General Dermatology Services

GENERAL DERMATOLOGY

While this website makes mention of the various cosmetic procedures Dr. Degnan has mastered, in reality much of his day-to-day practice involves general dermatology. This includes yearly skin cancer screenings, the treatment of common diseases ranging from acne to psoriasis, and the removal of benign and cancerous lesions. While there is not enough room here to describe how he treats all conditions, there are some general philosophies worth sharing. Much of it has to do with honesty...

An Honest Common Sense Approach

Most important to Dr. Degnan is to always perform the least invasive option. He has issue with physicians who use a scalpel blade when non-surgical options exist.
If surgery is indeed the only option, then the smallest incision necessary should be made to limit scarring, especially if the patient is young or if the scar will not be covered with clothing. Dr. Degnan feels the public should be aware that physicians are reimbursed more money from insurance companies for larger incisions relative to smaller ones, and similarly, reimbursed more for surgical treatments than non-surgical ones.

Secondly, common sense should be employed. If an individual has dozens of reddish pre-cancers on their face (called actinic keratosis), for example, then it is better to use topical creams that will wipe all of them out at once (as well as small ones unseen by the naked eye) as opposed to having the patient return frequently to be treated with liquid nitrogen. Again, a doctor is paid more money by insurance companies for liquid nitrogen treatments than for the use of topical creams.

Thirdly, there is no reason to perform biopsies (putting a piece of tissue under the microscope to confirm a diagnosis) of lesions that are obviously benign. Lesions that are often justifiably biopsied would include pigmented (dark) lesions to rule out malignant melanoma by far the most deadly skin cancer. Also non-pigmented lesions on the face that are in question should be biopsied as they could be either of two common skin cancers called basal cell and squamous cell skin cancers. Having said all this, however, there is rarely a good reason to biopsy a growth that even a lay person recognizes as harmless such as a skin tag or non-pigmented mole that has been present for years without change.  Performing unnecessary biopsies is a way for unscrupulous physicians to run up a patient’s bill. Whether the bill is being paid by the patient or an insurance company, such fleecing of pockets is wrong and contributes to the rising cost of health care in our country. If the patient didn’t want the harmless lesion removed in the first place, then the patient is also left with an unnecessary scar. Dr. Degnan does not bill insurance companies for removing benign lesions. So all patients (including Medicare) must pay out of pocket for harmless lesions (as required by law) and are given a pre-treatment price quote. Again, with this approach, there is less incentive to irresponsibly run up a patient’s bill.  Dr. Degnan feels that if a biopsy is to be done, the biopsy should be sent to an outside pathologist as opposed to the microscopic slide being read by the same doctor who obtained the biopsy. This keeps everyone far more honest. 

Finally, whenever possible, Dr. Degnan tries to arrange to treat the patients’ concerns the first day they present with the problem as opposed to the common practice of rescheduling a treatment visit on a subsequent day. Dr. Degnan recognizes that a patient’s time (and gasoline!) is valuable and that rescheduling something that could be quickly treated should be avoided.