General Skin Care

Question: What is the best anti-aging remedy?

Answer:  The best remedy is usually prevention.  Both direct sunlight exposure and cigarette smoking are hard on the skin and should be avoided.  Retinoids, glycolic acids, and vitamin C derivatives have all been shown to improve the appearance of sun-damaged skin and are available through Dermatology Surgery Center.

Tanning

Question: Is a tanning booth preferable to natural sunlight to get a suntan?

Answer: No.  A tan is a sign of sun damage.  Tanning booths use mostly ultraviolet light, which is the most harmful fraction of natural sunlight.  Both tanning booths and natural sunlight contribute to skin cancer and to aging the skin prematurely.

Sun protection

Question: What is the problem with being out in the sun at midday? 

Answer:  The ultraviolet radiation from the sun is filtered by the atmosphere.  At midday, the UV radiation goes through the smallest amount of atmosphere to get to the surface of the earth.  In the morning and evening, the sun passes through the atmosphere at more of an angle, so there is more filtration.  This is also why sun exposure in the mountains is more dangerous.  There is about one mile less atmosphere filtering the ultraviolet rays in Denver than in Omaha.

Sunscreens

Question: I've heard that sunscreens actually cause skin cancer.  Is this true? 

Answer: No.  However, having sunscreen on often leads us to stay in the sun too long, which can increase the incidence of skin cancer, particularly if it results in a sunburn.

Skin Growths

Question: I have a peeling area on my skin.  What is it? 

Answer: It may be simply a benign spot, or maybe a sign of something more serious, such as a skin cancer.  Unfortunately, you can't always tell by looking whether or not a spot is bad.  Sometimes a skin biopsy is necessary.  

Question:  How is a spot removed during a biopsy? 

Answer: Usually, the skin is numbed with anesthetic, and the spot is shaved off the surface of the skin.

Getting an Appointment

Question: What if I have a suspicious spot, and can't see a dermatologist for two months?  I’m nervous about waiting that long for an appointment. 

Answer:  You're right.  If you have a spot that is bothersome and you’re not sure what it is, don't wait to be seen. Please leave a message for one of our clinical staff members to give you a call.  They will get back with you to make an appointment sooner.

Skin Biopsy

Question:  What is the difference between simply removing a spot and a skin biopsy?  

Answer:  A spot can be removed by freezing, cautery, shaving, or excising.  A skin biopsy can be done either by shaving a spot off the surface or excising it, but with a biopsy the skin removed is then examined under a microscope.

Skin Cancer

Question:  I have a skin cancer.  When it is removed, how do I know you've got it all, and it will not come back? 

Answer:  When a skin cancer is removed by scraping therapy, we really don't know if it has been completely removed, although usually the cure rate is approximately 90 percent.  We watch the area for months and years afterwards.  With a very high cure rate therapy such as Mohs Surgery, we know we have it all when the edges of the removed tissue are completely clear of skin cancer cells by examination under a microscope.  The cure rate with Mohs surgery is as high as 98 or 99 percent, but we still keep an eye on the area, since recurrences sometimes do happen.  

Question: I have always had a suntan thinking it was healthy for me, but now my doctor tells me the bump by my eye might be a skin cancer. What should I do? Doesn’t a suntan protect your skin?

Answer: The sun produces invisible ultraviolet (UV) radiation, and the worst form of skin injury from the sun is sunburn. Sunburns, especially in childhood, can cause DNA mutations in skin, and skin cancers later in life. Sunburns are less likely in tanned skin. A suntan is the gradual skin reaction to UV injury. This form of chronic sun damage accelerates skin aging and can trigger new skin cancer growth. 

Not every bump on your skin is a skin cancer, but a new lesion on an adult that persists for over a month is suspicious, especially if it bleeds or scabs. The first step is a skin biopsy, a simple, quick office procedure using local anesthesia. The most common skin cancer is basal cell carcinoma. It does not spread through the body (metastasize). The next most common is squamous cell carcinoma. The most deadly skin cancer is malignant melanoma. 

Skin cancers near the eye are high-risk, because they are more difficult to completely remove than skin cancers elsewhere on the body. If a cancer is not completely removed, malignant cells left behind regenerate and multiply. The resulting cancer is called recurrent. Recurrent skin cancers are always high-risk, because of previous scarring and unpredictable growth. The best chance for complete removal is the first chance.

Mohs surgery consistently offers the highest cure rate (lowest recurrence), and leaves the smallest skin defect after the cancer is gone. The reason is that the complete surgical margin of the excised tissue is examined immediately under the microscope by the Mohs surgeon and mapped. Only cancer-containing tissue is removed, sparing normal tissue. When the margin is clear, the cure rate is up to 99%. 

Question: I have a growth on my ear that is getting bigger, and bled once after my comb hit it.  My ears got badly sunburned a couple of years ago.  Could this growth be related?  It can't be malignant, because I'm under 30 years old, right? 

Answer: Wrong.  The lesion sounds like a basal cell carcinoma or squamous cell carcinoma, two of the most common cancers afflicting humans.  And dermatologists definitely see persons under age 30 with these increasingly common skin cancers.  The most important risks factors are skin that burns rather than tans, history of severe sunburns, and cumulative lifetime exposure of unprotected skin to ultraviolet radiation. 

The ear is a common location for skin cancer, and is a high-risk area because tumors there often re-grow (recur) after insufficient treatment.  More accurately, tumors on the ear may not be completely removed by common skin cancer treatments, because malignant cells can spread in the skin some distance from the visible lesion without being noticeable on the surface. The technique with the highest cure rate is Mohs Surgery.  Skin cancers are tracked by a surgeon using a microscope and a map, so that only cancer-containing skin is removed.  In trained hands, Mohs Surgery is highly accurate, with a cure rate up to 99 percent in this situation. 

Early treatment is far better than late.  The first step is to confirm the diagnosis with a skin biopsy.  This is a simple and quick office procedure using local anesthesia.  If you think you may have a skin cancer on your face or ear, please call and ask about Mohs Surgery.  Or log on to the American College of Mohs Micrographic Surgery and Cutaneous Oncology website www.mohscollege.org to find the nearest fellowship-trained Mohs surgeon in your area.

Skin Surgery and Treatment

Question: Will I have a scar after skin surgery, and can it be lessened if there is one?  

Answer: There is a scar after any skin surgery, but the scar is controlled by orienting it correctly, and using proper surgical technique, to allow it to blend in and hide.  If a scar is noticeable after a surgical procedure, it can be often improved with dermabrasion ("sanding" the skin).  

 

Question: I sunburn easily, so I have not spent much time in the direct sun the last 10 years. Now my doctor tells me the bump on my nose is a basal cell carcinoma. Why now? What do I do?
 
Answer: Basal cell carcinoma is the most common cancer in humans, with nearly three- quarters of one million new cases in the United States alone each year. Fortunately, it is very curable, especially when recognized early and treated appropriately. It may appear as a small bump, a red rash, even as a scar. The first step is to confirm the diagnosis with a skin biopsy. The next is appropriate treatment. The nose is considered a high-risk location, because skin cancer there comes back more often than in other areas.
Mohs micrographic surgery gives the highest cure rates of all cancer treatments, because of precise mapping and complete microscopic examination of the margins of excised tissue. Cure rates reach 97 to 99 percent on cancers that haven't been treated except for skin biopsy. Smaller margins of tissue around a cancer are removed with Mohs surgery than with routine excision, so it is used in areas where it is particularly important to have both the highest cure rate and the smallest defect possible, such as the nose, ears, eyelids and lips. Smaller defects allow more elegant repair and imperceptible long-term results.
If you have any of the symptoms of skin cancer, such as a mole that is new or bleeds and scabs, or won't heal, please call immediately. The sooner any skin cancer is treated, the better.

Mohs Surgery

Question: When is Mohs surgery preferable to simply excising a skin cancer? 

Answer: When a skin cancer is large, on the face, has come back after a previous treatment, or has an aggressive architecture under the microscope, the recurrence rate of the skin cancer after a simple excision maybe as high as 20 percent, compared to perhaps 4 percent with Mohs surgery.  These skin cancers are termed high-risk skin cancers.  The reason Mohs surgery is more effective is that more of the tissue that is removed is examined under the microscope.