BCC by a board-certified dermatologist can be an efficient approach, with a high success rate and a low risk of negative outcomes. Invited Commentary | PRACTICE GAPS Immediate Curettage and Electrodessication Following Biopsy of Suspected Basal Cell Carcinoma at Initial VisitThis retrospective medical chart review attempts to establish the clinical value of performing a biopsy and treating a lesion suspected to be a basal cell carcinoma (BCC) with curettage and electrodessication (C & D) at first visit. The positive predictive value was 84% for lesions confirmed to be BCC on histologic confirmation. The success rate, defined as the proportion of lesions that were treated appropriately, was 95.8%.This study suggests that dermatologists are extremely accurate about clinically diagnosing lesions that are appropriately treated by same-day electrodessication and curettage. Diagnosis and treatment of BCC at the same office visit would improve clinical efficiency and practice outcomes. This would also allow for improved patient access to dermatological care, as appointment times would be more available for patients with suspicious lesions. The practice gap identified herein may be the predilection for practicing dermatologists to suspect skin cancer, biopsy it only, and then perform C & D at a later date. Many patients may not necessarily require surgical excision or Mohs micrographic surgery for treatment of all BCC lesions. This practice gap may exist because of current reimbursement strategies (ie, fee for service model; eg, the health care provider performs a skin biopsy at initial office visit to be followed by a procedure only at a subsequent office visit).Possible solutions to narrowing this gap may be an outcomes measure to confirm increased patient satisfaction and improved practice efficiency. Costs to the patient with the previous model include more than 1 office visit, with time away from work and travel to and from the physician's office. Considering our current environment of rising health care costs, an additional outcomes measure could be instituted to confirm the reduced cost incurred by academic and private practices of managing appropriate BCC lesions by C & D.Potential barriers to such a practice may be the perception that extending care into 2 office visits translates into more revenue for the health care provider. However, on deeper analysis, it may be financially more beneficial to include treatment in the initial office visit, thus providing more appointment slots for patients requiring skin cancer screening. Furthermore, histologic confirmation of all lesions treated by C & D and strict adherence to established guidelines of care may help alleviate any concerns on the part of the dermatologist. The caveat, however, is that established clinical guidelines for appropriate management of nonmelanoma skin cancer should be adhered to (eg, recurrent or morpheaform BCC should be treated with surgical excision or Mohs micrographic surgery, but patientcentered care should be included in this decision).T...

Chronic skin conditions can impact a patient's quality of life beyond the skin. This manuscript gives an overview of the negative impact of common chronic skin conditions, such as psoriasis, vitiligo, acne, and eczema measured by the validated quality of life instruments. Literature has shown that patients with vitiligo and acne are mostly affected by their psychosocial wellbeing, whereas psoriasis and atopic dermatitis patients are affected by both physical and psychosocial well-being. Effective treatments of the above skin conditions correlate with positive quality of life outcomes. Further studies are recommended to better understand factors affecting quality of life.

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Vitiligo has significant impact, requiring ongoing psychosocial support. There is a strong need for a psychoeducational intervention with focus on acceptance and managing social impact. The results of this study are the first steps to informing the development of a patient-centred psychological intervention.

Majority of the residents are sponsored by the training institutions.