Cryosurgery Using the Cryopen®
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Skin Lesions in Diabetic Patients
Rev Saúde Pública 2005;39(4) 1 www.fsp.usp.br/rsp Skin lesions in diabetic patients N T Foss, D P Polon, M H Takada, M C Foss-Freitas and M C Foss Departamento de Clínica Médica. Faculdade de Medicina de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil Keywords Abstract Skin diseases. Dermatomycoses. Diabetes mellitus. Metabolic control. Objective It is yet unknown the relationship between diabetes and determinants or triggering factors of skin lesions in diabetic patients. The purpose of the present study was to investigate the presence of unreported skin lesions in diabetic patients and their relationship with metabolic control of diabetes. Methods A total of 403 diabetic patients, 31% type 1 and 69% type 2, underwent dermatological examination in an outpatient clinic of a university hospital. The endocrine-metabolic evaluation was carried out by an endocrinologist followed by the dermatological evaluation by a dermatologist. The metabolic control of 136 patients was evaluated using glycated hemoglobin. Results High number of dermophytosis (82.6%) followed by different types of skin lesions such as acne and actinic degeneration (66.7%), pyoderma (5%), cutaneous tumors (3%) and necrobiosis lipoidic (1%) were found. Among the most common skin lesions in diabetic patients, confirmed by histopathology, there were seen necrobiosis lipoidic (2 cases, 0.4%), diabetic dermopathy (5 cases, 1.2%) and foot ulcerations (3 cases, 0.7%). Glycated hemoglobin was 7.2% in both type 1 and 2 patients with adequate metabolic control and 11.9% and 12.7% in type 1 and 2 diabetic patients, respectively, with inadequate metabolic controls. -
Topical Treatments for Seborrheic Keratosis: a Systematic Review
SYSTEMATIC REVIEW AND META-ANALYSIS Topical Treatments for Seborrheic Keratosis: A Systematic Review Ma. Celina Cephyr C. Gonzalez, Veronica Marie E. Ramos and Cynthia P. Ciriaco-Tan Department of Dermatology, College of Medicine and Philippine General Hospital, University of the Philippines Manila ABSTRACT Background. Seborrheic keratosis is a benign skin tumor removed through electrodessication, cryotherapy, or surgery. Alternative options may be beneficial to patients with contraindications to standard treatment, or those who prefer a non-invasive approach. Objectives. To determine the effectiveness and safety of topical medications on seborrheic keratosis in the clearance of lesions, compared to placebo or standard therapy. Methods. Studies involving seborrheic keratosis treated with any topical medication, compared to cryotherapy, electrodessication or placebo were obtained from MEDLINE, HERDIN, and Cochrane electronic databases from 1990 to June 2018. Results. The search strategy yielded sixty articles. Nine publications (two randomized controlled trials, two non- randomized controlled trials, three cohort studies, two case reports) covering twelve medications (hydrogen peroxide, tacalcitol, calcipotriol, maxacalcitol, ammonium lactate, tazarotene, imiquimod, trichloroacetic acid, urea, nitric-zinc oxide, potassium dobesilate, 5-fluorouracil) were identified. The analysis showed that hydrogen peroxide 40% presented the highest level of evidence and was significantly more effective in the clearance of lesions compared to placebo. Conclusion. Most of the treatments reviewed resulted in good to excellent lesion clearance, with a few well- tolerated minor adverse events. Topical therapy is a viable option; however, the level of evidence is low. Standard invasive therapy remains to be the more acceptable modality. Key Words: seborrheic keratosis, topical, systematic review INTRODUCTION Description of the condition Seborrheic keratoses (SK) are very common benign tumors of the hair-bearing skin, typically seen in the elderly population. -
NWDC Mohs & Dermatology Associates: Wound Care After Cryosurgery LIQUID NITROGEN/CRYOTHERAPY WOUND CARE INSTRUCTIONS
NWDC Mohs & Dermatology Associates: Wound care after Cryosurgery Dermatology (Adult & Pediatric), Dermatopathology, Mohs & Dermatologic Surgery, Phlebology LIQUID NITROGEN/CRYOTHERAPY WOUND CARE INSTRUCTIONS Cryosurgery is a procedure in which skin is quickly frozen by applying a spray of liquid nitrogen to the area being treated. Liquid nitrogen is very cold. Cryosurgery may be an alternative to regular surgery. It takes a few minutes and may be used to treat precancerous or noncancerous (benign) growths (warts, skin tags, large oil glands, etc.). Procedure Liquid nitrogen is applied directly on the skin as a spray or with a cotton-tipped applicator. Several applications may be needed to treat the area. You may feel a stinging or burning sensation during cryosurgery. The area treated will become swollen, turn pink, then red, and may blister. As the skin peels, the treated lesion will peel off as well. Occasionally, several treatment sessions may be needed to treat your condition. A black eye is not uncommon if you had cryosurgery near or above the eyes. Home Care Instructions Wounds heal best when kept covered and moist. Avoid crusting or scabbing. 1. If the skin is opened, clean the area twice a day with clean water (clean tap water or normal saline) and apply an ointment (Vaseline petrolatum or Aquaphor ). 2. Do not use Polysporin , Neosporin , or Bacitracin other antibiotic ointments. 3. Do not use hydrogen peroxide to clean the wound. 4. If a blister forms and causes pain, you may lance the blister with a sterilized needle (boil a sewing needle and let it cool before using) and use a clean gauze to express out the blister fluid. -
2Nd Quarter 2001 Medicare Part a Bulletin
In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care -
Fundamentals of Dermatology Describing Rashes and Lesions
Dermatology for the Non-Dermatologist May 30 – June 3, 2018 - 1 - Fundamentals of Dermatology Describing Rashes and Lesions History remains ESSENTIAL to establish diagnosis – duration, treatments, prior history of skin conditions, drug use, systemic illness, etc., etc. Historical characteristics of lesions and rashes are also key elements of the description. Painful vs. painless? Pruritic? Burning sensation? Key descriptive elements – 1- definition and morphology of the lesion, 2- location and the extent of the disease. DEFINITIONS: Atrophy: Thinning of the epidermis and/or dermis causing a shiny appearance or fine wrinkling and/or depression of the skin (common causes: steroids, sudden weight gain, “stretch marks”) Bulla: Circumscribed superficial collection of fluid below or within the epidermis > 5mm (if <5mm vesicle), may be formed by the coalescence of vesicles (blister) Burrow: A linear, “threadlike” elevation of the skin, typically a few millimeters long. (scabies) Comedo: A plugged sebaceous follicle, such as closed (whitehead) & open comedones (blackhead) in acne Crust: Dried residue of serum, blood or pus (scab) Cyst: A circumscribed, usually slightly compressible, round, walled lesion, below the epidermis, may be filled with fluid or semi-solid material (sebaceous cyst, cystic acne) Dermatitis: nonspecific term for inflammation of the skin (many possible causes); may be a specific condition, e.g. atopic dermatitis Eczema: a generic term for acute or chronic inflammatory conditions of the skin. Typically appears erythematous, -
The Costs and Benefits of Moving to the ICD-10 Code Sets
CHILDREN AND ADOLESCENTS This PDF document was made available from www.rand.org as a public CIVIL JUSTICE service of the RAND Corporation. EDUCATION ENERGY AND ENVIRONMENT Jump down to document HEALTH AND HEALTH CARE 6 INTERNATIONAL AFFAIRS POPULATION AND AGING The RAND Corporation is a nonprofit research PUBLIC SAFETY SCIENCE AND TECHNOLOGY organization providing objective analysis and effective SUBSTANCE ABUSE solutions that address the challenges facing the public TERRORISM AND HOMELAND SECURITY and private sectors around the world. TRANSPORTATION AND INFRASTRUCTURE U.S. NATIONAL SECURITY Support RAND Purchase this document Browse Books & Publications Make a charitable contribution For More Information Visit RAND at www.rand.org Explore RAND Science and Technology View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. This product is part of the RAND Corporation technical report series. Reports may include research findings on a specific topic that is limited in scope; present discus- sions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research profes- sionals, and supporting documentation; -
Cryocarboxy Surgery: a New Addition to the Armamentarium for the Treatment of Congenital Melanocytic Nevi of the Face Nader Elmelegy*
FM Publisher Frontiers Journal of Surgery (FJS) Volume 01, Issue 01, Article ID FJS-2020-02 Research Article Open Access Cryocarboxy Surgery: A New Addition to the Armamentarium for the Treatment of Congenital Melanocytic Nevi of the Face Nader Elmelegy* Professor of plastic surgery at Tanta University, Egypt Corresponding author: Elmelegy N, Professor of plastic surgery at Tanta University, Egypt. E-mail: [email protected] Citation: Elmelegy N (2020) Cryocarboxy surgery: A new addition to the armamentarium for the treatment of congenital melanocytic nevi of the face. Front J Surg Vol.1 No.1:2. Copyright: © 2020 Elmelegy N. This is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Received Date: 09 January 2020; Accepted Date: 17 January 2020; Published Date: 24 January 2020. ABSTRACT Background: Congenital melanocytic nevi (CMN) of the face cause substantial psychological and cosmetic problems in affected patients. The treatment of giant congenital nevi has been a longstanding challenge, but currently, various treatment options, such as cryotherapy, chemical peeling, electrical cautery, laser therapy, and surgery, have been tried for the treatment of CMN. In this article, we present our experience and the outcomes of the use of controlled CO2 gas as a cryogen in the treatment of CMN. Methods: This study included 28 patients with varying sizes of CMN seen from January 2014 to December 2017. Cryocarboxy surgery was performed in all cases. Results: The average evaluation score of our patients was excellent in 22 (78.6%) cases, good in 4 (14.3%) cases, satisfactory in two (7.1%) cases, and we had no poor results. -
A Case Report of Keratoacanthoma (KA) of the Alveolar Ridge of the Maxilla
Journal of Dental Health Oral Disorders & Therapy Case Report Open Access A case report of Keratoacanthoma (KA) of the alveolar ridge of the maxilla Abstract Volume 9 Issue 2 - 2018 Keratoacanthoma (KA) is a case related to skin squamous cell carcinoma but it is a self- limited case. It is usually seen in areas of exposed skin and rarely to be seen intra-orally. Sarraj Faysal,1,2 Sarraj Ayman,1 Pierrard Loïc,2 Here we present a case of oral keratoacanthoma on the alveolar ridge of the maxillae, Hafian Hilal,2 Lefevre Benoit2 which may arise as a result of trauma or unknown stimulus. The case was treated with 1Faculty of Dentistry, University of Aleppo, Syria liquid nitrogen for six sessions and completely resolving of the lesion was recorded without 2Faculty of Dentistry, Reims University, France a scar formation. Cryosurgery for exophytic lesions either benign or malignant (well differentiated) is worthy to be recommended than traditional surgery. Correspondence: Sarraj Faysal, Department of Odontology, Reims Champagne-Ardennes University, 2 rue du General Keywords: Keratoacanthoma (KA), squamous cell carcinoma, intraoral, cryosurgery, Koenig, 51100 Reims, France, Tel +33788543508, Fax liquid nitrogen +33326913480, Email [email protected], [email protected] Received: January 11, 2018 | Published: March 13, 2018 Abbreviations: KA, Keratoacanthoma; SCC, squamous cell be present as solitary or multiple lesions (Table 1).5 The etiological carcinoma factors for this lesion are sunlight exposure, viruses and possibly other suspected factors such as chemical carcinogens, trauma, and Introduction disordered cellular immunity.6 The lesion usually begins as a small red macule that soon becomes a firm papule. -
What to Expect Following Cryosurgery “Freezing”
What to Expect Following CryoSurgery “Freezing” What is Cryosurgery? Cryosurgery is a technique for removing skin lesions that primarily involve the surface of the skin, such as warts, seborrheic keratosis, or actinic keratosis. It is a quick method of removing the lesions with minimal scarring. The liquid nitrogen needs to be applied long enough to freeze the affected skin. By freezing the skin, a blister is created underneath the lesion. Ideally, as the new skin forms underneath the blister, the abnormal skin on the roof of the blister peels off. Occasionally if the lesion is very thick (such as a large wart), only the surface is blistered off. The base or residual lesion may need to be frozen at another visit. What to Expect Over the Next Few Weeks? During Treatment – Area being treated will sting, burn and then possibly itch. Immediately After Treatment – Area will be red sore and swollen. Next Day- Blister or blood blister has formed, tenderness starts to subside. Apply a Band-Aid if necessary. 7 Days- Surface is dark red/brown and scab-like. Apply Vaseline or an antibacterial ointment if necessary. 2 to 4 Weeks- The surface starts to peel off. This may be encouraged gently during bathing, when the scab is softened. No makeup should be applied until area is fully healed. How to Take care of the Skin after Cryosurgery A Band-Aid can be used for larger blisters or blisters in areas that are more likely to be traumatized- such as fingers and toes. If the area becomes dry or crusted, an ointment (Vaseline, Aquaphor) can also be applied. -
Treatment Or Removal of Benign Skin Lesions
Treatment or Removal of Benign Skin Lesions Date of Origin: 10/26/2016 Last Review Date: 03/24/2021 Effective Date: 04/01/2021 Dates Reviewed: 10/2016, 10/2017, 10/2018, 04/2019, 10/2019, 01/2020, 03/2020, 03/2021 Developed By: Medical Necessity Criteria Committee I. Description Individuals may acquire a multitude of benign skin lesions over the course of a lifetime. Most benign skin lesions are diagnosed on the basis of clinical appearance and history. If the diagnosis of a lesion is uncertain, or if a lesion has exhibited unexpected changes in appearance or symptoms, a diagnostic procedure (eg, biopsy, excision) is indicated to confirm the diagnosis. The treatment of benign skin lesions consists of destruction or removal by any of a wide variety of techniques. The removal of a skin lesion can range from a simple biopsy, scraping or shaving of the lesion, to a radical excision that may heal on its own, be closed with sutures (stitches) or require reconstructive techniques involving skin grafts or flaps. Laser, cautery or liquid nitrogen may also be used to remove benign skin lesions. When it is uncertain as to whether or not a lesion is cancerous, excision and laboratory (microscopic) examination is usually necessary. II. Criteria: CWQI HCS-0184A Note: **If request is for treatment or removal of warts, medical necessity review is not required** A. Moda Health will cover the treatment and removal of 1 or more of the following benign skin lesions: a. Treatment or removal of actinic keratosis (pre-malignant skin lesions due to sun exposure) is considered medically necessary with 1 or more of the following procedures: i. -
Lumps & Bumps: Approach to Common Dermatologic Neoplasms
Case-Based Approach to Common Dermatologic Neoplasms Patrick Retterbush, MD, FAAD Mohs Surgery & Dermatologic Oncology Associate Member of the American College of Mohs Surgery Private Practice: Lockman Dermatology January 27th 2018 Disclosure of Relevant Financial Relationships • I do not have any relevant financial relationships, commercial interests, and/or conflicts of interest regarding the content of this presentation. Goals/Objectives • Recognize common benign growths • Recognize common malignant growths • Useful clues & examination for evaluating melanocytic nevi and when to be concerned for melanoma/atypical moles • How to perform a basic skin biopsy and which method/type to choose • Basic treatment/when to refer Key Questions & Physical Examination Findings for a Growth History Physical Examination • How long has the lesion been • Describing a growth present? – flat or raised? • flat – macule (<1cm) or patch (>1cm) – years, months, weeks • raised – papule (<1cm) or plaque (>1cm) – nodule if deep (majority of lesion in • Has it changed? dermis/SQ) – Size – secondary descriptive features • scaly (hyperkeratosis, retention of strateum – Shape corneum) – Color • crusty (dried serum, blood, or pus on surface) • eroded or ulcerated (partial vs. full thickness – Symptoms – pain, bleeding, itch? epidermal loss) – Over what time frame? • color (skin colored, red, pigmented, pearly) • feel (hard or soft, mobile or fixed) • PMH: • size: i.e. 6 x 4mm – prior skin cancers • Look at the rest of the skin/region of skin • SCC/BCCs vs. melanoma -
Common Terminology Criteria for Adverse Events
Common Terminology Criteria for Adverse Events Version 3.0 Index Cancer Therapy Evaluation Program NATIONAL INSTITUTES OF HEALTH National Cancer Institute http://ctep.cancer.gov/ 10/22/2003 Public Health Service Cancer Therapy Evaluation Program National Institutes of Health National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) - Index Terms Report Bethesda, Maryland 20892 -- A -- abdomen ENDOCRINE HEPATOBILIARY/PANCREAS Adrenal insufficiency 17 Liver dysfunction/failure (clinical) 34 GASTROINTESTINAL Pancreatitis 34 Colitis 19 PAIN Distension/bloating, abdominal 20 Pain --Select 55 Enteritis (inflammation of the small bowel) 21 VASCULAR Fistula, GI --Select 22 Portal vein flow 70 Typhlitis (cecal inflammation) 27 HEMORRHAGE/BLEEDING abducens Hemorrhage, GI --Select 31 See: CN VI HEPATOBILIARY/PANCREAS abnormal Pancreatitis 34 BLOOD/BONE MARROW INFECTION Myelodysplasia 4 Colitis, infectious (e.g., Clostridium difficile) 35 CONSTITUTIONAL SYMPTOMS Infection (documented clinically or microbiologically) with 35 Odor (patient odor) 11 Grade 3 or 4 neutrophils (ANC <1.0 x 10e9/L) --Select Infection with normal ANC or Grade 1 or 2 neutrophils -- 35 ENDOCRINE Select Neuroendocrine: 17 Infection with unknown ANC --Select 36 ADH secretion abnormality (e.g., SIADH or low ADH) Neuroendocrine: 17 MUSCULOSKELETAL/SOFT TISSUE gonadotropin secretion abnormality Soft tissue necrosis --Select 46 Neuroendocrine: 17 PAIN growth hormone secretion abnormality Neuroendocrine: 17 Pain --Select 55 prolactin hormone secretion abnormality