Cassis Dermatology & Aesthetics Center

PA-C Allows Physician Time to Focus

This slideshow requires JavaScript.

PROSPECT Growth. In the context of clinical dermatology, the connotation of the word “growth” may be insidious when applied to an atypical skin lesion. However, from a business standpoint, growth is a measure of success, which is exactly the path Cassis Dermatology & Aesthetics Center has been on since we last spoke with them in 2011.

The growth is evident in the addition of a new practitioner to help manage volume and plans to build out an additional 4,200 square feet of adjacent office space for more exam rooms, dedicated procedure rooms, and a conference room. Construction is set to begin soon and be complete in early 2014.

Solo practitioner Tami Cassis, MD, added Heather Hill, PA-C, to her staff about a year and a half ago. With the addition of Hill, she has been able to lighten her patient load a little, while accommodating more patients overall. “When you have more extenders and more practitioners, you can offer more services and more time slots to patients,” says Cassis.

While Cassis’ dermatology practice has a two-prong focus – clinical and cosmetic dermatology, Hill sees only clinical patients. “I see more of the acute dermatology,” says Hill. She focuses on issues such as acne, warts, changing moles, psoriasis, shingles, rashes, and tick bites. This frees Cassis to focus on skin cancer screenings and patients at high risk for skin cancer.

When deciding what type of practitioner to add to her practice, Cassis’ position on the Kentucky Board of Medical Licensure (KBML) took a fortuitous turn when she was appointed the KBML’s physician representative on the Physician Assistant (PA) Board. While she knew nothing about PAs at the time, other members of the PA Board were helpful in deepening her understanding of the profession. As a result, Cassis began a dermatology rotation with PA students at UK as an extension of the residency rotation she does for dermatology residents at UofL. “The more exposure I got, the more understanding I had, the way more I felt comfortable with having PAs,” says Cassis.

Hill, who was not a student at UK, sought out Cassis for training and was a natural fit for the specialty and this particular practice. From Hardin County, Kentucky, Hill received her bachelor’s degree from UofL and her PA-C from South University in Savannah, Georgia. “As a PA you don’t necessarily specialize,” says Hill. “When I did my rotation, I did it with [Cassis] because regardless of where I want to work, I’m going to need to be able to recognize rashes … and know when I need to refer.” According to Cassis, Hill has been a huge asset with her pediatric population.

A Passion for Early Detection

A 2012 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) report cited skin cancer rates skyrocketing as rates of other major cancers were decreasing. “When that stat came out … it was the smack in the head for me that we are still not doing enough as physicians … I need to get more vocal,” says Cassis.

Cassis admits dermatology has been downplayed in the past, in part because melanoma is the only skin cancer with the threat of death, but she believes better education can change attitudes. “You will live from basal cell and squamous cell, but do you really want part of your face cut off?” she asks.

The good news is there are an increasing number of good options for treatment and prevention of pre-cancers. Photodynamic therapy has become more mainstream, and most insurance is now covering at least part of it. Chemotherapy creams and immunomodulators are getting easier for patients to use. A new cream for actinic keratosis (AK), Picato (ingenol mebutate), boasts a treatment period of three days as opposed to six weeks to three months, which has compliance increasing exponentially.

Cassis just recently purchased MelaFind®, a handheld instrument similar to a Dexa scan that gives a statistical significance for a suspicious mole. By using light refraction, the device can penetrate below the skin to measure the architectural disorganization of a lesion and give a range from -5 to 9. MelaFind is FDA-approved, and while Cassis is still a little skeptical, she says she is optimistic because “she was impressed enough with the science.” The appeal is the ability to catch melanomas much earlier without relying solely on a practitioner’s expertise and avoiding the biopsy of benign lesions. Currently it is not covered by insurance.

She also cites the advent of pharmacies that specialize in dermatologic agents as helping physicians providing the right drug at the right cost for patients. Cassis particularly likes Bluegrass Pharmacy in Lexington for their high-level of understanding and customer service. “They really understand dermatology and understand the rebate cards, insurance, mailing drugs to patients, the nurses limited time and my no time … They understand me!” says Cassis.

The Extension of Aesthetics Services

On the other side of the practice, Hill’s joining the Center has enabled Cassis more opportunity for cosmetics. For Cassis, providing a full range of aesthetic services is a natural fit for a dermatologist. After all, it was in fact dermatology that did the research behind many of today’s cosmetic treatments. Says Cassis of dermatology and plastic surgery, “We’re different, but we have some overlap. We don’t do cosmetic surgery, but we do non-surgical treatments.” CoolSculpting® is one of the newer treatments Cassis loves. Essentially the freezing of fat, the treatment is easy with minimal downtime, and patients get great results.

In skin care, SkinMedica, recently purchased by Allergan, is improving the side effects of Tretinoin, the most commonly prescribed acne medication and the best treatment for fine lines and wrinkles, and is developing a non-prescription product with the efficacy of Tretinoin.

The Future of Dermatology

Cassis foresees the continued development of biologics for psoriasis and more topical chemo-preventive therapies for AK, the most common type of pre-cancer.

A promising new oral medication for basal cell carcinoma has been FDA-approved for about a year. The first of its kind, Erivedge (vismodegib) is currently only approved for basal cell nevus syndrome. “What has really opened up our eyes is they’re responding so well to this drug with minimal side effects that maybe we can now start to do clinical trials to see if this type of drug or this class of drug works for the patient that’s got the big basal cell on their nose, maybe we don’t have to cut,” says Cassis.

WITH THE ADDITION OF A PA, I CAN KEEP SKIN CANCER MY NUMBER ONE PRIORITY FOR PATIENT CARE AND STILL DO THE COSMETIC PERSON WITHOUT FEELING LIKE I’M SLIGHTING ACUTE DERMATOLOGY PATIENTS.