Assuntos
Carcinoma de Célula de Merkel , Neoplasias Cutâneas , Humanos , Carcinoma de Célula de Merkel/epidemiologia , Carcinoma de Célula de Merkel/cirurgia , Carcinoma de Célula de Merkel/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Estadiamento de Neoplasias , Programa de SEERRESUMO
BACKGROUND: Mohs micrographic surgery may be discontinued with positive margins as an anticipated strategy for multidisciplinary care or as an unanticipated occurrence. Management of primary tumors has not been compared after anticipated versus unanticipated incomplete Mohs micrographic surgery (iMMS). OBJECTIVE: To compare rates and timing of adjuvant surgery after iMMS and final margin status when iMMS is anticipated versus unanticipated. Secondary outcomes were preoperative and intraoperative clinicopathologic factors associated with iMMS. METHODS: Cases of iMMS of keratinocyte carcinomas at a tertiary academic center between 2005 and 2022 were classified as anticipated (preoperative assembly of multidisciplinary teams) or unanticipated (ad hoc management of positive margins). Rate, timing, and final margin status of adjuvant surgery was compared between anticipated and unanticipated iMMS cohorts using χ2/Fisher exact test for categorical variables and t-test for continuous variables. RESULTS: Of 127 iMMS cases, 51.2% (65/127) were anticipated. Anticipated iMMS cases were more likely to undergo additional resection (98.5% vs 72.6%, p < .001), with fewer delays (3.9 vs 13.2 days, p < .001) and higher rates of final margin clearance (84.6% vs 59.7%, p < .001). CONCLUSION: When iMMS is anticipated as part of multidisciplinary care, patients are more likely to undergo additional resection, with fewer delays to next surgery and higher final margin clearance rates.
Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Cirurgia de Mohs , Tempo para o Tratamento , Resultado do Tratamento , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Margens de Excisão , Estudos RetrospectivosRESUMO
Background: Policymakers and payers are reevaluating the temporary telehealth flexibilities granted during the COVID-19 public health emergency, which will shape future teledermatology utilization. Objective: To summarize the recently expanded telehealth flexibilities in the United States, projected changes, and corresponding implications for dermatologists. Methods: Narrative review of the literature, United States policies and regulations, and white paper reports. Results: Key telehealth flexibilities included expansion of payment parity, relaxation of originating site requirements, loosening of state licensure requirements, and HIPAA (Health Insurance Portability and Accountability Act of 1996) enforcement discretion. These changes enabled widespread accessibility and adoption of teledermatology, which enhanced high-quality and cost-effective dermatologic care. Most waivers will end 151 days following the end of the public health emergency declaration. Notably, asynchronous telehealth was not included in the reimbursement expansion. Limitations: Only policies and regulations through December 2022 are included. Conclusion: It will be important for the field of dermatology to stay abreast of the upcoming changes in telemedicine policies and reimbursement, to demonstrate teledermatology's value through evidence-based studies and to advocate for enduring policies that will promote the accessibility of teledermatology for patients.
Assuntos
Melanoma , Neoplasias Cutâneas , Suicídio , Morte , Humanos , Incidência , Estado Civil , Pacientes , Prognóstico , Fatores de Risco , PeleRESUMO
Hidrocystomas are benign cysts of sweat duct epithelium that can present as single or multiple lesions, with or without pigmentation. The size is typically 1-3mm in diameter. Although hidrocystomas commonly occur in most parts of the head and neck region, occurrence on the scalp is rare. Herein, we present a 29-year-old woman with a giant pigmented apocrine hidrocystoma of the scalp, which, to our knowledge, represents the largest of its kind reported to date.
Assuntos
Glândulas Apócrinas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Hidrocistoma/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adulto , Feminino , Humanos , Pigmentação , Couro Cabeludo/patologiaAssuntos
Fármacos Dermatológicos/economia , Dermatologia/economia , Custos de Medicamentos/legislação & jurisprudência , Política de Saúde/economia , Dermatopatias/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Dermatologia/legislação & jurisprudência , Dermatologia/tendências , Custos de Medicamentos/tendências , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Indústria Farmacêutica/tendências , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Farmacoeconomia/tendências , Política de Saúde/legislação & jurisprudência , Política de Saúde/tendências , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/tendências , Legislação Farmacêutica/economia , Legislação Farmacêutica/tendências , Dermatopatias/economia , Estados UnidosRESUMO
There has been rapid growth in teledermatology over the past decade, and teledermatology services are increasingly being used to support patient care across a variety of care settings. Teledermatology has the potential to increase access to high-quality dermatologic care while maintaining clinical efficacy and cost-effectiveness. Recent expansions in telemedicine reimbursement from the Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will play an increasingly prominent role in patient care. Therefore, it is important that dermatologists be well informed of both the promises of teledermatology and the potential practice challenges a continuously evolving mode of care delivery brings. In this article, we will review the evidence on the clinical and cost-effectiveness of teledermatology and we will discuss system-level and practice-level barriers to successful teledermatology implementation as well as potential implications for dermatologists.
Assuntos
Análise Custo-Benefício , Dermatologia/métodos , Política de Saúde/economia , Dermatopatias/terapia , Telemedicina/organização & administração , Centers for Medicare and Medicaid Services, U.S./economia , Dermatologia/economia , Dermatologia/organização & administração , Implementação de Plano de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Reembolso de Seguro de Saúde/economia , Dermatopatias/diagnóstico , Dermatopatias/economia , Telemedicina/economia , Resultado do Tratamento , Estados UnidosRESUMO
Post-transplant lymphoproliferative disorder (PTLD) is an uncommon complication after solid-organ transplants and hematopoietic stem cell transplants. Isolated involvement of the skin without systemic involvement in PTLD is extremely rare. Primary cutaneous PTLD is generally categorized as either cutaneous T-cell lymphoma or cutaneous B-cell lymphoma, with variable Epstein-Barr virus (EBV) positivity. Herein, we describe an exceedingly uncommon case of a primary cutaneous Hodgkin-like polymorphic PTLD. A man in his 60s, with a history of kidney transplant, presented with a 5-week history of two indurated plaques. Clinical, histologic and immunohistochemical findings were consistent with primary cutaneous Hodgkin-like polymorphic PTLD. Reduction in immunosuppression led to resolution of his lesions. This case highlights a rare case of primary cutaneous Hodgkin-like PTLD and increases awareness of this uncommon post-transplant complication. It also underscores the importance of collaboration between dermatology, hematology, dermatopathology and hematopathology in order to diagnose challenging cases.
Assuntos
Doença de Hodgkin , Transplante de Rim , Neoplasias Cutâneas , Idoso , Doença de Hodgkin/metabolismo , Doença de Hodgkin/patologia , Humanos , Masculino , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologiaRESUMO
The American Medical Association-Specialty Society Relative Value Scale Update Committee, also known as the RUC, plays a critical role in assessing the relative value of physician services and procedures. This committee provides access for all physicians, including dermatologists, to the reimbursement process. Since the introduction of the Resource-Based Relative Value Scale by Medicare, the RUC has done important work to evaluate and refine reimbursement for physician services. The RUC recommendations have also led the Current Procedural Terminology (CPT) Editorial Panel to develop additional reimbursement codes as new procedures and services are developed. In this article (from the series Future Considerations for Clinical Dermatology in the Setting of 21st Century American Policy Reform), we will review the RUC, including its history and membership, the RUC update process, and a brief discussion of a few issues of particular importance to dermatologists.
Assuntos
Dermatologia , Escalas de Valor Relativo , Previsões , Comitê de Profissionais , Sociedades Médicas , Estados UnidosRESUMO
As the implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act begins, many dermatologists who provide Medicare Part B services will be subject to the reporting requirements of the Merit-based Incentive Payment System (MIPS). Clinicians subject to MIPS will receive a composite score based on performance across 4 categories: quality, advancing care information, improvement activities, and cost. Depending on their overall MIPS score, clinicians will be eligible for a positive or negative payment adjustment. Quality will replace the Physician Quality Reporting System and clinicians will report on 6 measures from a list of over 250 options. Advancing care information will replace meaningful use and will assess clinicians on activities related to integration of electronic health record technology into their practice. Improvement activities will require clinicians to attest to completion of activities focused on improvements in care coordination, beneficiary engagement, and patient safety. Finally, cost will be determined automatically from Medicare claims data. In this article, we will provide a detailed review of the Medicare Access and Children's Health Insurance Program Reauthorization Act with a focus on MIPS and briefly discuss the potential implications for dermatologists.
Assuntos
Dermatologia/tendências , Medicare Access and CHIP Reauthorization Act of 2015 , Planos de Incentivos Médicos , Reembolso de Incentivo , Criança , Previsões , Humanos , Estados UnidosRESUMO
With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall. As a result, additional APMs relevant to dermatologists are needed to allow those interested in the APMs to explore this pathway. Fortunately, the Medicare Access and Children's Health Insurance Program Reauthorization Act establishes a process for new APMs to be approved and the creation of bundled payments for skin diseases may represent an opportunity to increase the number of APMs available to dermatologists. In this article, we will provide a detailed review of APMs under the Medicare Access and Children's Health Insurance Program Reauthorization Act and discuss the development and introduction of APMs as they pertain to dermatology.
Assuntos
Dermatologia/tendências , Medicare Access and CHIP Reauthorization Act of 2015 , Modelos Teóricos , Mecanismo de Reembolso , Criança , Previsões , Humanos , Estados UnidosAssuntos
Dermatologia/tendências , Reforma dos Serviços de Saúde/legislação & jurisprudência , Avaliação de Resultados em Cuidados de Saúde , Padrões de Prática Médica/tendências , Mecanismo de Reembolso/tendências , Adulto , Criança , Dermatologistas/normas , Dermatologistas/tendências , Dermatologia/economia , Feminino , Previsões , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Medicare Access and CHIP Reauthorization Act of 2015 , Padrões de Prática Médica/normas , Estados UnidosRESUMO
BRAF inhibitors are highly effective therapies in treating a subset of melanomas but are associated with induction of secondary cutaneous squamous cell carcinoma (cSCC). Recently, Human Polyomavirus 6 (HPyV6) was found to actively express viral proteins in BRAF inhibitor-induced cSCCs; however, the specific cellular mechanisms by which HPyV6 may facilitate neoplastic cell growth require further investigation. The current study describes a novel pathogenic mechanism of action for HPyV6 small tumor (sT) antigen which involves binding to protein phosphatase 2A (PP2A) via its WFG motif and zinc binding sites. Our findings demonstrate an important role of HPyV6 sT for activation of PP2A's downstream oncogenic pathways (MEK/ERK/c-Jun), which may underlie the pathogenesis of BRAF inhibitor-induced neoplasms. J. Med. Virol. 89:742-747, 2017. © 2016 Wiley Periodicals, Inc.