<p> WWW.MTINFORMATION.COM</p><p>SUBJECTIVE: 59-year-old woman who presents for evaluation of “facial skin problems”. I saw her one year ago. She has been using Retin-A Micro. She has noticed an improvement in the texture of her skin and the brown spots on her face. She is interested in options for further treatment of the brown spots. She also has several growths on her legs. They are asymptomatic. </p><p>MEDICATIONS: Prograf, acyclovir, trazodone, Premarin, lorazepam, Ambien, and Bactrim.</p><p>ALLERGIES: CLINDAMYCIN, CHLORAMPHENICOL, CODEINE, COMPAZINE, TALWIN, ERYTHROMYCIN, EPINEPHRINE, AND FLAGYL.</p><p>PAST MEDICAL HISTORY: Status post liver transplant in 1989 due to sclerosing cholangitis. History of ulcerative colitis, fibromyalgia, renal deficiency. She also has a history of hepatitis. </p><p>PHYSICAL EXAMINATION: She has Fitzpatrick type 1 skin. Her lateral cheeks have several scattered brown to tan macules. Her right medial cheek has three 1 mm dark blue to gray macules. Her mid upper lip has a 2/3 mm pearly papule. Both lower legs have a few scattered tan “stuck-on” papules. </p><p>IMPRESSIONS: 1. Lentigines. I discussed the risks, benefits, and options for treatment. She will consider treatment using the V-Beam laser with a Q-switched 532 nanometer laser. </p><p>2. Thrombosed angioma versus exogenous pigment, right medial cheek. I discussed the risks, benefits, and options for treatment. She will consider a test using the VersaPulse laser.</p><p>3. Seborrheic keratoses, legs. No treatment is needed.</p><p>4. Possible basal cell carcinoma, upper lip. I discussed the risk, benefits, and options for treatment. She did not want to do a biopsy today. She will consider doing this in the near future. </p>