This case involves the removal of actinic keratosis with cryotherapy by a physician’s assistant on the right arm of a 67-year-old male patient with an arteriovenous fistula. Over a period of 3 weeks, the wound on the right arm began to fester and did not show signs of healing. The patient’s cousin had a collagenase ointment used from a previous injury that the patient used on his right arm in an attempt to encourage the healing process. However, the wound still did not heal after a few days and he ultimately needed a skin graft on his right arm.
Patient Requires Skin Graft After Cryotherapy
Question(s) For Expert Witness
- 1. Do you regularly treat actinic keratosis with cryosurgery?
- 2. Do you work with a PA and are you able to comment on the level of supervision required, what they are certified to do and what they are certified not to do?
- 3. Would you be concerned performing a procedure on the same arm as a patient with an arteriovenous fistula for dialysis access?
- 4. Have you reviewed similar cases?
Expert Witness Response E-004454
I regularly treat actinic keratosis with cryotherapy. As far as the arteriovenous fistula, the actinic keratosis had to be removed and I think cryotherapy was a reasonable choice for this patient, especially if that was their only resource. I train PA’s for a university in my private practice and am currently working with two. I reviewed a similar case but the PA misdiagnosed a perineural SCC for actinic keratosis.
Expert Witness E-004454
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