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Do We Need to Change Dermatology Practices for Older Patients?

As baby boomers continue to age, their propensity for skin cancer develops. These escalating rates of skin cancer have prompted the dermatology industry to make unexpected changes. The New York Times recently published a feature detailing the ways skin cancer diagnosis and treatment practices have shifted in the last few decades. Their findings include:

Uptick in basal and squamous cell carcinomas. These two skin cancers rarely spread, yet the rate of incidence has grown immensely. Today, more than 5.4 million cases in 3.3 million people are treated each year, a 250 percent increase since 1994.

Medicare. Although Medicare enrollment had slightly declined from 2005 to 2015, 5.9 million Medicare patients received skin biopsies in 2015, a 55 percent spike from 2005.

The role of physician assistants. In 2015, 15 percent of Medicare patients who had biopsies were under the care of physician assistants (PA) or nurse practitioners “working independently.” According to the former president of the American Academy of Dermatology, Brett Coldiron, MD, virtually no PAs or nurse practitioners performed biopsies on Medicare patients in 2005. A University of Wisconsin, Madison study from that same year found that “physician assistants and nurse practitioners performed nearly six biopsies for every skin cancer found — more than twice the number performed by physicians.”

Bedside Dermatology. A Michigan-based mobile dermatology clinic called Bedside Dermatology travels to different nursing homes and administers thousands of cryosurgeries, which require clinicians to spray liquid nitrogen on precancerous lesions with a blowtorch-like apparatus. They also treat lesions with steroid injections or remove them surgically. Aside from the strong possibility of these lesions being asymptomatic, 75 percent of these patients treated in 2015 had been diagnosed with Alzheimer’s disease.

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