annual skin checks

Because Dermatology is one of the hardest hit for not allowing an E/M charge when a procedure is done, we are struggling a little with when you can bill both using a -25 modifier.
If a patient is in for their annual skin check because they have history of BCCA or SQCA and the physician needs to treat an area or several in the same manner as in the past, should only the procedure be charged?
Same scenario, but a more serious lesion is treated such as a melanoma, or patient is treated for actinic keratois, eczema, etc. is an office visit billiabe if documentation fully supports the treatment of these?