Updates on coding in dermatology.

Correct coding is an important component of effective dermatology practice management. Over the past several years there have been updates to many commonly used codes within dermatology. This review highlights many of these updates, such as: the skin biopsy codes have been subdivided to reflect the different biopsy techniques.

Inconsistent Associations Between Risk Factor Profiles and Adjuvant Radiation Therapy (ART) Treatment in Patients with Cutaneous Squamous Cell Carcinoma and Utility of the 40-Gene Expression Profile to Refine ART Guidance.

Introduction: National Comprehensive Cancer Network (NCCN) recommendations for adjuvant radiation therapy (ART) use are similar for High Risk and Very High Risk cutaneous squamous cell carcinoma (cSCC) with negative post-surgical margins. Although studies report reductions in disease progression following ART treatment, ART use is likely inconsistent when guided by available risk factors. This study evaluated the association of ART with clinical risk factors in ART-treated and untreated patients and showed the clinical utility of the 40-gene expression profile (40-GEP) for guiding ART.

Identifying critical quality metrics in Mohs Surgery: A national expert consensus process.

Background: Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care.

Objective: The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS.

Private Payer Engagement.

Private payers or commercial insurers play an ever-increasing role in physician payment policy. Effective interaction with these groups is an important part of organized dermatology's function.

Contribution of Beta-HPV Infection and UV Damage to Rapid-Onset Cutaneous Squamous Cell Carcinoma during BRAF-Inhibition Therapy.

Purpose: BRAF-inhibition (BRAFi) therapy for advanced melanoma carries a high rate of secondary cutaneous squamous cell carcinoma (cSCC) and risk of other cancers. UV radiation and α-genus human papillomavirus (HPV) are highly associated with SCC, but a novel role for β-genus HPV is suspected in BRAFi-cSCC. Cutaneous β-HPV may act in concert with host and environmental factors in BRAFi-cSCC.

Enhanced cosmetic outcome with running horizontal mattress sutures.

Background: Cutaneous sutures should provide good wound eversion, firm closure, and cosmetically elegant results. Simple running sutures are commonly employed in cutaneous surgery but may not always be effective in achieving wound eversion.

Objective: We compared the cosmetic results of simple running nonabsorbable sutures with running horizontal mattress sutures in primary closures of facial defects.

Anesthesia for office-based oculoplastic surgery.

Background: Many common oculoplastic surgical procedures can be performed in an office-based setting.

Objective: To describe a system of local anesthetic use that provides superb anesthesia administered in a nearly painless manner.

Methods: Combined conjunctival, topical, and injected local anesthesia is used in outpatient oculoplastic surgical procedures.

Collagen remodeling after 585-nm pulsed dye laser irradiation: an ultrasonographic analysis.

Background And Objectives: Nonablative dermal remodeling is an evolving technology that has generated great interest among both laser surgeons and patients. Evidence indicates that dermal collagen formation is the key mechanism of action for the nonablative techniques. We studied, with ultrasound, new collagen formation after nonablative laser irradiation.

Standing cone avoidance via advancement flap modification.

Background: Tissue redundancy manifesting as a standing cutaneous cone is a common surgical problem.

Objective: We describe modifications to traditional advancement flap design that allows for standing cutaneous cone avoidance.

Methods: In addition to traditional incisions employed in advancement flaps, an additional curvilinear incision is made along one or more limbs of the flap.

Surgical rosacea.

Background: Rosacea is a common cutaneous disease. The dermatologic surgeon will frequently encounter rosacea in the surgical patient.

Objective: To describe observations regarding surgical and wound care techniques that facilitate and improve outcomes in the rosacea patient.