Surgical Dermatology

A skin biopsy is a simple outpatient procedure that occurs when a small piece of skin is removed after numbing it and then sent for pathology to make a diagnosis under the microscope.  A provider uses a skin biopsy to diagnose or rule out certain skin conditions and diseases. It can be done in your normally scheduled appointment and only takes only a few minutes. There are two main types of skin biopsies. The most common is a shave biopsy in which a provider uses a tool similar to a razor to remove or shave a small section of the top layers of skin. This heals on its own over a few weeks without stitches. Alternatively in certain situations a punch biopsy can be preformed using a circular tool to remove a deeper section of skin and usually requires stitches. With any biopsy the results are given to you within 1-2 weeks and further treatment recommendations will be made if needed. Wound care simply includes twice daily cleaning with a bandaid. Any post procedure pain can be addressed with an over the counter pain reliever.  

A surgical excision is an outpatient procedure that is used to remove both benign and cancerous skin lesions. After local anesthetic is injected into the skin to numb the area, the skin lesion along with a small margin of healthy tissue around it is cut out, usually in a football-shaped ellipse. After the tissue has been removed, the edges of the wound are sutured together with 2 layers of sutures. The deep stitches dissolve and the top ones are removed later. The tissue is then sent for processing and margins evaluated by a physician to ensure adequate removal.  An excision is used most commonly for basal cell carcinomas, squamous cell carcinomas, early stage melanomas that still are confined to the skin, and atypical moles but can be used for any benign or malignant skin lesion that requires removal.  It offers a high cure rate, good cosmetic results and allows for microscopic examination of surrounding tissue. Unlike chemotherapy and radiation, it can be accomplished in one session. Results will be given to you within 1-2 weeks. Before the procedure you will answer a list of questions about your medical history including prescribed and over-the-counter medicines, bleeding history, allergies or other medical problems. The procedure takes about 45 minutes to 1 hour in one of our state of the art procedure rooms. After care includes cleaning instructions and a suture removal appointment in 1-2 weeks after the surgery. Any limitations after the surgery will be discussed by your provider, but generally we recommend avoidance of swimming and exercise for 2 weeks after the procedure. Any post operative pain can be treated with an over-the-counter pain reliever.

Cryotherapy is a simple, quick outpatient procedure where a Dermatology provider applies liquid nitrogen using a spray device to your skin to remove unwanted or abnormal layers of skin. Many lesions can be treated including precancerous lesions, warts, brown spots and age related keratosis. This can be done at a regularly scheduled appointment. The goal is to freeze the skin quickly and then allow it to slowly thaw to cause maximum destruction to targeted skin cells. In some cases, additional applications may be needed.  After the procedure you may notice redness, swelling and possibly the formation of a blister at the treatment site. The layer of skin will slough off over the next 1-2 weeks. An over-the-counter pain reliever can be used to control discomfort. Patients will be directed to wash the site daily usually for five to 14 days until it heals.

ED&C is a procedure in which superficial, uncomplicated skin cancers are removed by scraping the affected area using a circular blade instrument known as a curette. After the lesion has been scraped, the wound typically is cauterized to increase the likelihood for successful treatment and to minimize bleeding. Since this is a tissue destruction method, no pathology is sent to the lab.  Electrodessication and Curettage  is effective on superficial basal and squamous cell carcinomas with well-defined borders. It can be used on any area of the body and leaves a more circular type scar without any stitches.

Curettage and desiccation may be a good choice for patients who cannot tolerate more involved surgical procedures. With a high cure rate in the treatment of carefully selected skin cancers, this treatment method is efficient and cost-effective. Post operative wound care includes simple cleaning twice daily with application of a bandaid.

Mohs is a specialized type of skin cancer surgery that is used to treat only certain kinds of skin cancers which may be found on sensitive areas on the scalp, face, hands, and feet, or are larger, ill defined, high risk, recurrent or more aggressive forms of skin cancer. It is an outpatient procedure which involves removing the visible skin cancer and layers of adjacent skin for microscopic examination. Maps are created to follow tumor extensions, and excisions are sequentially continued until no cancer cells are evident upon microscopic examination. Mohs minimizes the size of the surgical wound required for skin cancer treatment and may reduce the size and appearance of the resulting surgical scar. The surgical wound is then repaired, or allowed to heal on its own (by secondary intention) to preserve as much form and function as possible. Sometimes in larger skin cancer surgeries, a graft or flap may be needed. Mohs micrographic surgery offers a very high cure rate and our dermatology team will determine if you are a candidate for this kind of procedure.

In topical treatments for skin cancer, a prescribed cancer-fighting medication is applied to the skin in the form of a cream. Topical medications can be effective for the treatment of pre-malignant skin conditions such as actinic keratoses. These medications also may be used in some cases to treat small and superficial basal cell and squamous cell carcinomas. Topical medications occasionally can offer non-invasive alternatives to surgery, although these treatment options may have less success than surgical treatment methods. Topical skin cancer treatments use medications to directly target cancer cells or to promote an immune response intended to eliminate cancer cells. These topical treatments are performed by the patient at home and treatment length can range from 2 to 3 weeks for pre-cancerous skin lesions to 6 to 12 weeks for uncomplicated skin cancers.

Melanoma is the third most common type of skin cancer and can potentially be a serious type of skin cancer.  Anyone can get melanoma. Most people who get melanoma have light skin, but people who have darker skin can also get melanoma.

Risk factors for developing melanoma include: tanning bed use, blistering sunburns as a child/young adult, living close to the equator, living in a sunny area of the United States, failure to protect your skin from the sun, men over 50 and people older than 65. Your risk of getting melanoma also increases if you have had melanoma or another type of skin cancer, had another type of cancer, such as breast or thyroid cancer, having a disease or taking a medication that weakens your immune system, and having a history of melanoma in your family.  When found early, melanoma is highly treatable.  You can find melanoma early by following this 3-step process:

If you notice a mole that differs from others on your body or a spot that is changing, bleeding, or itching, see a dermatologist. Learn the warning signs of melanoma and look for the warning signs while examining your skin. See one of our providers if you find any of the warning signs. If you are diagnosed with a melanoma our Dermatology team will help formulate a comprehensive treatment plan for you.