Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)
CPT4 code
Name of the Procedure:
Destruction of Premalignant Lesions (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement)
Summary
This procedure involves removing premalignant skin lesions, specifically actinic keratoses, using various techniques such as laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement. The process is repeated for each additional lesion from the second through the fourteenth lesion.
Purpose
The procedure targets premalignant lesions like actinic keratoses, which are areas of skin damage with the potential to develop into skin cancer. The goal is to eradicate these lesions to prevent progression to malignant cancer, thereby ensuring better skin health and reducing cancer risk.
Indications
- Presence of multiple actinic keratoses
- Lesions not responding to less invasive treatments
- Patient at high risk for skin cancer due to extensive sun exposure or previous history of skin cancer
Preparation
Patients may be instructed to:
- Avoid sun exposure before the procedure
- Discontinue certain medications as advised by their doctor
- Undergo a dermatological examination and skin biopsy if necessary
Procedure Description
- The area around the lesion is cleaned and sterilized.
- Local anesthesia may be administered to numb the area.
- Depending on the technique used (e.g., laser, cryotherapy), the healthcare provider will systematically treat each lesion:
- Laser Surgery: Uses focused light beams to destroy the abnormal cells.
- Electrosurgery: Employs electric currents to remove the lesions.
- Cryosurgery: Freezes the lesions with liquid nitrogen.
- Chemosurgery: Applies chemicals to destroy abnormal cells.
- Surgical Curettement: Scrapes away lesions using a curette.
- This process is repeated for the second through the fourteenth lesions as needed.
Duration
Typically, the procedure lasts between 30 minutes and 1 hour, depending on the number and size of lesions treated.
Setting
The procedure is usually performed in an outpatient clinic or a dermatologist's office.
Personnel
- Dermatologist or specialized surgeon
- Medical assistant or nurse
Risks and Complications
Common risks include:
- Pain or discomfort at the treatment site
- Redness and swelling
- Scarring or changes in skin pigmentation Rare but serious complications:
- Infection
- Prolonged healing times
- Poor cosmetic outcomes
Benefits
- Effective removal of premalignant lesions
- Reduced risk of skin cancer development
- Generally quick recovery time
Recovery
- Patients may experience redness, swelling, or scabbing at the treatment sites.
- Post-procedure care includes applying prescribed ointments and keeping the area clean.
- Avoid sun exposure and protect the treated area with sunscreen.
- Recovery time varies but usually ranges from a few days to a couple of weeks.
- Follow-up appointments may be needed to monitor healing and effectiveness.
Alternatives
Other treatment options include:
- Topical medications (e.g., 5-fluorouracil, imiquimod)
- Photodynamic therapy
- Observation and regular monitoring for any changes in lesions
Each alternative has its pros and cons, with some being less invasive but requiring longer treatment times or multiple sessions.
Patient Experience
During the procedure, patients might feel a sensation of heat or cold depending on the technique used. Post-procedure discomfort can often be managed with over-the-counter pain relievers and proper wound care as advised. Most patients can return to normal activities shortly after, though they should follow all post-procedure care instructions for optimal healing and results.