Cold Iron Truth

Melanoma in situ: It’s hard to know what you don’t know


There are other costs beyond monetary ones from unnecessary skin biopsies: scarring, follow-up procedures for uncertain diagnoses such as mild dysplastic nevi, ambiguous results, and emotional angst to patients.

Dr. Brett M. Coldiron, a dermatologist and Mohs surgeon in Cincinnati.

Dr. Brett M. Coldiron

Further, three new skin biopsy CPT codes have recently been surveyed by the Relative Value Scale Update Committee, which means that the increasing number of skin biopsies has triggered a review. This is not good news.Dermatology appears simple and easy, but in fact it is not. While less dramatic than a closed head injury, a missed melanoma in situ can be just as deadly. It is hard to know when you do not know something.

If the results of this large study are to be believed, many melanomas in situ are going to be missed if PAs perform unsupervised skin cancer screenings. This is not a tenable proposition, ethically or legally. Dermatologists and PAs need to work together to ensure this does not happen.

An estimated 2,520 dermatology PAs were practicing in the United States in 2016, based on membership data from the Society of Dermatology PAs (SDPA), according to a research letter published last year (J Am Acad Dermatol. 2017 Jun;76[6]:1200-2). The SDPA, as stated in an SDPA position statement published in the winter 2017 newsletter, hopes to gain access to direct billing to public and private insurers, which would include the Centers for Medicare & Medicaid Services, and for PAs to no longer report to other health care professionals.


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