Frequent skin examinations in patients with actinic keratoses: Ethical, financial, and moral implications

      Dr Kandu has a busy dermatology practice in a rural town. As the only dermatologist in the area, Dr Kandu has a 3- to 4-month wait list for new patients. Ms Rhodes, a 65-year-old woman, presents at her initial visit with a concern for scaly spots on her forearm and a desire for a full-body skin examination. She has no personal or family history of skin cancer and had relatively mild sun exposure as a youth. On examination, Ms Rhodes has a few lentigines on her face and 2 thin actinic keratoses (AKs) on her left forearm. Dr Kandu administers cryotherapy to the lesions and counsels her on sun protection. He indicates that she can follow up in 1 year for another skin examination. Ms Rhodes interjects, stating that she saw her previous dermatologist every 3 months to make sure she did not have skin cancer. Given the patient's history and examination, Dr Kandu does not think there is an indication to see her so frequently, especially when this would take away an appointment slot from another patient in need of dermatologic care. He explains to her that such frequent monitoring is not warranted for minimal actinic damage, but Ms Rhodes insists that it makes her feel better to be scheduled for skin examinations every 3 months.

      Abbreviation used:

      AK ( actinic keratosis)
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