Medical & Surgical Dermatology

The practice of dermatology involves both medical and surgical treatment of the skin, as well as, its appendages such as hair, nail or sweat glands.

The most common skin conditions treated in dermatology are:

  • skin cancer
  • moles
  • acne
  • eczema
  • psoriasis
  • warts
  • allergic skin reactions
  • benign growths of the skin
  • other skin rashes and infections

The providers are extremely skilled at surgical removal of both malignant and benign lesions.

In addition, dermatologists diagnose and treat conditions of the hair and nail such as:

  • fungus
  • growths of nails
  • hair loss

Many of this conditions can occur in any age group, which is why dermatologists provide specialized skin care to patients ranging from newborns to the very elderly.

Acne (Acne is the most common skin condition in the United States.)

Acne is the most common skin condition in the United States. Although it’s common, accurate information about acne can be scarce. This can make it difficult to get clearer skin. The information on this site can help you understand acne and how to successfully treat it. Dermatologists know that letting acne run its course is not always the best advice. Here why:

  • Without treatment, dark spots and permanent scars can appear on the skin as acne clears.
  • Treating acne often boosts a person's self-esteem.
  • Many effective treatments are available.

Why treat acne professionally?

Acne symptoms: Acne can cause more than blemishes. Studies show that people who have acne can have: Low self-esteem: Many people who have acne say that their acne makes them feel insecure. Because of their acne, they do not want to be with friends. They miss school and work. Grades can slide, and absenteeism can become a problem because of their acne.

Depression: Many people who have acne suffer from more than low self-esteem. Acne can lead to a medical condition called depression. The depression can be so bad that people think about what it would be like to commit suicide. Many studies have found that teens who believe that they have "bad" acne were likely to think about committing suicide.

Dark spots on the skin:These spots appear when the acne heals. It can take months or years for dark spots to disappear.

Scars (permanent):: People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early - between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.

Basal Cell Carcinoma (Basal-cell carcinoma (BCC) is the most common cancer in the United States.)

Basal-cell carcinoma (BCC) is the most common cancer in the United States. It rarely spreads to other parts of the body (metastasizes). However, because it can cause significant destruction and disfigurement by invading surrounding tissues, it is still considered malignant.

The head and neck are the most common locations, but any sun-exposed areas of the body are at risk. In the United States, about 3 in 10 Caucasians may develop a basal-cell cancer within their lifetimes.

A basal cell carcinoma has several typical appearances. The most common type is a nodular basal cell carcinoma, which looks pearly or translucent, and may have visible blood vessels throughout. Other types include a sore that does not heal, or a consistently scaly patch. These lesions should be diagnosed and treated by a dermatologist. Treatment is easily achieved by a quick procedure called electrodessication and curettage, or by a complete surgical excision with stitches which is performed right in our office. Occasionally a patient may be referred for a specialized skin cancer surgery called Mohs’ surgery. After the BCC is treated, routine follow-ups and continued sunscreen application are extremely important.

Benign Growths (People can develop many types of benign (noncancerous) growths on their skin over time.)

People can develop many types of benign (noncancerous) growths on their skin over time. The most common types of benign growths are cysts, skin tags, lipomas, and seborrheic keratoses. Cysts are subcutaneous nodules that are essentially made up of skin cells underneath the skin. Skin tags are hanging little flaps of skin that occur most frequently on the neck, armpits and groin areas. A lipoma is a soft subcutaneous nodule that is comprised of enlarged fat cells. As people age, many will develop some rough gray to brown scaly growths which are called seborrheic keratoses.

None of these benign growths are harmful, although people may want to get them removed for various reasons. They are unsightly in some instances, or they can become irritated or infected. Cysts and lipoma removal may be covered by medical insurance, whereas the removal of skin tags and seborrheic keratoses is an out of pocket expense. Generally they are all easily removable with modern dermatologic procedures.

Eczema (Eczema is a term for a group of medical conditions that cause the skin to become inflamed or irritated.)

What Is Eczema?

Eczema is a term for a group of medical conditions that cause the skin to become inflamed or irritated. The most common type of eczema is known as atopic dermatitis, or atopic eczema. Atopic refers to a group of diseases with an often inherited tendency to develop other allergic conditions, such as asthma and hay fever. No matter which part of the skin is affected, eczema is almost always itchy. Sometimes the itching will start before the rash appears, but when it does, the rash most commonly appears on the face, back of the knees, wrists, hands, or feet. It may also affect other areas as well.

Affected areas usually appear very dry, thickened, or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brown. Among darker-skinned people, eczema can affect pigmentation, making the affected area lighter or darker. In infants, the itchy rash can produce an oozing, crusting condition that happens mainly on the face and scalp, but patches may appear anywhere.

What Is Eczema?

The exact cause of eczema is unknown, but it’s thought to be linked to an overactive response by the body’s immune system to an irritant. It is this response that causes the symptoms of eczema. In addition, eczema is commonly found in families with a history of other allergies or asthma. Also, defects in the skin barrier could allow moisture out and germs in.

Some people may have “flare-ups” of the itchy rash in response to certain substances or conditions. For some, coming into contact with rough or coarse materials may cause the skin to become itchy. For others, feeling too hot or too cold, exposure to certain household products like soap or detergent, or coming into contact with animal dander may cause an outbreak. Upper respiratory infections or colds may also be triggers. Stress may cause the condition to worsen.

Although there is no cure, most people can effectively manage their disease with medical treatment and by avoiding irritants. The condition is not contagious and can’t be spread from person to person.

How Can Eczema Flare-ups Be Prevented?

Eczema outbreaks can sometimes be avoided or the severity lessened by following these simple tips.

  • Moisturize frequently.
  • Avoid sudden changes in temperature or humidity.
  • Avoid sweating or overheating.
  • Reduce stress.
  • Avoid scratchy materials, such as wool.
  • Avoid harsh soaps, detergents, and solvents.
  • Be aware of any foods that may cause an outbreak and avoid those foods.
Malignant Melanoma (Malignant Melanoma is the most serious form of skin cancer.)

Malignant Melanoma is the most serious form of skin cancer. Although genetic susceptibility does play a significant role in the development of melanoma, there is no question that sun exposure is a chief culprit in causing many melanomas. For this reason, the incidence of melanoma has risen dramatically in recent decades.

Melanoma typically occurs in sun exposed areas of the skin, although it may occur on any skin surface, including the palms, soles, scalp and even mucous membranes. Typically it is characterized by a brown mole that becomes larger and darker. The ABCDEs of melanoma are helpful in determining if a mole may need to be checked by a dermatologist. They are as follows:

A- Asymmetry. Mole does not look the same on both sides
B- Border of the mole becomes irregular
C- Color variegation. Several colors are present in the mole, especially dark brown or black
D- Diameter greater than 4mm (the size of a pencil eraser)
E- Evolution: Mole appears to be changing over time.

It is important to note that many of these features may be seen in normal moles, however, their presence should prompt a skin check.

Melanoma is an unusual type of cancer in that, if it is caught early, it usually causes no further problems; however, if it has already begun to spread internally it is very difficult to treat. This is another reason to get frequent skin checks and to see a dermatologist if a mole appears to have changed. The treatment of melanoma is surgical: a complete excision with a margin of normal tissue is the standard of care and is often all that is necessary. If the initial biopsy reveals a somewhat deeper lesion, the patient may be referred to a general surgeon for a lymph node dissection. In advanced cases adjuvant chemotherapy may be utilized. In all cases continued skin surveillance is necessary as is sun avoidance.

Because melanoma is so easily treated when caught early, and because the prognosis becomes quite poor if it is caught late, prevention and early diagnosis are imperative, which is why dermatologists so often preach about sun avoidance and the need for skin examinations.

Moles (A melanocytic nevus (also known as “nevocytic nevus”) is a type of lesion that contains nevus cells.)

The medical term for a mole is a “nevus,” although many times physicians use the term “mole” to refer to any type of benign (non-cancerous) growth. A nevus may be flat or raised, and it can range in color from flesh-colored, to tan, to shades of brown or even black. That being said, any very dark brown or black mole should be evaluated by a dermatologist to ensure that it is not cancerous or pre-cancerous. Some people have a genetic predisposition to having many moles, and extra sun precautions and skin surveillance may then be warranted. Although the vast majority of moles remain harmless, a mole can potentially transform over time into a melanoma. The ABCDEs of melanoma can be helpful in determining if a lesion should be examined by a physician:

A- Mole does not look the same on both sides
B- Border of the mole becomes irregular
C- Color variegation: Several colors are present in the mole, especially dark brown or black
D- Diameter greater than 4mm (the size of a pencil eraser)
E- Evolution: Mole appears to be changing over time

Because melanoma has a very high cure rate if detected early, dermatologists encourage all people to be aware of changing moles and to consult their dermatologist if any of their moles exhibit the above features. Sun exposure plays a significant role in changing a mole from benign to malignant; therefore, dermatologists recommend protection for people when they are outdoors. Tanning salons – even those that purport to be “safe” – are also a significant risk factor for the development of melanoma.

Psoriasis (Psoriasis is a common skin condition that changes the life cycle of skin cells.)

Psoriasis is a long-term (chronic) skin problem that causes skin cells to grow too quickly, resulting in thick, white, silvery, or red patches of skin.

Normally, skin cells grow gradually and flake off about every 4 weeks. New skin cells grow to replace the outer layers of the skin as they shed.

But in psoriasis new skin cells move rapidly to the surface of the skin in days rather than weeks. They build up and form thick patches called plaques. The patches range in size from small to large. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. Psoriasis is most common in adults. But children and teens can get it too.

Having psoriasis can be embarrassing, and many people, especially teens, avoid swimming and other situations where patches can show. But there are many types of treatment that can help keep psoriasis under control.

Experts believe that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin. In some cases, psoriasis runs in families. People with psoriasis often notice times when their skin gets worse. Things that can cause these flare-ups include a cold and dry climate, infections, stress, dry skin, and taking certain medicines.

Psoriasis isn’t contagious. It can’t be spread by touch from person to person.

Symptoms of Psoriasis

Symptoms of psoriasis appear in different ways. Psoriasis can be mild, with small areas of rash. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. If psoriasis is severe, the skin becomes itchy and tender. And sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such as the entire back.

In some people, psoriasis causes joints to become swollen, tender, and painful. This is called psoriatic arthritis. This arthritis can also affect the fingernails and toenails, causing the nails to pit, change color, and separate from the nail bed. Dead skin may build up under the nails. Symptoms often disappear (go into remission), even without treatment, and then return (flare up).

Skin Cancer (Skin cancers are cancers that arise from the skin. Skin cancers develop when abnormal cells invade or spread to other parts of the body.)

Skin cancers are cancers that arise from the skin.Skin cancers develop when abnormal cells invade or spread to other parts of the body. There are three main types: basal cell cancer (BCC), squamous cell cancer (SCC) and melanoma. The first two are known as non-melanoma skin cancer (NMSC). Basal cell cancer grows slowly and can damage the tissue around it. Skin cancer often appears as a painless raised area of skin that may be shiny with small blood vessels running over it, or may appear as a raised area with an ulcer. Squamous cell cancer is more likely to spread. It usually appears as a hard lump with a scaly top, but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, more than one color, is itchy, or sometimes bleeds.

Studies show that greater than 90% of all skin cancer is caused by exposure to ultraviolet radiation from the sun. This exposure increases the risk of all three main types of skin cancer. Exposure has increased partly due to a thinner ozone layer. In addition, tanning beds are becoming another common source of ultraviolet radiation.

Melanomas and basal cell cancers exposure during childhood is particularly harmful. For squamous cell cancers, total exposure, irrespective of when it occurs, is more important. Between 20% and 30% of melanomas develop from moles. People with light skin are at higher risk as are those with poor immune function. Diagnosis is by biopsy.

Skin cancer is the most common form of cancer, globally accounting for at least 40% of cases. It is especially common among people with light skin.

Squamous Cell Carcinoma (Squamous cell carcinoma (SCC) is the second-most common type of skin cancer.)

Squamous cell carcinoma (SCC) is the second-most common type of skin cancer (after basal cell carcinoma, but more common than melanoma). It usually occurs in areas exposed to the sun. Sunlight exposure and immunosuppression are risk factors for SCC of the skin, with chronic sun exposure being the strongest risk factor.[ The risk of metastasis (spreading throughout the body) is low, but is higher than with basal cell carcinoma. Squamous cell cancers of the lip and ears have high rates of local recurrence and distant metastasis. Squamous cell cancers of the skin in individuals on immunotherapy or suffering from lymphoproliferative disorders (i.e. leukemia) tend to be much more aggressive, regardless of their location.

Squamous cell carcinomas usually appear as thick rough scaly persistent lesions or sores that may bleed. Any sore lasting over 6 weeks should be evaluated by a dermatologist to ensure rapid diagnosis and appropriate treatment. Treatment often consists of complete surgical excision with stitches which is performed right in the office. A very small lesion may warrant only a scraping and cautery. Larger lesions, those which are recurrent, or those in surgically difficult areas may require referral to a Mohs’ surgeon.

After treatment, it is imperative that the patient use appropriate measures to protect their skin from the sun, and to have regular skin examinations.

Warts (Warts are benign (not cancerous) skin growths that appear when a virus infects the top layer of the skin.)

Warts are benign (not cancerous) skin growths that appear when a virus infects the top layer of the skin. Viruses that cause warts are called human papillomavirus (HPV). You are more likely to get one of these viruses if you cut or damage your skin in some way.

Wart viruses are contagious. Warts can spread by contact with the wart or something that touched the wart. Warts are often skin-colored and feel rough, but they can be dark (brown or gray-black), flat, and smooth.

There are a few different types of warts. The type is determined by where it grows on the body and what it looks like. The following describes the signs (what a person sees) and symptoms (what a person feels) for some of the different types of warts

Common warts (also called vurruca vulgaris)

Common warts have these traits:
  • Grow most often on the fingers, around the nails, and on the backs of the hands.
  • Are more common where skin was broken, such as from biting fingernails or picking at hangnails.
  • Can have black dots that look like seeds (often called “seed” warts).
  • Most often feel like rough bumps.

Flat warts

Flat warts have these traits:
  • Can occur anywhere. Children usually get them on the face. Men get these most often in the beard area, and women tend to get them on their legs.
  • Are smaller and smoother than other warts.
  • Tend to grow in large numbers — 20 to 100 at a time.

Filiform warts

Filiform warts have these traits:
  • Looks like long threads or thin fingers that stick out.
  • Often grows on the face: around the mouth, eyes, and nose.

The providers are extremely skilled at surgical removal of both malignant and benign lesions.In addition, dermatologists diagnose and treat conditions of the hair and nail such as:

  • fungus
  • growths of nails
  • hair loss

Many of these conditions can occur in any age group, which is why dermatologists provide specialized skin care to patients ranging from newborns to the very elderly.

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