Vision Dermatology

Follicular

lesions located within or around hair follicles

Nummular

round (coin-shaped) lesions

Hyperpigmentation

darkened skin compared to normal

Hypopigmentation

paler skin compared to normal

Telangiectasia

prominent, dilated superficial blood vessels (red or purple)

Purpura

a bleeding into the skin causing small red areas

Erythema

red skin due to an increased blood supply

Macule

a well-defined area with a change in skin color; totally flat

Patch

a large area of color change, with a smooth surface

Nodule

a raised solid lesion greater than 1 cm in size

Papule

a raised solid lesion less than 1 cm in size

Plaque

a well-defined raised flat-topped lesion more than 1 cm in size

Cyst

an enclosed sac in the skin which can contain fluid or solid material

Bulla

a blister greater than 0.5 cm in size which contains clear fluid

Abscess

a closed pocket containing pus

Psoriasisiform

large white flakes (resembles psoriasis)

Keratotic

horny scale

Verrucous

warty

Lichenification

area of thickening of the skin caused by chronic scratching or rubbing

Dystrophy

degeneration or abnormal formation of the skin (usually with nail diseases)

Erosion

a sore due to focal loss of the top surface of skin; usually heals without a scar

Fissure

a thin linear crack, split, erosion, or narrow ulceration in the skin

Ulcer

full-thickness loss of the epidermis (top layer of skin) plus at least a portion of the dermis; heals with a scar

Atrophy

a localized thinning of skin which may cause a depression in the skin (usually caused by steroids)

Hypertrophic

component of the skin (usually a scar) that is enlarged or has grown excessively

Atypical

unusual’; the pathologist is worried about something, but not worried enough to say that the patient has cancer

Carcinoma

malignant neoplasm; ‘cancer’

Lesion

any single area of altered skin; a vague term meaning ‘the thing that is wrong with the patient’

Neoplasm

‘new growth’

Metastatic

the spread of cancer cells from the place where they first formed to another part of the body

Dermatitis

a number of skin conditions characterized by inflammation of the skin

Common Prescriptions

Tretinoin

Steroids (usually for rashes)

Clobetasol

Triamcinolone

Fluocinonide

Biopsy Results

BASAL CELL CARCINOMA

SQUAMOUS CELL CARCINOMA

MELANOMA

DYSPLASTIC NEVUS

BENIGN

PRECANCEROUS

Mohs Surgery

a procedure that is indicated for skin cancers located on areas of harder closure (such as the scalp, hands, or lower legs) or cosmetic areas (face).

Cryosurgery

• Used to spray skin lesions to ultimately remove them

• Actinic Keratoses (AKs)

• Irritated Seborrheic Keratoses (ISKs)

• Warts - Verruca vulgaris

• It is so cold that it burns - will form a blister, then scabs over, and eventually falls off; acts as its own bandage, no specific wound care is required of patient

• use LN2 canister

Common Procedures

CRYOSURGERY (LIQUID NITROGEN)

BIOPSIES

ED&C

EXCISION

PUNCH BIOPSY

Quality Measures for Merit-Based Incentive Payment System (MIPS)

• Tobacco

• Alcohol

• Melanoma

• Advanced Care Plan

• Diabetes

Common Diagnoses

DERMATOFIBROMA

ACTINIC KERATOSIS

SEBORRHEIC KERATOSIS

SOLAR LENTIGO

NEVUS

SEBORRHEIC DERMATITIS

ALOPECIA

ANGIOMA

ATOPIC DERMATITIS (ECZEMA)

CANDIDIASIS

CELLULITIS

COLD SORE

CONGENITAL NEVUS

CONTACT DERMATITIS

EPIDERMAL INCLUSION CYST

FIBROUS PAPULE

FOLLICULITIS

GRANULOMA ANNULARE

HERPES ZOSTER (SHINGLES)

HIVES (URTICARIA)

HIDRADENITIS SUPPURATIVA

IMPETIGO

KELOID

KERATOSIS PILARIS

LIPOMA

MELASMA

MILIA

PARONYCHIA

PSORIASIS

ROSACEA

SEBACEOUS HYPERPLASIA

TINEA VERSICOLOR

VITILIGO

WARTS

Referral Steps

• We send referrals to outside providers for Mohs surgery.

• Patients who have had Mohs surgery before, can be sent to the same group.

• If they have never had Mohs surgery before, our default recommendation is Raleigh Skin Surgery Center. But it can be done anywhere they would like.

Referral Places

Raleigh Skin Surgery Center (RSSC)

• Our sister clinic (0.2 miles down Ed Drive, ~ 5 minute walk)

• It is a good option for people who are local to the area

• Dr. Housman is the Mohs surgeon here and she has two surgical PAs (Bri and Amy) who do the closures

• Some people get uncomfortable when they hear the doctor is not doing the closures. There is an option for patients to be sent to Plastics for closure. (remind patients that Bri and Amy are doing Mohs closures all day, every day (mainly on the face)).

• Go to the patient’s chart to refer them to this office

Duke - Dr. Jonathan Cook

Cary Skin Center

UNC - Dr. Merritt

Dr. Carlino

• Retired plastic surgeon who does not believe in Mohs surgery. Since Dr. Carlino is retired, he no longer files insurance, so it will be a 100% out of pocket expense & only works on Wednesday mornings