What to Expect at Your Dermatology Visit, and How a Proposed Medicare Cut Could Change It

Whether this is your first dermatology appointment or your twentieth, it helps to know what is coming. Most visits follow a simple rhythm: we listen, we look, and we make a plan together.

Dermatology is also one of the few specialties where a problem can often be diagnosed and treated in a single appointment. A suspicious spot can be biopsied before you leave. A rough precancer can be frozen in seconds. For Alaskans who drive for hours, catch a flight, or ride the ferry to see us, that same-day care is more than a convenience.

This guide walks you through a typical visit and explains the most common in-office procedures in plain language. It ends with an important update on a proposed Medicare payment change. A final decision is expected around November 1, and if the change is finalized, it could make same-day care harder to provide nationwide starting January 1, 2027. If you have Medicare, or love someone who does, please read to the end.

Before your visit: how to prepare

A little preparation helps us make the most of your time. Please arrive 15 minutes early so check-in does not cut into your visit. Our New Patients page has more details, including which forms you may be asked to fill out in advance.

What to bring

• Photo ID and your current insurance card or cards
• A referral or prior authorization, if your plan requires one
• A list of your medications, including blood thinners such as aspirin, warfarin, apixaban, or clopidogrel, plus vitamins and supplements
• Your allergies, including any reactions to numbing medicine, tape, or bandages
• Your skin cancer history: what type, when, and how it was treated, plus any family history of skin cancer
• Phone photos of any spot that has changed, or of a rash that comes and goes
• A short list of your questions, with the most important one first

Preparing for a full skin check

• Remove nail polish from your fingers and toes so we can examine your nails.
• Skip makeup, or bring remover, so we can see the skin around your eyes.
• Wear your hair loose, without clips or ponytails, so we can check your scalp.
• Wear clothing that is easy to change out of.

Please tell us if you:

• Take a blood thinner
• Have a pacemaker, implanted defibrillator, or other implanted device
• Have had heavy bleeding after a procedure, or thick, raised scars
• Have a weakened immune system or an organ transplant
• Are pregnant or breastfeeding

If you take a blood thinner, do not stop it on your own before a visit. We will tell you if anything needs to change.

During your visit: what happens

A board-certified dermatologist is trained to diagnose and treat more than 3,000 conditions of the skin, hair, and nails, so one visit can cover a lot of ground (AAD). Here is the usual flow.

1. Check-in and history. We review why you came in, your medications and allergies, and any personal or family history of skin cancer.
2. Your clinician. You will see one of our board-certified dermatologists or one of our dermatology-trained physician assistants, who work closely with our physicians.
3. The exam. We examine the area that concerns you, or your skin from scalp to soles if you came in for a full skin check.
4. The plan. We explain what we see, what it most likely is, and your options. That might mean reassurance, a prescription, a procedure today, or a follow-up visit.

Some treatments, biopsies, and minor procedures can be done the same day. Others need their own appointment, usually because they take more time or preparation.

Ask questions at any point. If something does not make sense, we would rather explain it twice than have you leave unsure.

The full-body skin exam

A full-body skin exam is quick and painless. For most people without a history of skin cancer or unusual moles, it takes about 10 to 15 minutes (MedlinePlus; Skin Cancer Foundation). It can take longer if you have had skin cancer or have many or unusual moles.

You change into a gown, and we check your skin from scalp to soles: behind your ears, between your fingers and toes, your nails, and the bottoms of your feet. In most cases you can keep your underwear on unless you have a concern in that area, and you can always ask us to skip any area.

We often use a dermatoscope, a handheld magnifier with a built-in light that shows the surface of the skin and the layers just beneath it. It does not hurt.

Most spots turn out to be harmless, and we can often tell you so during the visit. When a spot needs a closer look, a skin biopsy is the only way to know for sure whether it is skin cancer (AAD). Learn more about mole checks and full-body skin exams at our clinics.

Between visits, checking your own skin regularly helps you catch changes early. Our guide How to Do a Skin Self-Exam shows you how.

What is a skin biopsy?

A skin biopsy removes a small sample of skin so a physician can examine it under a microscope. For some skin diseases, including skin cancer, infections, and conditions that cause blisters, that microscopic view is the only way to make a sure diagnosis. A biopsy can also help find the cause of a rash (AAD).

A biopsy does not mean we think you have cancer. It is how dermatologists confirm many different diagnoses, and most biopsies take about 15 minutes (Mayo Clinic).

How it is done

1. Numbing. We clean the skin and inject a local anesthetic such as lidocaine. You may feel a pinch and a few seconds of burning; after that, you should not feel pain.
2. Taking the sample. The method depends on what we suspect and where the spot is:
   • Shave biopsy: a thin blade removes the top layers of skin. Stitches usually are not needed.
   • Punch biopsy: a small round tool, like a tiny cookie cutter, removes a deeper core of skin. You may need a stitch or two.
   • Excisional biopsy: the whole growth is removed with a border of normal skin, then closed with stitches.
3. Bandaging. We stop any bleeding with pressure or a medicine, then apply petroleum jelly and a bandage.

Caring for the site at home

• Start the day after your biopsy. Wash your hands, remove the bandage, and gently wash the site with mild soap and water.
• Pat dry, apply a thin layer of petroleum jelly from a squeeze tube, and cover with a fresh bandage. Moist, covered wounds heal faster.
• Repeat daily until healed. Most biopsy sites heal in 7 to 10 days; sites on the lower legs take longer.
• Showers are fine, but skip pools, hot tubs, and baths until the site heals.
• Skip antibiotic ointment. Dermatologists note it is more likely to cause an allergic reaction than to prevent an infection after a biopsy.
• For soreness, acetaminophen or an ice pack over the bandage usually helps.
• If the site bleeds, press firmly with gauze for 20 minutes without peeking. If it is still bleeding, call us.

These steps follow the AAD's biopsy wound care guidance, and we will give you written instructions before you leave.

A biopsy usually leaves a small scar that fades with time; its final color can take 1 to 2 years to settle. Thick, raised (keloid) scars are more common in brown and Black skin and on the chest, back, and neck, so tell us if you have formed one before (Mayo Clinic). Protecting the healed site from the sun helps the mark fade.

Getting your results

Your sample goes to a lab, where a physician with special training in diagnosing skin disease, usually a dermatopathologist, examines it under the microscope. Results are often ready in a few days, though some samples need special testing and take longer. We will contact you with your results, and you can also view test results in our secure patient portal.

Learn more about skin biopsies and excisions at Advanced Dermatology of Alaska.

What is cryotherapy?

Cryotherapy, also called cryosurgery, destroys abnormal skin cells by freezing them with liquid nitrogen, which is about minus 320 degrees Fahrenheit (American Family Physician). It is one of the most common treatments done in a dermatology office.

What it treats

• Actinic keratoses, the rough, scaly precancerous spots caused by sun damage (learn more)
• Warts
• Seborrheic keratoses and other harmless growths that are irritated, itchy, or catching on clothing
• Skin tags

What it feels like

We apply the liquid nitrogen with a spray device or a cotton-tipped applicator, a few seconds at a time. It feels intensely cold, then stings or burns. Most people do not need numbing (American Family Physician), and any mild soreness is usually gone within about three days (Cleveland Clinic).

What happens next

• Within hours, the spot turns red and may swell. A blister, sometimes filled with blood, often forms. That is expected: the frozen skin blisters and peels so healthy new skin can grow.
• A scab forms and falls off on its own, usually within 1 to 3 weeks. Spots on the lower legs heal more slowly.
• Wash gently once a day. Petroleum jelly and a bandage help if the spot rubs on clothing. Leave the blister intact if you can, and do not pick the scab.
• Some growths, especially warts, need more than one treatment.

Possible side effects

A common side effect is a lighter or darker spot where the skin was frozen. This is more likely, and more noticeable, in darker skin. It often fades with time, but a lighter spot can be permanent (American Family Physician; British Association of Dermatologists). Hair loss in the treated area, changes in feeling, and scarring are less common.

Call us if you see signs of infection, such as spreading redness, pus, or fever, or if the spot is still there after it heals.

If you have many precancerous spots, freezing them one at a time is not the only option. Our post on field therapy explains treatments for whole areas of sun damage.

Other treatments that may happen the same day

Depending on what we find, a visit may include other quick, in-office procedures. These are among the most common.

• Injections into the skin. A small amount of a corticosteroid such as triamcinolone, injected directly into an inflamed cyst, a thick scar, or a patch of hair loss, can calm inflammation in that spot.
• Electrodesiccation and curettage (ED&C). For certain small, low-risk basal cell carcinomas on areas such as the back, abdomen, arms, or thighs, we scrape away the cancer with a tool called a curette and use heat to destroy the remaining cancer cells. It is usually done after a biopsy confirms the diagnosis.
• Excision. We numb the area, cut out the growth with a margin of normal skin, and close the wound with stitches. The tissue goes to the lab to confirm the edges are clear.

Larger procedures, such as many excisions and Mohs surgery, are usually scheduled as their own appointment so we can set aside the time they need.

Mohs surgery

Mohs surgery removes skin cancer one thin layer at a time. Each layer is checked under the microscope while you wait, and the surgeon removes more only where cancer remains. Because the surgeon can see where the cancer stops, Mohs has the highest cure rate of all skin cancer treatments (AAD). It is often recommended for skin cancers on the ears, eyelids, nose, hands, or feet, and for cancers that are likely to grow deep or have come back. Learn more about Mohs surgery at Advanced Dermatology of Alaska.

After your visit

• Results. We will contact you when biopsy or lab results are back, and you can also view them in your patient portal.
• Questions and refills. For non-urgent questions, including refill requests, you can message your care team through the patient portal. Call us for urgent or time-sensitive concerns. For a medical emergency, call 911.
• Follow-up. Many skin conditions need a recheck to see how treatment is working. If we recommend one, it is easiest to schedule before you leave.
• Your next skin check. How often you need one depends on your skin type, sun exposure, and personal or family history of skin cancer. If you have had skin cancer before, a yearly exam is usually recommended (MedlinePlus).

Call us right away at (907) 267-5890 if you notice:

• Bleeding that does not stop after 20 minutes of firm, steady pressure
• Signs of infection: worsening pain, increasing swelling or redness, warmth, pus, yellow crusts, or fever
• A treated spot that does not heal, or that comes back

The Medicare update: a proposed cut to same-day care

On July 14, 2026, the Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicare, proposed cutting payment when the same practice provides an office visit and a procedure on the same day (CMS). Public comments closed September 14. A final decision is expected around November 1, and if finalized, the change would take effect January 1, 2027 (AMA).

What is modifier 25?

When you come in with a new or worsening problem, the work of evaluating it, from the exam to the diagnosis to the treatment decisions, is billed as an office visit. If you also need a procedure that day, such as a biopsy or cryotherapy, the procedure is billed separately. A billing code called modifier 25 tells Medicare that the visit was a significant, separate service, beyond the brief evaluation already included in every procedure's payment (AMA).

For example, say you come in about an itchy rash on your arms. While examining you, we find a suspicious spot on your back and biopsy it. Diagnosing and treating the rash is one service, and the biopsy is another. Modifier 25 is how both are recognized on the same day.

What CMS proposed

Under the proposal, when a separate office visit and a procedure happen on the same day with the same physician or practice, Medicare would pay full price only for the most expensive service. Every other visit or procedure that day would be paid at half price (CMS).

CMS says a visit and a procedure on the same day share some of the same work, so paying for both in full is likely paying twice for that overlap. It proposed a similar policy for 2019 and did not finalize it.

Physician groups strongly disagree. In August, the American Medical Association led more than 150 medical societies and organizations, including the Alaska State Medical Association, in urging CMS not to finalize the cut (letter). They argue that CMS has not measured the overlap it describes, that existing payment values already remove duplicated work, and that for some common procedures the reduced payment would fall below what it costs to provide them (AMA).

Why dermatology would be hit hardest

Same-day care is at the heart of dermatology. An analysis by Milliman, an independent actuarial firm commissioned by the American Academy of Dermatology Association, estimated the policy would cut payments for Medicare patients' care by about $969 million nationally, based on 2024 claims. Dermatology would absorb about $291 million of that, roughly 30% of the total and more than any other specialty (Milliman).

The same rule makes other changes too. Taken together, CMS's own estimate shows dermatology's Medicare payments falling about 9%, tied with ear, nose, and throat care for the largest drop of any specialty (HFMA). That comes on top of a 1.68% cut to Medicare's base payment rate for most physicians, mainly because a one-year 2.5% increase Congress approved for 2026 expires (CMS).

Looking further ahead, an analysis funded by the American Academy of Dermatology estimates that, once a second proposed change to how Medicare pays for practice overhead is fully phased in by 2028, the combined cuts could reduce dermatology's Medicare payments by nearly 16% compared with 2026 (Avalere Health).

What this could mean for you

This proposal changes how much Medicare pays physicians, not which services Medicare covers. The concern is access. The dermatology community warns that cuts this deep could restrict clinic capacity, delay skin cancer diagnoses, and put care for seniors at risk (AADA). If the proposal is finalized, here is what that could look like:

• More return trips. If same-day care is paid less, some practices may have to schedule biopsies and treatments on a separate day instead of at the visit where the problem is found. For a patient in Wasilla, that is an inconvenience. For an Alaskan who flies in from a rural community or rides the ferry to Juneau, it can mean another ticket, another night away, and another missed day of work.
• Slower answers. A delayed biopsy means a delayed diagnosis, and with skin cancer, time matters. Melanoma found before it spreads has a five-year relative survival rate above 99% (American Cancer Society).
• Longer waits for everyone. Every extra visit fills an appointment slot that could have gone to another patient.
• Fewer choices. Physician groups warn that practices facing cuts of this size may have to reduce staff, cut services, or close, with rural patients feeling it most (AAO-HNS).
• Possibly another copay. Depending on your plan, a second visit can also mean a second copay.

This update reflects the proposal as of October 14, 2026. We will update this page when CMS releases its final rule.

What you can do: make your voice heard

Your senators and representative can urge CMS to drop this proposal before it is final (AAO-HNS). In September, dozens of members of Congress did just that in a letter to CMS (letter). Congress can also pass laws that change how Medicare pays physicians, and it has before: it approved the one-year 2.5% increase for 2026 (CMS). Lawmakers listen to the people they represent, and reaching them takes only a few minutes.

1. Find your lawmakers. Every Alaskan is represented by two U.S. senators and one U.S. representative, who serves the whole state. Use the official Senate contact page (choose Alaska) and the House Find Your Representative tool.
2. Call or write. The U.S. Capitol switchboard at (202) 224-3121 can connect you to any senator's or representative's office. Each lawmaker's website also has a contact form.
3. Make it personal. Use the message below and add a sentence or two about your own experience. Your story is what makes it stand out.
4. Share this page with family and friends on Medicare. Caregivers and family members can write, too.

Sample message: copy, personalize, and send

Dear [Senator or Representative] [Last name], I am a Medicare patient [or: my parent is a Medicare patient] in [your town], Alaska. I am asking you to urge the Centers for Medicare & Medicaid Services not to finalize its proposed 50% payment cut for same-day office visits and procedures (modifier 25) in the 2027 Medicare Physician Fee Schedule. Please also support lasting fixes that protect Medicare patients' access to their physicians. When I see my dermatologist, a biopsy or treatment can often be done at the same visit. For me, that means [one trip instead of two / a faster answer about a worrisome spot / not missing another day of work]. In Alaska, a second trip can mean [a long drive, a flight, or a ferry ride]. Please protect same-day care for Alaskans on Medicare. Thank you, [Your name] [Your mailing address and phone number]

The bigger picture

Congress is also weighing long-term reform. The bipartisan Patients First Act of 2026 (H.R. 9693), introduced in July, would tie yearly Medicare physician payment updates to inflation (HFMA). Adjusted for inflation, the AMA estimates that Medicare physician payment has fallen about 33% since 2001 (AMA).

Why this matters

Same-day care is one of dermatology's quiet strengths. It turns a worry into an answer in a single visit, gets skin cancers diagnosed sooner, and spares patients extra trips. In a state as large as ours, that matters more than almost anywhere.

Whatever happens in Washington, our goal stays the same: expert, efficient care, and keeping you informed along the way.

We are here to help

Questions about your visit, a biopsy result, or your coverage? Call us at (907) 267-5890 or request an appointment online. You can also review our insurance and billing information before your visit.

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Medical disclaimer

This article is for general education and is not medical, legal, or insurance advice. Medicare policies change, and the Medicare section reflects the proposed rule as of October 14, 2026. For advice about your own skin or coverage, please contact our office.