), low in income (-6.1%), and with <4.0 dermatologists per 100,000 population (-7.0%). CONCLUSION: Aggregate procedural volume decreased across the study period with general dermatologists, Mohs surgeons, and PCPs performing a progressively smaller proportion. The increase in procedures by NPCs may help to address demand but underscores the value of formalized procedural training. The procedural decline by general dermatologists in rural and low-income counties and those with baseline dermatologist shortages may exacerbate existing unmet need. Primary limitation included lack of commercial data.

Ethics of Patients Losing Insurance Coverage Due to Hospital-Insurer Contract Disagreements.

Despite most Americans having healthcare coverage, coverage does not equate to access. For many, healthcare coverage is being threatened by contractual disagreements between major health insurers and hospitals. In New York, in efforts to control costs, Aetna and United Healthcare have recently engaged in contentious contract negotiations with New York-Presbyterian and Mount Sinai medical centers, resulting in unprecedented ripples in patients' health plans and access. These disruptions have been shown to negatively impact patient health and result in patients managing their treatment at steep out-of-pocket rates or scrambling to find new providers in-network. We discuss the ethical implications of fallouts between insurance companies and hospitals and their impacts on patients.

Double V-Y Island Pedicle Flap for Dorsal Hand Reconstruction Following Mohs Micrographic Surgery.

Medium to large defects on the dorsal hand pose a reconstructive challenge following dermatologic surgery. Repairs in this location can be complicated by a paucity of adjacent tissue reservoirs, competing tension vectors, thin cutaneous tissue, and superficial tendons and vasculature. In such cases, a double V-Y island pedicle flap is an effective reconstructive solution. It preserves hand function, harnesses local tissue with a robust blood supply, facilitates complete closure, and provides skin that closely matches the original's color and texture. Here, we present the repair of a medium to large dorsal hand defect after Mohs micrographic surgery for melanoma in situ, using a double V-Y island pedicle flap.

Disaster Preparedness in Dermatology Residency Programs.

Dermatology residency programs must be prepared to address the unpredictable but seemingly inevitable impacts of natural (eg, hurricanes) and manmade (eg, threats of violence) disasters as well as widespread infectious disease (eg, the COVID-19 pandemic). However, there is a paucity of literature regarding how residency programs should prepare for and respond to these types of disasters. From the equipment trainees utilize in clinic to the didactic education dermatology residents receive, preserving the means of clinical care delivery and mastery of core competencies in the face of unique and disastrous circumstances poses a great challenge to dermatology residency programs. Addressing disaster preparedness early may help to mitigate the short- and long-term impacts of such events, allowing for a more sustainable residency program.

The effects of alcohol and illicit drug use on the skin.

Early identification of cutaneous manifestations of alcohol and illicit drug use can aid in the diagnosis and management of these uses, as well as their sequelae. In addition, the effects of alcohol and illicit drug use on the skin can result in significant morbidity. Alcohol misuse can present with jaundice, pruritus, pigmentary alterations, urticaria, hair and nail changes, and oral changes. It is also a risk factor for skin cancer and infections. Vascular disturbances associated with alcohol misuse include telangiectasias, palmar erythema, caput medusae, and flushing. Diseases related to alcohol misuse include nutritional deficiencies, porphyria cutanea tarda, psoriasis, seborrheic dermatitis, nummular dermatitis, and rosacea. Other conditions seen in alcohol misuse include Dupuytren contracture, Peyronie disease, and pancreatitis. Dermatologists should also be aware of hepatotoxic medications that are commonly prescribed for skin diseases so as to avoid initiating hepatoxicity in patients who use alcohol. Illicit drug use can manifest with cutaneous fibrosis, scarring, granulomas, ulceration, pruritus, infections, cocaine-levamisole-induced vasculitis, tooth decay, and oral disease. By recognizing the cutaneous stigmata of alcohol and illicit drug use, dermatologists can aid in the identification and treatment of patients suffering from these addictions.