WWW.MTINFORMATION.

COM

SUBJECTIVE: 59-year-old woman who presents for evaluation of facial skin

problems. I saw her one year ago. She has been using Retin-A Micro. She has noticed
an improvement in the texture of her skin and the brown spots on her face. She is
interested in options for further treatment of the brown spots. She also has several
growths on her legs. They are asymptomatic.

MEDICATIONS: Prograf, acyclovir, trazodone, Premarin, lorazepam, Ambien, and

Bactrim.

ALLERGIES: CLINDAMYCIN, CHLORAMPHENICOL, CODEINE,

COMPAZINE, TALWIN, ERYTHROMYCIN, EPINEPHRINE, AND FLAGYL.

PAST MEDICAL HISTORY: Status post liver transplant in 1989 due to sclerosing
cholangitis. History of ulcerative colitis, fibromyalgia, renal deficiency. She also has a
history of hepatitis.

PHYSICAL EXAMINATION: She has Fitzpatrick type 1 skin. Her lateral cheeks have
several scattered brown to tan macules. Her right medial cheek has three 1 mm dark blue
to gray macules. Her mid upper lip has a 2/3 mm pearly papule. Both lower legs have a
few scattered tan stuck-on papules.

IMPRESSIONS:
1. Lentigines. I discussed the risks, benefits, and options for treatment. She will
consider treatment using the V-Beam laser with a Q-switched 532 nanometer laser.

2. Thrombosed angioma versus exogenous pigment, right medial cheek. I discussed the
risks, benefits, and options for treatment. She will consider a test using the VersaPulse
laser.

3. Seborrheic keratoses, legs. No treatment is needed.

4. Possible basal cell carcinoma, upper lip. I discussed the risk, benefits, and options for
treatment. She did not want to do a biopsy today. She will consider doing this in the near
future.