Spring 2017 Skin Lines

SPRING 2017 president’s message

Annual Meeting Update.............2 Melanoma Wednesday..............2 Saving Lives through Shopping........................................3 Model State Award......................4 AADA Advocate of the Year......4 Residency Program Corner.......5 Survival of Physicians in a Value-Based World..................6 Sports Medicine Award..............7 Factoid............................................8 Office Management Pearls.......9 Protect Children from Skin Cancer.................................. 11 Legislative Update..................... 12

We Are In The Midst of Difficult Changes in Healthcare By: Rosalie Elenitsas, MD I am honored to serve as the President of the Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) for 2017. The PAD plays an important role for all Pennsylvania physicians and has a long history as an outstanding state society. Our board consists of 24 physicians who generously volunteer their time and talents to lead our organization. Dr. Glen Crawford, immediate past president, was a superb leader in 2016, and we are grateful that he will continue on our board for the next few years.

Please take a minute to thank our board members when you see them at conferences or at our annual meeting in October. These colleagues have dedicated years of service helping make PAD a great society which has had many remarkable accomplishments. The AADA recently acknowledged our society as a “Model State with Honors”. It was a privilege to accept this award on behalf of the PAD at the March AADA meeting in Orlando (please see page 4).

We are in the midst of difficult changes in healthcare requiring more time from physicians in order to maintain the status quo of our practices. PAD is your representative for Pennsylvania specialty board initiatives. We are your voice in affecting state laws that influence your practice. It is important for all Pennsylvania dermatologists to be a member of PAD and the PA Medical Society. Our organization has an active political advocacy committee, led

by Dr. Bruce Brod. I would like to thank Dr. Brod’s outstanding efforts, which were recently recognized by the American Academy of Dermatology when Bruce was chosen as “Advocate of the Year”. Please read about this welldeserved honor on page 4.

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Melanoma Wednesday

Annual Meeting Update By: Lorraine L. Rosamilia, MD The PAD’s 50th Annual Scientific Meeting will be held on October 19-22, at the Hotel Hershey in Hershey, PA. On Thursday, October 19, Grand Rounds with patient viewing will occur at Penn State Hershey Medical Center. The scientific conference will commence on Friday through Sunday with a range of expert commentary. Joseph Sobanko will outline his research and innovations in procedural dermatology; William James and Warren Heymann will provide master opinions in medical dermatology; Douglas Kress with pediatric dermatology; Julie Harper with acne/rosacea; Matthew Zirwas with contact dermatitis; and Marta VanBeek with all-around dermatology practice and advocacy will round out

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this diverse program. In addition, there will be our annual socioeconomic session, with topics for all practice types, and the return of the resident ‘Mole Bowl’ as a lively competition for our resident attendees.

Our website will provide you with more information over the next few months, including registration details and event schedule and venues. You can also visit the Hotel Hershey website to learn about its amenities and regional offerings. Join us for an enjoyable and informative 50th anniversary conference!

About the Author Dr. Lorraine Rosamilia practices dermatology at Geisinger Scenery Park State College. She currently serves as the Vice President of the PAD.

The Pennsylvania Academy of Dermatology and Dermatological Surgery will recognize Melanoma Awareness month (May) with its annual free skin cancer screening and prevention program at the State Capitol on Wednesday, May 10th. In addition to volunteers providing complimentary skin exams, members of the PAD will also participate in legislative visits to promote the importance of safe sun practices.

We know skin cancer is preventable and treatable when caught early. The signs of skin cancer are visible on the surface, so we need to involve patients and all clinicians in spotting skin cancer — to call when you see something unusual, growing, or changing on your skin. This annual event allows our organization to continue to promote the importance of self-exams and safe sun practices. The PAD continues to provide the public with education on the dangers of indoor tanning and this year our organization is focusing its legislative efforts towards the use of sunscreen in schools.

Through these community service events and grassroots advocacy, the PAD continues to promote the safety of our patients.

Saving Lives through Shopping

SPRING 2017

By: Joslyn R. Sciacca Kirby, MD We know skin cancer is an epidemic. As part of our jobs, we educate our patients about prevention not only for themselves, but also their children. Startlingly, rates of skin cancer in children rose about 2 percent per year from 1973 to 2009.

We slather children in sunscreen, but it’s worn off by recess and many schools don’t supply or apply sunscreen for their students. In order to combat this ongoing issue, the Pennsylvania Dermatology and Dermatologic Surgery (PAD) created the Sun Defense Contest in 2011 to encourage the community to practice sun safety. Students across Pennsylvania submit essays on sun safe practices and the winning school is award funds to be used for sun safety project of their choice.

Your Donations Are Needed!

How You Can Help this Initiative Interested in some shopping at our upcoming Annual Meeting? Get ready for the PAD Silent Auction!

The PAD leadership has generously donated items to be auctioned at this year’s meeting. The Silent Auction will start on the first day of the meeting and bidding will end at the President’s Gala. Funds raised by the Auction will go toward the Sun Defense fund, to continue the PAD’s sun safety projects across the state.

If you would like to contribute to the silent auction, please contact Joslyn Kirby at jkirby1@hmc.psu.edu. Whether or not you plan to attend the 2017 PAD Annual Meeting, you can contribute to the fund by donating an item, bidding on the fantastic items at the Annual Meeting, or contributing a monetary donation to the fund online.

We are looking forward to this new and lively event at the PAD Annual Meeting — see you there (and don’t forget your wallet!) Thank you for your support!

The PAD Public Health Education Fund which supports the annual Sun Shade Essay Contest is in need of funds. The PAD Health Education Fund was established to support grants and educational outreach regarding skin and sun safety. Your donation is tax-deductible.

Go to the Foundation’s online giving page to make your gift to PAD...

Click the “Designating my gift” drop down menu and choose “PAD Public Health Education Fund” to donate to this fund. The Foundation will acknowledge your tax-deductible gift.

About the Author Dr. Joslyn Kirby is an Associate Professor of Dermatology at Penn State Hershey Medical Center.

She serves as chair of the PAD’s Skin Cancer Screening Committee.

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PAD Wins Model State Award for 15th Consecutive Year The Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) received its 15th Model State Society Award with Honors from the American Academy of Dermatology Association (AADA) during the March 2nd reception held in conjunction with the AADA’s Annual Meeting in Orlando, FL. The PAD received Special Recognition for an exceptional Young Physician Outreach program with the first Annual “Mole Bowl Resident Competition”.

Bruce A. Brod, MD wins AADA Advocate of the Year

The Model State Award program was initiated in 2000 to recognize the significant accomplishments of state dermatology societies.

These awards encourage state dermatology societies to develop or to continue to develop essential services to their membership, including leadership opportunities, involvement in state and federal legislation that affects dermatology and community service.

PAD President, Dr. Rosalie Elenitsas, accepts the 2016 Model State Award with fellow board member, Dr. Lorraine Rosamilia, and PAD Executive Director, Jennifer Keeler.

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The American Academy of Dermatology Association recognized Bruce Brod, MD, as Advocate of the Year during its Annual Meeting in Orlando, FL. Dr. Brod has dedicated countless hours to grassroots advocacy in both Pennsylvania and the federal level. Dr. Brod was instrumental in getting Pennsylvania’s indoor tanning legislation passed and has continuously ensured the best quality of dermatologic care through the legislative process. Congratulations on this accomplishment and thank you for your continued service to our patients and practice.

SPRING 2017

residency program corner

Drexel University College of Medicine Department of Dermatology By: John Durkin The Department of Dermatology at Drexel University College of Medicine is committed to providing extraordinary care to a diverse patient population, superior medical education, and innovative clinical research. The program is home to nine dermatology residents and would like to highlight its three graduating residents.

special because of the people. She’s happy to have her co-residents with her every day - through the good and the bad days and enjoys hanging out with them outside of work. Following her residency, Christine will be entering a Mohs surgery fellowship with Dr. Richard Bennett in Santa Monica, California.

Dr. Warner (left) with her husband.

Dr. Etzler (left) with her fiancé.

Dr. Shaver (right) meeting Michael Strahan during her medical journalism elective.

Dr. Christine Shaver is from the town of Carlisle, MA and spends her free time rowing on the Schuylkill River.

She is particularly interested in treating high-risk patients with skin cancer especially transplant recipients and other immunosuppressed populations.

She finds Drexel Dermatology to be

Dr. Chloe Etzler grew up in the town of Westminister, MD. She has been an avid equestrian since childhood and is hoping to find a horse of her own soon. She enjoys treating inflammatory skin diseases and skin cancers. When asked what makes Drexel Dermatology special she said, “Our program is filled with really great people. We always have a good time together, inside and outside of the office.” After graduation, she is joining CGH Medical Center in Sterling, Illinois and will practice a mixture of general, pediatric, and surgical dermatology. The Midwest is new to her and she is looking forward to a new adventure.

Dr. Catherine Warner hails from the city of Atlanta, Georgia. She is a competitive squash player and enjoys cooking and traveling in her free time.

Catherine’s academic interests include pediatric melanoma. She is currently writing a textbook chapter and helping to create a registry for pediatric melanoma cases. When asked what makes Drexel Dermatology special she replied, “We work in a great community and treat a diverse patient population.”

After residency, she will be spending time on the beaches of California while completing her fellowship in pediatric dermatology at University of California, San Diego.

About the Author Dr. Durkin is a dermatology resident at the Drexel University College of Medicine Department of Dermatology.

Dr. Durkin is also a member of the PAD Resident Committee.

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Survival of Physicians in a Value-Based World By: Dennis Olmstead, MPA We’re past the tipping point as we proceed headlong into new market-driven accountability for quality, cost, and value. As employers and payers demand proven, valuebased health care, and the market shifts from rewarding volume to rewarding value, physicians must be able to demonstrate the highest standard of care to effectively remain competitive for the foreseeable future.

It’s not something we should do — it’s something we must do.

Information from the Centers for Medicare and Medicaid Services (CMS), the Commonwealth of Pennsylvania, and commercial payers indicates this value shift will account for a significant portion of physician reimbursement within just a few short years.

maintaining practice autonomy, physicians are given every opportunity to succeed in the new value-based world.

To lead this effort and help Pennsylvania physicians survive and thrive in this new health care landscape, the Pennsylvania Medical Society’s 2016 House of Delegates (HOD) passed a landmark initiative on Oct. 23, 2016. This historic initiative — called the Practice Options Initiative ― will create clinically integrated networks (CINs) as well as a Management Services Organization (MSO) to help Pennsylvania physicians succeed in value-based care, while maintaining leadership roles and clinical autonomy.

As payment models quickly change, employers and payers are demanding greater accountability. Physicians are in a unique position to work together to co-create meaningful solutions that result in the highest quality of patient care available and the appropriate rewards for its delivery.

The MSO will initially provide services within the general categories of revenue cycle, practice operations, and finance and business operations.

It will include services such as front end management as well as back end management of the practice, staff payroll, reimbursement, charge capture, appeals, coding, practice management, etc., as well as Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) readiness and MeritBased Incentive Payment System (MIPS) reporting. These services will be available to any physician practicing in Pennsylvania or elsewhere.

As a result, many physicians are joining together to seek opportunities for higher levels of success amid these changes. By participating in an aggregated, larger network while

One way physicians can succeed in value-based care is through CINs. A CIN is a group of separate practices — each with a unique Tax Identification Number (TIN) — collaborating to

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demonstrate value, meet quality metrics, and improve patient outcomes.

This is a direct response to the evolving health care delivery system, which is moving rapidly toward valuebased care led by passage of MACRA and its accompanying regulations.

This guidance outlines the use of MIPS reporting and development of Alternative Payment Models (APMs).

A well-led CIN provides the infrastructure to efficiently, effectively, and comprehensively address the known issues in health care for the foreseeable future, and an established physician-led, physicianowned network to efficiently address the unknown health care shifts of tomorrow.

In a physician-owned and physicianled CIN, physicians are not only “at the table,” but are creating and implementing the local approach collectively. The more physicians understand the value of physiciandriven networks, the more successful and sustainable they will be as health care leaders. It will also increase professional satisfaction — a very important part of who physicians are, and something that has recently been at an all-time low.

The ultimate goal is for CINs to serve as the high-performing, local catalysts for greater value for the health care dollar, while rewarding participating physicians for their work. PAMED plans to advance these networks by providing physicians with the knowledge, tools, and confidence

SPRING 2017 that patients are receiving the best, most appropriate care possible throughout the entire continuum of care provided.

This means physician engagement must occur at a granular level. Physician-created initiatives, with input and buy-in from the entire network, and resulting in better overall coordination, is a cornerstone of success. This will allow physicians to directly affect health outcomes for large populations of patients while also being able to bend the cost curve, as the market so desperately needs.

PAMED must and will support physicians during this transition through use of services offered through the MSO or CINs. PAMED is looking to engage Pennsylvania physicians; provide the necessary education, clinical tools, and data; and offer hands-on practice support to assure successful transitions.

This is the value of becoming part a CIN, and of being a PAMED member.

Dr. Kenneth Wasserman Receives Prestigious Sports Medicine Award

If you would like additional information about PAMED’s Practice Options Initiative, which is now referred to as the Care Centered Collaborative(CCC) , please contact Dennis Olmstead, the CCC’s Chief Operative Officer, at 866-441-2392 or www.patientccc.com.

If you haven’t already, check out PAMED’s online, on-demand CME series — “Addressing Physician Uncertainty about Payment Reform: Skills for Success in Value-Based Delivery Systems.” Free to PAMED members, this series is facilitated by Ray Fabius, MD, a PAMED member and a nationally respected expert in the field of population health. It covers a variety of important topics, including practical health informatics, using a data toolbox in your practice, quality management, process improvement, lessons learned from the managed care era, and population health. Access the CME at www.pamedsoc. org/valuebasedcare.

About the Author Dennis Olmstead is the Senior Vice President of Business Strategy & Development at the Care Centered Collaborative, a subsidiary of the Pennsylvania Medical Society.

PAD board member, Kenneth Wasserman, MD, recently received the James R. Andrews Excellence in Baseball Sports Medicine award. The award recognizes individuals who have significantly contributed to baseball sports medicine, and is presented by the American Sports Medicine Institute. Dr. Wasserman is the founder of Major League Baseball’s skin cancer program. Since starting the initiative 18 years ago, over 41,000 baseball players and team employees have undergone screenings. Dr. Wasserman is an assistant clinical professor at Hahnemann University Hospital, clinical instructor at Jefferson University Hospital, and the team dermatologist for the Baltimore Orioles.

A version of this article first appeared in the summer 2016 issue of the Pennsylvania Physician and was updated on Dec. 13, 2016.

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FACToid By: Alison Spiker, MD Case A 7-year-old Hispanic boy presented for a concerning dark lesion on his occipital scalp.

The lesion had been present for 1-2 years and had grown in size as the patient grew. It had become irritated while shaving the patient’s hair to the point of bleeding on several occasions.

There was no family history of melanoma. On exam, there was a 5mm dark brown-black firm nodule on the occipital scalp. Dermoscopy revealed homogenous black pigment with bluewhite veil. Histopathology revealed a heavily pigmented predominantly dermal melanocytic proliferation composed of pigmented epithelioid melanocytes with prominent blue nucleoli admixed with pigmented spindled to dendritic appearing melanocytes, 1 dermal mitosis/mm2, and extensive melanophages. Ki67 staining demonstrated increased signal in the dermis; MART1 was positive but difficult to discern due to the pigmented nature of the lesion.

Dermoscopy reveals homogenous black pigment with a blue-white veil.

Heavily pigmented predominantly dermal melanocytic proliferation (H&E, 40x).

What’s the diagnosis?

A. B. C. D.

Banal nevus Blue nevus Malignant melanoma Pigmented epithelioid melanocytoma

Continue to page 10 for the diagnosis

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Presence of pigmented epithelioid melanocytes with admixed pigmented spindled to dendritic appearing melanocytes, 1 dermal mitosis/mm2, and extensive melanophages (H&E, 400x).

SPRING 2017

OFFICE MANAGEMENT PEARLS

Practice Management Tips By: Scott Lim, DO Whether we are in private practice or academic medicine, we are all faced with the challenges of managing our practice and our resources as efficiently as possible.

Many of us share the same challenges and some of us have come up with useful solutions to deal with some of these challenges. One of the advantages of our PAD is that we can pull our resources to accomplish goals. We all have a wealth of free resources- our experience and ideas!

This section of Skin Lines will enable our membership to share with other members such useful tips.

Prior Authorizations and Ways to Minimize the Headaches Prior Authorizations are one of the biggest headaches for many dermatologists, causing significant extra time, costs, and resources to our practices. Although the AMA, AADA and our State Medical Societies are doing what they can to make positive changes for physicians, we need to deal with some of these problems right now! Here are some “work arounds” to possibly avoid, or at least minimize, some of the dreaded prior authorization requests that disrupt our day: •

Familiarize yourself with what is covered on your major insurance plans. It seems obvious, but if you know it won’t be covered, then you may try something that is covered first. Some EMR systems help you sort this out.

•

Use Apps such as “Formulary Search” to have an idea about what is covered before you prescribe. It may take some extra steps and may not be always accurate, but can help.

•

Talk to your pharmaceutical sales representative about what Specialty pharmacies they partner with since these Specialty pharmacies are more likely to utilize rebates and try to troubleshoot prior authorizations. This will help minimize your staff’s time and get the product into your patients’ hands with the least out of pocket expense. If your EMR permits, include in the “message to pharmacist” section any information that would help them in getting the drug approved- ex. Did not respond to previous formulary drug, side effect or contraindication for a previous formulary drug, etc.

•

Some of these Specialty pharmacies are willing to keep your “Standing Order Form” on file. This means that if your initial medication order cannot be filled, they will fill your “1st Conversion Preference” followed by your “2nd Conversion Preference”, followed by your “3rd Conversion Preference”. This reduces extra phone calls or faxes to your office requesting options to your prescription prescribed.

If you have something useful to share, please send information to me at slimderm3243@gmail.com and I will collect, organize, and present to membership in our newsletters on a regular basis.

About the Author Dr. Lim has been a solo private practice dermatologist in Erie, PA since 1990. Dr. Lim completed medical school at the Philadelphia College of Osteopathic Medicine.

He currently serves as the Secretary of the PAD and Editor of Skin Lines.

Again, these tips are to avoid the Prior Authorization requests before they are generated.

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FACTOID Continued form page 8 Diagnosis D. Pigmented epithelioid melanocytoma

Discussion: Pigmented epithelioid melanocytoma (PEM) was first described in 2004 by Zembowitz et al as a group of very rare melanocytic tumors previously described as “animal-type melanoma” and epithelioid blue nevus (of Carney complex).1 PEM is most often diagnosed in children, adolescents and young adults but can occur over a broad age range. There is no ethnic predilection, but it frequently occurs in races less susceptible to melanoma, including Hispanic, African-American, Asian, and Persian.1 Lesions have been identified most often on the extremities but also on the trunk, head and neck, and genitalia, suggesting that UV light may not play a role in pathogenesis.1 Clinically, PEM can resemble blue nevi or melanoma. Dermoscopic findings previously reported in PEM include blue-black pigmentation, homogenous blue pigmentation, brown comedolike openings, crystalline structures, and blue pigmentation into lymphatic vessels.2 Our case revealed homogenous black pigmentation and the presence of a blue-white veil, a finding suggestive of melanoma.3 Histopathology of PEM reveals a mixture of heavily pigmented spindled and epithelioid melanocytes which is indistinguishable from animaltype melanoma and epithelioid blue nevus of Carney complex.1 Ulceration may support the diagnosis of PEM over epithelioid blue nevi of Carney

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complex.1 As in our case, mitoses may be present, although risk of metastasis has not been found to correlate with presence of mitoses or aggressive cytologic features.1 The majority of PEMs have loss of expression of a Carney complex gene, cyclic adenosine 3’,5’ monophosphatedependent protein kinase regulatory subunit 1α (R1α).4 Loss of expression of R1α was not evaluated in our patient’s tumor, yet testing may help distinguish PEM from histological mimickers such as blue nevi and equine melanoma.4 Lymphatic involvement with rare visceral metastasis has been reported,1 but long term outcome is favorable.5 Management typically involves surgical excision with consideration of sentinel lymph node biopsy,1 however no formal guidelines exist. Some authors have suggested surgical excision without sentinel lymph node evaluation unless clinical evidence of metastasis.6 In our case, the patient underwent excision with 5-10 mm margins by pediatric plastic surgery after an evaluation by a pediatric pigmented lesion specialist. The patient continues to follow in the pediatric pigmented lesion clinic for skin examinations and has had no lesion recurrence or palpable lymphadenopathy 8 months after surgery.

Take-away PEM is a low-grade melanocytic tumor with good long-term prognosis despite possible metastasis to lymph nodes.

References: 1. Zembowicz A, Carney JA, Mihm MC. Pigmented epithelioid melanocytoma: a low-grade melanocytic tumor with metastatic potential indistinguishable from animaltype melanoma and epithelioid blue nevus. Am J Surg Pathol 2004;28:31-40.

2. Moscarella E, Ricci R, Argenziano G et al. Pigmented epithelioid melanocytoma: clinical, dermoscopic and histopathological features. Br J Dermatol 2016;174:115-7.

3. Crotty KA, Menzies SW. Dermoscopy and its role in diagnosing melanocytic lesions: a guide for pathologists.

Pathology 2004;36:470-7.

4. Zembowicz A, Knoepp SM, Bei T et al. Loss of expression of protein kinase a regulatory subunit 1alpha in pigmented epithelioid melanocytoma but not in melanoma or other melanocytic lesions. Am J Surg Pathol 2007;31:1764-75.

5. Mandal RV, Murali R, Lundquist KF et al. Pigmented epithelioid melanocytoma: favorable outcome after 5 year follow-up.

Am J Surg Pathol 2009;33:177882.

6. Lim C, Murali R, McCarthy SW et al. Pigmented epithelioid melanocytoma: a recently described melanocytic tumour of low malignant potential.

Pathology 2010;42:284-6.

About the Author Dr. Spiker is a dermatology resident at Geisinger Medical Center. Dr. Spiker is also a member of the PAD Resident Committee.

SPRING 2017

Protect Children from Skin Cancer: Support Efforts to Allow Sunscreen Use in Schools!

By: Million & Goodman Just one blistering sunburn event during childhood more than doubles your chance to develop skin cancer later in life. Therefore, it is a high priority to ensure that children can use sunscreen and sun-protective clothing when outdoors. Yet in most states, students need a doctor’s note just to bring sunscreen to school.

In Pennsylvania, only the school nurse can administer sunscreen because it is considered an over the counter medication by the Food and Drug Administration (FDA). Just like Neosporin, students must have a doctor’s order, not just their parent’s permission, and the sunscreen must be administered by a nurse. Kids can’t even bring sunscreen to school and apply it themselves.

The Centers for Disease Control and Prevention believes that school policies that prohibit hats or student possession of sunscreen can create barriers to the use of important sun protection methods. Moreover, the United States Preventive Services Task Force recommends educating children, adolescents and young adults on the dangers of sun exposure to reduce the risk of skin cancer.

To remedy this problem, Pennsylvania state Representative Hal English (R-Allegheny) has introduced House Bill 1228, which was referred to the House Education Committee on April 17, 2017.

Specifically, House Bill 1228 amends the Public School Code to allow for the outdoor use by students of sunprotective clothing, including, but not limited to hats. The bill provides that nothing would prevent a school entity from prohibiting certain clothing or hats based on the inappropriateness of the graphics, color or message of the clothing or hats.

sunscreen product with parental permission.

In addition, this legislation would allow students, during school hours or at a school-sponsored activity, to apply a non-aerosol topical sunscreen product without a physician’s note or prescription if the product is approved by the FDA for over-the-counter use.

Five other states (California, New York, Utah, Oregon, and Texas) already allow kids to use sunscreen in school and the state of Washington will soon follow, as its Legislature has passed similar legislation, which awaits the signature of the Governor.

Moreover, a school entity may allow, but not require, school personnel to assist students in applying a topical

NBC’s Today Show even picked up on the issue with an April 18, 2017

Finally, school personnel may not be held liable in a criminal action or for civil damages for application of a nonaerosol topical sunscreen product if the topical sunscreen product is available to and used by the student in accordance with the legislation.

CONTINUED ON PAGE 12

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PROTECT CHILDREN Continued from page 11

Legislative Update Spring 2017

segment that was very supportive of the sunscreen in schools’ issue.

By: Bruce A. Brod, MD Pennsylvania House Bill 1228 to Allow for Easier Access to Sun Protection in Schools

However, elected officials want to hear from their constituents – the people that elected them and can re-elect them. Therefore, in addition to the work that we at Milliron & Goodman are doing in Harrisburg, we need you to reach out to your state Representative and Senator in Pennsylvania and ask them to support House Bill 1228.

If you are unsure of who your state legislator(s) are, click on the following link to identify them: http://zipstickers. mypls.com/LookUp.aspx?cid=200030 Simply type in your home and/ or work address and this link will direct you to your state and federal legislator’s (although you only need to contact your state legislators) contact information.

With your help, we can get House Bill 1228 moving and in position for consideration by the House before Summer recess. So, contact your state legislators and express your support for House Bill 1228!

References 1. http://www.legis.state.pa.us/cfdocs/

billinfo/billinfo.cfm?syear=2017&sin d=0&body=H&type=B&BN=1228

Pennsylvania state representative Hal English (R-Allegheny) is the prime sponsor of HB 1228. This bill will accomplish three main goals that will help to reduce the risk of skin cancer for Pennsylvania children: • Allow students to possess and apply their own approved non-aerosolized sunscreen.

•

Eliminate burdensome requirement of a doctor’s note and a visit to the school nurse to apply an FDA approved sunscreen.

•

Allow students to use sun-protective clothing, including, but not limited to hats, while participating in outdoor activities.

Please contact your state representative and ask them to co-sponsor HB 1228.

May is Skin Cancer Awareness Month Representative Frank Farry (R-Bucks) plans to introduce a resolution next month to declare May as Skin Cancer Awareness Month in Pennsylvania. Representative Farry was the prime sponsor of the indoor tanning bill that passed in Pennsylvania.

In-Office Compounding Under the Microscope PAD and AAD/A recently sent a joint letter commenting on recently proposed regulations issues by the PA Board of Pharmacy. Our comments focused on preserving our ability to perform low risk office compounding such as buffering lidocaine as we use it so commonly for outpatient surgery. In addition, in the letter we asked for clarity on our ability to have bulk substances compounded.

Additionally, the AAD/A remains engaged with authoritative bodies including the FDA and the FSMB on the low risk compounding practices performed by dermatologists.

2. http://www.today.com/video/

sunscreen-in-school-parents-pushfor-kids-to-be-allowed-to-useit-923483715505

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About the Author Dr. Bruce Brod is a Clinical Professor of Dermatology and is on the faculty of the University of Pennsylvania Department of Dermatology.

He is also the Co-Director of the Contact Dermatitis Clinic at Penn.

In addition he is an attending physician at Children’s Hospital of Philadelphia. Dr. Brod is currently a board member of the PAD and is the Congressional Policy Chair of the American Academy of Dermatology.

SPRING 2017

PRESIDENT’S MESSAGE Continued from page 1

I would also like to thank the PAD staff members: Jennifer Keeler, Executive Director; Kim Whetsell, Assistant Executive Director; Jill Senior, Meeting Manager; and Melanie Dupont, Member Services Specialist. These staff members help our physician leadership tremendously and make things happen. We are lucky to have such dedicated and hardworking advisors.

2017 marks the 50th anniversary of the PAD’s annual meeting. Dr. Lorraine Rosamilia and her committee are

planning an outstanding conference at the Hershey Hotel this October 19-22, 2017.

The PAD meeting offers an excellent opportunity for both CME credits and MOC credits. The venue is beautiful, providing an attractive and fun place for family members of all ages.

My husband and daughters have attended more than 10 PAD meetings and are looking forward to another wonderful weekend in the “Sweetest Place on Earth”.

See you there!!

About the Author Dr. Rosalie Elenitsas is Professor of Dermatology and Pathology at the University of Pennsylvania in Philadelphia where she practices both dermatology and dermatopathology.

She is the director of Penn Cutaneous Pathology Services and the director of the Dermatopathology Fellowship training program.

She is a member of the Penn Dermatology Oncology Center focusing on malignant melanoma and other cutaneous tumors.

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