The Health Department has put on probation the medical license of Dr. Nomate Toate Kpea, a dermatologist with five practices around the state, and has required Kpea to undergo a competency evaluation.

The state Board of Medical Licensure and Discipline found that Kpea misdiagnosed benign lesions as cancer and performed needless surgery, failed to completely remove a skin cancer, failed to properly train and supervise his advanced practice clinicians (nurse practitioners and physician assistants), advertised “with a tendency to deceive,” and prescribed human growth hormone without adequate evaluation of the patients.

In one case, the board found, an advanced practice clinician in Kpea’s office misidentified a skin lesion that was later found to be malignant melanoma, a form of skin cancer that can be deadly if not diagnosed early.

Probation is a level of discipline that is stronger than a reprimand but less severe than a license suspension. Kpea can continue to practice, but he has agreed not to perform a method of skin-cancer removal known as Mohs surgery until he has completed his competency evaluation and undergone any training the evaluators recommend.

Kpea’s practice, called Skin Medicine USA or Skin Medicine and Cosmetic Surgery Centers, included offices in Warwick, Providence, North Smithfield, Newport and Narragansett, as well as several out of state. Kpea, 54, is well known in the community. According to a recent news report, he is also the “paramount chief” of a town in Nigeria that was founded and ruled by his family.

Dr. Robert S. Crausman, the medical board’s chief administrative officer, said that the board had complaints against Kpea dating to 2000, but only the more recent ones clearly violated medical standards.

Many of the findings focused on his use of the Mohs precision cutting tool, which allows surgeons to remove skin cancer without harming healthy tissue. In one case, Kpea misdiagnosed squamous cell carcinoma and performed Mohs surgery on a patient. The patient actually had a benign skin lesion called an actinic keratosis. In another case, nonmalignant lesions were misdiagnosed as cancer. Having needless surgery can leave a patient with unnecessary scars, Crausman said.

In another instance mentioned in the board’s report, Kpea “performed an incomplete excision and missed an obvious tumor at the lowest level excised.”

In two other cases, Kpea prescribed human growth hormone to a patient diagnosed with a deficiency of the hormone and to another with short stature. The board concluded that Kpea “was not using this medication for its purported anti-aging effect,” which would have been a violation of Food and Drug Administration regulations. But it did find that he did not adequately evaluate the patients before prescribing.

Additionally, the board found, Kpea too frequently used frozen biopsies to quickly diagnose a condition and proceed immediately to Mohs surgery; it is better practice in most instances to send samples to a laboratory and wait for a diagnosis from a pathologist, Crausman said.

His advertisements had a “tendency to deceive,” Crausman said, because they led patients to believe they would be seen by a doctor, only to discover after they arrived that a physician assistant or nurse practitioner would do the exam.

Kpea has agreed to undergo a skills and competency evaluation by the Colorado Center for Personalized Education for Physicians, and complete any additional training and evaluation that the board recommends based on the Colorado findings. Meanwhile, he must not practice Mohs surgery.

Kpea also must now have all biopsy specimens read by a board-certified pathologist or dermatopathologist.

Additionally, the board has required that all advanced practice clinicians at his offices be supervised at least a half day a week by Kpea or an appropriately trained physician, meet weekly with a physician to review cases, and meet monthly for training.

Kpea must also pay an administrative fee of $2,500.

Neither Kpea nor his lawyer returned phone calls yesterday.

ffreyer@projo.com