Helping Patients Decide on Treatment Options for Actinic Keratosis

The senior author (D.J.E.) saw the patient one time over 20 years ago, but remembers the visit vividly. A short, dapper, articulate 90-year-old retired executive, the man related an appointment he had with another dermatologist in the Southern state he wintered in. The doctor entered the examination room, cryotherapy spray bottle in hand, and with little preamble, liberally administered the sacrament of liquid nitrogen; then turned to leave. "Wait, I have some questions," the patient said. "Sir," the dermatologist replied, "I'm a very busy man. Make another appointment." The patient held his right thumb and index finger a centimeter apart in front of him and said, "He made me feel this small." At a loss for words, Dr Elpern teared up.

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