Women's Health

Q A new patient who just moved into town was seen for a dark mole on the chin. After taking the appropriate history and doing an exam, the dermatologist decided to perform a diagnostic biopsy. The patient also indicated she had been treated for acne in the past and asked for a prescription refill. Would the diagnosis for the new patient E/M visit be the neoplasm of undetermined nature (e.g. 238.2) or should I attach the acne diagnosis? I remember reading that the primary diagnosis is the reason the patient came into the office and that should be used as the diagnosis for the office visit. However, many times carriers don't pay if there is only one diagnosis for both the procedure and the E/M visit. Would I be committing fraud if I used the acne diagnosis for the office visit?

Q Is there such a condition as permanent postpartum telogen effluvium?

National report - Hirsutism may signal an underlying medical condition including polycystic ovary syndrome (PCOS) or Cushing's syndrome that dermatologists can help detect without laboratory tests, says Marcelle Cedars, M.D., who also suggests several treatment plans available to the dermatologist.

National report - There are different types of cutaneous wounds with varying degrees of depth; therefore, there are also various methods to treat these wounds.

Bethesda, Md. - A compound already used in many sexual lubricants may prevent infection with strains of human papillomavirus (HPV) that can cause genital warts and vaginal, cervical and anal cancers.

National report - What we ingest - whether medication, food or drink - can affect the skin barrier.

Louisville, Ky. - In treating difficult dermatologic conditions such as acne, atopic dermatitis (AD) and plantar warts, a leading expert says the key to successful treatment often involves picking the right vehicle.

Washington - The death rate for melanoma continues to rise among women, while overall death rates from cancer continue to decline in the United States, according to the latest statistics.

Gardasil (Merck) is made of virus-like particles - copies of the capsids or the outer shell of the virus; there is no DNA - therefore, it is impossible to become infected with HPV through vaccination. The vaccine stimulates an antibody response to that outer coating of the virus, and is 100 percent protective if administered prior to exposure to the four strains of HPV that it protects against.

National report - "My sister died of cervical cancer," says New Orleans-area dermatologist Patricia Farris, M.D., who has a private practice that is overwhelmingly female.

Liability for failure to warn is transferred from the drug manufacturer to the treating physician. The sole exception to this doctrine is when the drug manufacturer relies on direct-to-consumer marketing.

Birmingham, England - Researchers at City Hospital here have found that topical application of tacrolimus may be an effective treatment for most patients with vulval lichen sclerosus.

These strains differ from hospital-acquired strains in that they are more manageable and may respond to treatments to which they would appear to be resistant, according to their sensitivity cultures.

Chicago - Acne, common in women of all ages, can be treated differently depending in part upon age, according to Julie C. Harper, M.D., assistant professor of dermatology at University of Alabama School of Medicine, Birmingham.

National report - Experience with a new topical product line containing hyaluronic acid sodium salt 0.2 percent (Bionect, JSJ Pharmaceuticals) indicates it may be useful for optimizing the healing environment when the skin barrier has been disrupted by various dermatologic treatments.

Cleveland - The North American Clinical Dermatologic Society (NACDS) is accepting applications for new members.

Evanston, Ill. - Aggressive melanoma cells secrete Nodal, a protein critical to proper embryo formation, according to researchers at Northwestern University.

Philadelphia - Human papillomaviruses (HPV) are responsible for a variety of proliferative diseases in the squamous epithelia of humans, causing localized benign proliferations (e.g. the common warts), some of which have the potential to progress to cancer.

Philadelphia - Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are just two examples of non-melanoma skin cancer.

Seattle - Accurate diagnosis of vascular proliferations can be both difficult and critical, given a relatively wide disparity in clinical outcome between the different types of lesions, according to Omar P. Sangueza, M.D., professor and director of dermatopathology at the Wake Forest University School of Medicine, Winston-Salem, N.C.

Noninvasive skin cancer treatment can be an attractive option for patients, especially in this age of new techniques and pharmaceutical discovery. But with new and exciting advancements often come new and complex questions. Dermatology Times asked Ronald Moy, M.D., a Los Angeles Mohs surgeon and former professor at the University of California, Los Angeles, and Marc D. Brown, M.D., a Mohs surgeon and professor of dermatology and otolaryngology at the University of Rochester Medical School, Rochester, N.Y., to discuss noninvasive skin cancer treatments.

Stem cell research is among the "one or two paradigm-changing medical breakthroughs" that may occur in a lifetime, and it's vitally needed to bring hope to millions, says Ron Reagan, son of the late President Ronald Reagan. Mr. Reagan addressed the Friday morning plenary session at the American Academy of Dermatology's Academy '06, couching in impassioned and often stinging political commentary his plea for support for stem cell research.

The very recent approval of the quadrivalent human papilloma virus (HPV) virus-like particle vaccine (Gardasil) is the biggest breakthrough in medicine in the 21st century so far because its prevents infection with the virus that is the second leading cause of cancer deaths in women worldwide, says Stephen K. Tyring, M.D., Ph.D.

The most common cause of primary septal panniculitis is erythema nodosum. The clinical and microscopic features causing this disease are well known to the experienced dermatologist. The most common etiologic agents in erythema nodosum include infections (e.g. group A beta hemolytic strep, deep fungal and viral), drugs (e.g. oral contraceptives and sulfonamides), inflammatory bowel disease, sarcoidosis, pregnancy and malignancy.Dr. Robinson-Bostom says that, "We have found new associations concerning the etiologies in erythema nodosum. These include hepatitis C and HIV infections, all trans retinoic acid, echinacea herbal therapy, celiac disease, as well as carcinoid syndrome."

Although competing modalities have stolen some of cryotherapy's thunder, technical advances under development could one day restore cryotherapy's luster, an expert says.

San Francisco - Results from several studies performed with imiquimod 5 percent cream (Aldara, 3M Pharmaceuticals) suggest that the immune response modifier may have a role as a surgical adjuvant for improving local tumor control and/or to enhance scar appearance, says James M. Spencer, M.D., M.S., clinical professor of dermatology, Mt. Sinai School of Medicine, New York.

San Francisco - Results from several studies performed with imiquimod 5 percent cream (Aldara, 3M Pharmaceuticals) suggest that the immune response modifier may have a role as a surgical adjuvant for improving local tumor control and/or to enhance scar appearance, says James M. Spencer, M.D., M.S., clinical professor of dermatology, Mt. Sinai School of Medicine, New York.

National report - Sources say glitches in the Food and DrugAdministration's online registry for limiting pregnancy exposuresto isotretinoin have resulted in overburdened office staffs,locked-out patients and end runs around the system.

CPT codes 17000, 17003 and 17004 are the bread-and-butter codes ofmost dermatologists. Actinic keratoses, warts and other benignlesions such as seborrheic keratoses, condylomata and papillomataare the most common types of lesions treated by the destructionmethod. Per CPT, the definition of destruction means "the ablationof benign, premalignant or malignant tissues by any method, with orwithout curettement, including local anesthesia, and not usuallyrequiring closure.

National report - Researchers at Dartmouth Medical Schoolhave for the first time established an association betweeninfection with certain strains of human papillomavirus (HPV) andincreased risk for developing squamous cell carcinoma (SCC).