What is acne?
Acne is characterized by blackheads, whiteheads, red inflamed bumps called papules and pustules, and in severe cases, deep-seated nodules and cysts. Acne is caused by increased sebum or oil production, clogged hair follicles, altered bacteria and hormones. The T zone is the area between the forehead, nose and chin where acne frequently occurs. However, the back, neck, chest, shoulders, upper arms and buttocks can be affected by acne.

Acne (acne vulgaris)
Acne vulgaris is a common skin problem that presents with blackheads, whiteheads, inflamed, and cystic lesions. It frequently results in scarring and can lead to significant social and emotional distress for sufferers. Acne on the face affects more than 90% of people at some time in their lives, acne on the chest affects about 60% of people, and acne on the back affects approximately 15% of people. It commonly begins in adolescence and often resolves in the mid-twenties. This is also the time when peer pressure, self-image, self-esteem and confidence are being tested. However, acne can also persist into or begin in adulthood, primarily in women.

Studies show that acne and acne scarring can lead to low self-esteem, anxiety, depression and thoughts of suicide. These aspects can negatively impact functioning in daily activities, school, and work. Treatments are available that improve acne and subsequently, increase self-esteem, and reduce social and emotional distress.

Who is at risk for acne?
Acne affects men and women of all races and ethnicities. 85% of acne sufferers are teens and young adults. Pre-adolescents can develop acne when there is an increase in hormones that trigger oil production and acne. Adult acne primarily affects women in their thirties and older.

What causes acne?
Acne commonly begins around puberty when androgen hormones increase. This stimulates enlargement of sebaceous glands and increased oil production. Excess oil with increased skin cell turnover (dead skin cells) block the sebaceous gland duct and hair follicle. The result is whiteheads and blackheads. Further, bacteria normally resides on skin. When certain bacteria become trapped in the hair follicle, it can cause inflammation and infection and lead to pustules, papules, nodules and cysts.

Genetics and hormones contribute to the formation of acne. Other factors associated with acne include:
- Insulin resistance
- Hormone imbalance such as in Polycystic Ovarian Syndrome (PCOS)

Treatment
Treatment is aimed at unclogging pores, reducing acne-causing bacteria, decreasing inflammation and sebum production. Combination therapy consists of topical or oral antibiotics, anti-inflammatory agents, anti-hormonal agents and retinoids. Chemical peels with glycolic acid and salicylic acid are good options to exfoliate and reduce oil in acne-prone skin. Women with hormonal acne or PCOS may receive oral contraceptives or other oral therapy to combat the hormonal component of acne. In the most severe cases, isotretinoin (Accutane) is very effective to treat nodular and cystic acne. Phototherapy using non-invasive light helps kill acne-causing bacteria and clear acne.

Nodular and cystic acne commonly cause scarring. Professional medical treatments can help to prevent or reduce scarring. Acne that is inadequately treated can cause permanent scarring of the skin and have a significant impact on self-esteem.

The most important action you can take is to start treatment early to prevent side effects and scarring. Early treatment can prevent mild acne from becoming severe and prevent red or dark spots called post -inflammatory hyperpigmentation. Early treatment can control acne, prevent future breakouts, and prevent scarring. If scarring is already established, there are treatments available to minimize and reverse the effects. During your consultation Dr. Rachel White will discuss your concerns and the best treatments for your specific condition, severity, and lifestyle.

Dr. Rachel White is a board certified dermatologist in Buckingham, Pennsylvania. She will tailor treatments to meet your needs. She may suggest a combination of therapies that may include topical and oral medications, chemical peels, skincare products, microneedling and laser therapy.

Skin cysts are lumps under the skin filled with fluid or other skin debris. They appear as yellow or white with a small dark spot in the middle. Cysts can be treated with drainage, injections or simple excisions.

Epidermoid cysts
Epidermoid cysts are firm, flesh-colored nodules that grow from the top layer of skin and most commonly appear on the face, neck and trunk of young and middle-aged people. Cysts are associated with acne-prone skin. They are filled with dead skin cells. They usually cause no symptoms, unless they become irritated or infected. Epidermoid cysts on the scalp are called pilar cysts. Epidermoid cysts are more common in women and have a genetic component. They don’t require treatment unless they rupture, are irritated or infected.

Sebaceous cysts
Sebaceous cysts are fluid-filled cysts or lumps found on the ears, neck, face, scalp and upper body that arise from sebaceous glands. These cysts are filled with sebum, which is a yellow oily material produced by sebaceous glands to keep the skin and hair moisturized and protect the skin.

What is eczema?
Eczema is also known as atopic dermatitis (AD). It is a common inflammatory skin disease that affects up to 13% of children and 10% of adults in the US. Eczema is a systemic and chronic disease meaning it is often a life-long condition that comes and goes and tends to flare with triggers. There is no cure for eczema. It presents with red, itchy and inflamed patches that appear anywhere on the body. Scratching leads to inflammation, swelling and eventually cracking and weeping of the skin. This can lead to subsequent skin infections. It is not contagious, but has a considerable impact on quality of life.

95% of people develop eczema before age 5. In infancy, eczema appears as itchy, red, scaly patches on the baby’s face or chest. Usually the condition goes away as the child grows, but not always. Even when the red, itchy patches resolve, the child can be left with easily irritated, dry, sensitive skin.

What causes eczema?
Many factors contribute to the development of eczema including genetic susceptibility, environmental factors, microbiome and immune system dysregulation. A family history of allergic diseases like hay fever or asthma is an important risk factor.

What are the symptoms?
Infant eczema is usually acute, with lesions on the face, body and limbs. Children that are 1 year old and above often manifest red patches around the mouth, on the neck, behind the knees and inside the elbows. Adolescents and adults present with thickened or scratched lesions behind the knees and inside of the elbows, on the wrists, ankles and eyelids, around the mouth and on the hands. Eczema may be mild, moderate or severe. Despite the various manifestations the condition is treated as a single disease.

Complications include skin infections from constant scratching that creates open sores, and contact dermatitis from harsh soaps, detergents and disinfectants. The itch-scratch cycle can interfere with sleep, and the more the itch is scratched, the more it itches. Triggers include sweat, stress, heat, itchy fabrics, fragrances, pet dander, environmental allergies, soaps, detergents, dust and pollen, and hot dry air. Some food allergies can also trigger flares.

How is eczema diagnosed?
There is no objective test to confirm a diagnosis of atopic dermatitis. Medical dermatologist Dr. Rachel White will diagnose the disease based upon the clinical features and medical history. Diagnosis requires exclusion of other skin conditions with similar appearance including infections and other inflammatory skin conditions. It may also include performing a patch test where a small amount of an allergen is placed on the skin and is checked for skin reactions.

How is eczema treated?
The goal is to manage eczema in an effort to prevent worsening of the disease, calm the skin, control itching, and prevent infections and skin thickening. Traditional treatments involve topical and oral medications. Moisturizers are essential to maintain the integrity of the skin barrier. The skin barrier keeps out bacteria, allergens and irritants that aggravate AD. Topical anti-inflammatory medications reduce inflammation, itching, and redness.

Treatments for adults with stubborn or severe disease include phototherapy, immunosuppressants and short courses of steroids. Long-term topical treatment is frequently needed. Newer therapies include crisaborole (Eucrisaâ) ointment for mild to moderate AD, and dupilumab (Dupixentâ) for moderate to severe AD.

RW Dermatology provides board certified medical dermatology to Buckingham Township and the surrounding suburbs of Philadelphia. When you are concerned about red, itchy patches of skin on your child’s face or body or you suffer with chronic skin irritations, schedule an appointment today. From diagnosis to treatment and management, Dr. White can help.

What is hyperhidrosis?
Hyperhidrosis is a medical condition characterized by excessive sweating. Normally, sweating helps control the body’s temperature, but when sweating occurs too often and in an amount over what is needed, this may result in hyperhidrosis.

Many patients who have hyperhidrosis sweat from one or two areas of the body. Most often, they sweat from their underarms, palms or soles.

Hyperhidrosis can be uncomfortable, embarrassing and interfere with everyday activities. Underarm sweat can be seen through clothing and cause embarrassment. Sweaty palms can create the appearance of nervousness or lack of confidence in work or social situations.

Causes of hyperhidrosis
Our body’s nervous system tells the body when to sweat. Hyperhidrosis is caused by dysregulation of the nervous system, or by abnormal glands that produce sweat. There are many underlying etiologies of hyperhidrosis. The leading causes of excess sweating are:
- Idiopathic
- Hereditary
- Underlying medical condition such as diabetes and gout
- Side effect of medications
- Anxiety disorders

Hyperhidrosis effects all ethnicities and ages. For many people, hyperhidrosis begins during puberty. Hyperhidrosis occurs independent of outside temperature or environment.

If you are experiencing excessive sweating, board certified dermatologist Dr. Rachel White will assess for an underlying cause and further, discuss the myriad of treatments available to you such as those listed below.

Treatment options for hyperhidrosis

Topical prescription strength antiperspirants
Antiperspirants are considered first line treatment for excessive sweating of the underarms, hands, and feet. They are the least invasive treatment option for hyperhidrosis and Dr. White often recommends that they be tried first before other more invasive treatments. If topical prescription strength antiperspirants fail, other modalities are recommended, such as, oral medications or injections with Botox or other botulinum toxin products that reduce sweating in these sensitive areas.

Qbrexza
Qbrexza is a newer topical medication that can be used for excessive underarm sweat in patients 9 years of age and older. The medication is incorporated into a cloth that is wiped under each arm once daily. Qbrexza, an anticholinergic medication, works on the sweat glands directly to decrease sweating. Although it’s relatively simple to use, Qbrexza should be avoided in certain medical conditions like glaucoma, myasthenia gravis, Sjogren’s syndrome among others. It is also not recommended in pregnancy or lactation.

Botox and other botulinum toxin injections
Botox and other botulinum toxin products are excellent methods for controlling hyperhidrosis. They work by temporarily blocking the chemical signals from the nerves that tell sweat glands to produce sweat. When the glands don’t receive these signals, sweat isn’t produced and your skin stays dry in the targeted areas. Sweat continues normally in untreated regions of the skin. Prior to injections, the skin is numbed to increase your comfort. Typically, one session of Botox is needed to achieve results and sweating gradually returns between 6 and 9 months.

Oral agents
Systemic anticholinergic medications are also considered; however, side effects often outweigh the benefit of these medications.

What is melasma?
Melasma is a common skin condition that primarily affects women. It causes blotchy patches of hyperpigmented skin that appear as tan or dark discolorations on the cheeks, nose, forehead, chin, and upper lip. However, it can appear on any area that is frequently exposed to the sun including the forearms and neck. Melasma develops over time and is more common in skin of color and people with a family history of melasma.

The only symptom is discoloration. It is common in women during pregnancy and has been called “the mask of pregnancy” because hormones increase during pregnancy. However, melasma can affect all sexes and ages and can last for years. It often negatively affects self-image, self-esteem, and confidence.

What causes melasma?
The cause of melasma is unclear, but sun exposure and fluctuations in hormone levels activate the skin cells, called melanocytes, to produce excess melanin, the substance that gives skin its color. Skin of color is more prone to melasma because it has more active melanocytes than lighter skin. Melasma often runs in families.

Common melasma triggers include:
Ultraviolet (UV) light from the sun is a major trigger and can aggravate underlying causes like hormonal changes. Even a short exposure to the sun’s light and heat can worsen existing melasma and cause it to return after treatment.

Hormone fluctuations common during pregnancy, oral contraceptives or hormone replacement therapy are known to cause melasma.

How is melasma diagnosed?
Because of its characteristic appearance, melasma is often diagnosed visually and with the use of a Wood’s Lamp which can distinguish excess melanin in the top skin layer from discoloration in the dermis or lower skin layer. However, because melasma can be caused by an underlying medical condition, board certified dermatologist Dr. Rachel White will review your medical history and determine the triggers that underlie your condition and tailor your treatment specifically.

How is melasma treated?
First and foremost, treatment is geared at preventing aggravation of the condition by the sun which requires the diligent use of sunscreens that block the sun’s rays as well as light and heat.

There are two kinds of sunscreens: one uses chemicals and the other uses physical blocking agents. The best choice of sunscreen is a physical blocking agent such as zinc and titanium dioxide. When spending time outdoors, wear a hat and long sleeves.

Topical medications to lighten the patches include retinols which when applied speed up cell turnover and facilitate faster clearing of the dark patches. The treatment may include skin lightening cream that contains hydroquinone, a bleaching agent, that is supervised by Dr. White to avoid developing areas of hypopigmentation. Kojic acid, azelaic acid, and cysteamine are also topical skin lighteners that may be recommended.

Additional treatments include chemical peels and laser treatment. Combination treatments are the most effective. Dr. White will personalize a treatment plan to successfully address your specific needs, help the skin heal, and prevent future damage.

Melasma is a frustrating, chronic condition. At RW Dermatology, Dr. White will work with you to obtain a good outcome including restoring your appearance and confidence. Contact her today to schedule a consultation and learn about all your options.

Moles (nevi)
Moles are common benign growths that can appear during childhood, adolescence and early adulthood. Moles are usually round, flat or slightly raised brown lesions, but can be tan, red, black, pink, blue or colorless. Some moles have hair, and some fade overtime. Moles can develop anywhere on the body, even under the fingernails, between the fingers and toes, and on the scalp. Changes in a mole can be cause for concern and may be a sign of melanoma. When changes occur, a dermatologist should evaluate the concerning mole. Atypical or dysplastic moles are larger than a pencil eraser, have an odd shape and show more than one color. They require evaluation by a dermatologist, and a biopsy may be needed.

Warts (verruca vulgaris)
Warts are benign skin growths caused by a virus that resides in the top layer of skin. They appear as scaly white or skin-colored rough bumps. There may be one or a cluster of warts together. They can be spread by contact with other warts; therefore, it is advised to not scratch or manipulate them. Warts can be treated with topical agents, cryotherapy, surgical excision and laser.

What is psoriasis?
Psoriasis is a common, chronic inflammatory, immune disease affecting about 2% of adult Americans. It can affect children as well. While psoriasis is considered to be a skin disorder, the damage the inflammation causes can result in serious complications that affect multiple organ systems. 25% of patients develop joint inflammation called psoriatic arthritis. Beyond its physical manifestations, psoriasis has an extensive emotional and psychological impact, affecting social functioning and interpersonal relationships.

90% of patients have plaque psoriasis, which is the most common presentation. Psoriasis is not contagious, but is irritating and uncomfortable and often times cosmetically unappealing for patients. Psoriasis can last a lifetime. Symptoms may appear and remit.

What causes psoriasis?
Psoriasis is an inflammatory immune system disorder. An autoimmune disease is where the immune system attacks the body causing an overgrowth of skin cells that form a rash. One third of cases run in families but research reports that multiple genetic abnormalities have been associated with psoriasis. It begins when immune system cells, called T-cells, produce signals that lead to inflammation and accelerate the growth of skin cells within days rather than weeks.

Psoriasis can be triggered or worsened by environmental forces such as stress, infection, some medications, cold and dry weather, and tobacco consumption.

Psoriasis increases the risk of developing other medical problems and comorbidities such as joint problems, inflammatory bowel disease, diabetes, heart disease, and depression.

What are the symptoms?
The characteristic psoriasis plaques are thick, and red with silvery scales that shed. The plaques develop all over the body and most commonly are found on the knees, elbows, scalp, lower back, face, hairline, palms and soles of the feet. Studies report that about 50% of patients also have finger and/or toenail psoriasis. It may be confused with eczema which is intensely dry and itchy skin that usually develops on the backs of knees and elbows.

As mentioned, plaque psoriasis is the most common presentation. The second most common form is called guttate psoriasis. It is characterized by widespread small, red scaly spots on the arms and legs that develop weeks after strep throat or viral infection. This type often begins in childhood or early adulthood. It may go away on its own or develop into plaque psoriasis.

Other types:
- Smooth, red patches that are sore and painful in folds of skin, such as, armpits, genitals, and buttocks.
- Pustular psoriasis presents with pus-filled bumps usually on the hands and feet that are sore and painful and can be life-threatening.
- Nail psoriasis leads to changes of the finger and toenails causing dents, discoloration, and lifting the nail due to buildup of skin cells below it.
- It is important to note that symptoms can be mild or severe. Psoriasis can lead to negative social impact for patients due to the appearance of the rash, discoloration of the skin after the rash has resolved, and shedding of scales. Treating psoriasis effectively can improve quality of life for patients.

How is psoriasis diagnosed?
Board certified medical dermatologist, Dr. Rachel White will conduct a physical examination of your skin or areas of concern, inquire about your symptoms, and whether there are family members with this disorder. Dr. White may take a biopsy of the skin to rule out other conditions.

TREATMENTS
There are many options to manage psoriasis but there is no cure.

Topical therapies
Corticosteroids are first-line foundational treatments to reduce inflammation and control itching. However, topical steroids can thin and damage the skin so they are not used for long-term maintenance therapy. Other prescription therapies rely on Vitamin D (Dovonex) and Vitamin A (Tazorac) and combinations to treat psoriasis. They are effective and safe for long-term use.

Phototherapy
Phototherapy is the controlled use of ultraviolet light. It may be recommended as a treatment option. Phototherapy may be combined with topical treatments.

Systemic therapy
Patients with severe psoriasis, psoriatic arthritis or other comorbidities may require systemic therapy that works on the entire body. The most difficult cases are treated with oral drugs like methotrexate and cyclosporine, an immune suppressive medication. Biologic oral and injectable treatments target the immune system. They are used in moderate to severe cases, when the disease is negatively affecting your quality of life, and when traditional treatments cannot control psoriasis, or cause side effects.

Despite psoriasis’ considerable effect on quality of life, psoriasis is underdiagnosed and under treated. When you have concerns about a rash seek evaluation from a board certified skin expert at RW Dermatology in Buckingham Township, PA. Schedule a consultation to assure you receive the correct diagnosis and treatments that can help you restore your quality of life, self-image and confidence.

What is rosacea?
Rosacea is a common chronic inflammatory skin disease that is often underrecognized and underdiagnosed. It commonly affects the skin on the face, cheeks, and nose. There is a continuum of disease processes that may begin with facial flushing, leading to persistent redness, and progressing over time to include permanent spider veins (broken capillaries). Other presentations include pimple-type bumps, and eye and nose symptoms. Presentation and progression are different for each person. Acne and rosacea share overlapping features.

Rosacea affects more than 16 million people in the US. Men and women are equally affected. Those with an Irish background are at an increased risk of developing rosacea.

The exact cause of rosacea is unknown. Environmental factors trigger its development and also aggravate it. Rosacea is incurable. Long term treatment and lifestyle modifications can keep the condition under control. Demodex mites, which normally live on the skin, are found in greater numbers in those with pimple-type rosacea. Demodex mites live on tiny hair follicles on facial skin and eyelashes. They are microscopic meaning one cannot see them with the naked eye. Mounting evidence suggests that in large numbers these mites are a cause of skin and ocular rosacea.

Who is at risk for rosacea?
Although rosacea affects all skin types, it is more apparent in people with lighter skin tones between the ages of 30 and 50. There is a possible genetic component as well.

What are the symptoms?
Rosacea is a syndrome that produces overall redness on the forehead, cheeks, nose, and chin and can spread to the ears, chest, and back. Redness on the face can become permanent.

Characteristic symptoms are:
- Flushing and redness
- Dilated blood vessels (spider veins)
- Pimples or small bumps on the face that look like an acne breakout
- Skin that stings and burns
- Swollen and thickened facial skin
- Thickened and bumpy skin on the nose
- Eyes that are watery or irritated, sensitivity to light, burn and itch
- Swollen, red and irritated eyes and eyelids

The symptoms of rosacea can flare for weeks or months at a time before diminishing.

Triggers may include:
- Sun exposure
- Hot foods or drinks
- Spicy foods
- Alcohol
- Extreme temperatures
- Stress, anger, or embarrassment
- Intense physical exercise

How is rosacea diagnosed?
Dr. Rachel White reviews your medical history, current complaints including symptoms and examines your skin and eyes. She may take a small sample of the skin surface to biopsy. Demodex mites are visible under a microscope. She may also order tests to rule out other conditions like lupus and allergic reactions that look like rosacea.

Dr. White will create a detailed plan to address your specific needs, and help you identify triggers that cause your rosacea to flare up so that you can learn to avoid these triggers.

Rosacea treatment
While the cause is not completely understood and the disease is not curable, it can be treated. Treatment is geared towards reducing or eliminating signs and symptoms, treating Demodex mite overgrowth, preventing flare ups, and preventing progression of the disease.

For most patients, treatment involves a combination of topical and oral medications. Lasers and light-based treatments can be effective. If you have ocular rosacea, your treatment plan may include warm compresses, eyelid cleansing, eye medications, as well as, oral anti-inflammatory antibiotics.

Schedule a consultation with Dr. White to learn if you have rosacea or other inflammatory skin disease, and the best options to control your symptoms. Left untreated rosacea signs and symptoms can become increasingly severe.

Seborrheic keratosis (SK)
Seborrheic keratoses are the most common benign skin growths that affect people older than 50 years old. They are often found in groups but can occur as a single growth. Most people will develop at least one during their lives. SK tends to run in families. SKs are flat or slightly raised scaly, pigmented growths that look “stuck on” the face, chest, shoulders and back; however, they may occur anywhere on the body. SKs may itch and becomes irritated. Picking at them can cause bleeding, and infection. If they are not irritated or infected treatment is not necessary, but cryotherapy and other modalities may be used to address cosmetic concerns.

Every year more people are diagnosed with skin cancer than all other cancers combined. Skin cancer commonly occurs on sun-exposed skin. Those at highest risk are fair-skinned individuals and those who spend a significant time in the sun for work or outdoor activities. Better prognoses result from early skin cancer diagnosis and treatment.

The most common types of skin cancer
There are two main categories of the most common types of skin cancer: melanoma and nonmelanoma skin cancers (NMSC). There are two types of NMSCs: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Approximately 80% of skin cancers are BCC,16% are SCC, and 4% are melanomas. At least one in five Americans will develop skin cancer by age 70.

What causes skin cancer?
90% of nonmelanoma skin cancer, and 86% of melanomas are associated with UV radiation.

More people develop skin cancer from indoor tanning than lung cancer from smoking.

Indoor tanning is responsible for about 6200 cases of melanoma.

5 or more sunburns double the risk for developing melanoma.

Just one blistering sunburn in childhood or adolescence more than doubles the lifetime risk of developing melanoma.

Diagnosis of skin cancer
Board certified dermatologists are formally trained to identify skin lesions that are highly suspicious for skin cancer. They are also trained to use various devices to aid in the diagnosis of skin cancer, such as, using an instrument called a dermatoscope. A dermatoscope allows the dermatologist to see features of the skin lesion that are not viewable with the naked eye, such as, blood vessels and various colors. When the dermatologist suspects skin cancer, the physician will take a biopsy. The biopsy is reviewed by a board certified dermatopathologist to determine the type and staging of skin cancer.

TYPES OF SKIN CANCER
Melanoma
The deadliest form of skin cancer is malignant melanoma. It is a result of the overgrowth and mutation of skin cells called melanocytes. Melanocytes produce melanin, which gives color to skin. It is malignant and invades deep into the skin, other vital structures, and spreads to other parts of the body. Because there are melanocytes in all skin and other vital organs, melanoma can be found in the eyes and also under the finger and toenails. 7% of new cancer cases in men, and 5% of new cancer cases in women are melanomas. Men are more likely to develop melanoma on the chest and back, while women are more likely to develop melanoma on the legs. The majority of people who develop melanoma are white men over the age of 55. However, all individuals including skin of color can develop melanoma. Furthermore, only 20-30% of melanomas are found in existing moles. Melanoma most commonly occurs as a new skin spot.

Risk factors for melanoma

• UV radiation from the sun

• A family history of melanoma

• Pale skin and light-colored hair and eyes

• High number of moles

• Age

• Melanoma symptoms

The ABCDE’s of melanoma:
Asymmetric: normal moles are symmetric, one side looks like the other side, but melanomas do not follow this pattern.
Borders: melanomas have irregular borders. They can be jagged, notched or blurred. Normal moles have round borders.
Color: melanomas usually include more than one color including black, brown, tan, white and blue.
Diameter: melanomas tend to be larger than a pencil eraser or normal mole.
Evolving: melanoma changes appearance overtime. This is an important red-flag to alert your dermatologist.

Tumor staging
When the diagnosis is made the tumor is staged to determine the aggressiveness of the tumor. Stage 0 means it is in the outermost layer of the skin.
Stage 0 means it is in the most superficial layer of the skin.
Stage I means it is thicker (up to 2MM), may be ulcerated but has not spread.
Stage II means the cancer is thicker (greater than 2MM), may be ulcerated but has not spread.
Stage III means the cancer has spread to the lymph nodes.
Stage IV means the cancer has spread to other organs or metastasized.

Melanoma treatment
Treatment depends on the stage of the tumor. Complete surgical removal is the goal. Mohs surgery is a technique that removes the lesion and leaves as much normal tissue as possible so as to avoid disfigurement.

Basal cell carcinoma (BCC)
BCC is a slow-growing skin cancer that almost never spreads to other parts of the body. However, BCC continues to grow and invade and destroy local tissue. Those at risk are fair-skinned individuals with significant amounts of sun exposure. BCC most commonly develops on the face, nose, chest, neck and back of the hands. BCC appear as small, shiny bumps that slowly enlarge. They can break open, bleed and form a scab or look like a scar. Early diagnosis and treatment can reduce the risk that BCC can grow deep and destroy tissue and bone. Mohs surgery is often recommended to spare healthy tissues and prevent disfigurement.

Squamous cell carcinoma (SCC)
SCC is also caused by years of sun exposure that most commonly affects light-skinned individuals. It can appear anywhere including the mouth, lips and genitals. SCC most commonly presents on sun-exposed skin. SCC appears as firm, red bumps, scaly patches, or a sore that won’t heal. SCC has potential to spread to other parts of the body and be fatal. When caught early SCC can be cured. Surgery or Mohs surgery is the treatment of choice, but may include topical chemotherapy drugs, and at times radiation therapy may be recommended.

Certain types of skin cancer grow slowly and spread locally, while others grow quickly and spread to lymph nodes and other organs. In every case, it is essential that all cancer cells be removed. Treatment options vary based on the type of skin cancer, the size, location and depth of the tumor, as well as, age and health of the patient. The majority of skin cancer treatments can be performed in the office or outpatient facility under local anesthesia.

Diagnosis and staging
Diagnosis of the type of cancer and its stage requires pathological examination of the tumor tissue either from a biopsy of the tumor, and/or after the tumor has been removed. Staging is the determination of the thickness and characteristics of the tumor, and whether it has spread locally, to the lymph nodes or other parts of the body. Depending on the stage, a lymph node biopsy may be recommended. An imaging scan will reveal if the cancer has spread to other organs. The stage of the cancer determines the prognosis (chance of recovery) and the treatment options.

SURGICAL OPTIONS
Localized treatments are generally reserved for low-risk superficial tumors and include: cryosurgery, topical therapy, photodynamic therapy (PDT), and electrosurgery

Wide local excision involves cutting out the tumor along with extra margins of normal skin. If wide margin excision can cause disfigurement or loss of anatomical function, Mohs micrographic surgery will be recommended.

Mohs micrographic surgery (Mohs or Mohs surgery) involves removing the tumor in stages or layers. Each layer is mapped and examined under a microscope to check for cancer cells. The procedure is repeated until no more cancer cells are seen. While Mohs surgery can take hours, the result is the preservation of as much healthy skin as possible and a hidden scar. Mohs surgery requires specialized training. It is recommended when wide local excision can cause disfiguration, when tumors are on certain locations such as, the face, eyes, lips, nose and genitals, and when it is difficult to determine the extent of the cancer.

The Procedure
During the Mohs surgery, patients are awake and alert as it is performed under local anesthesia. It is performed safely and comfortably in our medical office. On the day of surgery, each patient is prepped for the procedure after an in-depth discussion of what the day will entail including wound care instructions and post-operative considerations.

Prior to the surgery, an anesthetic is injected to minimize pain during the procedure. The skin cancer is surgically removed via an intricate technique to provide tissue sparing while removing the visible tumor. While the surgical layer is being processed in the lab, a bandage is placed over the area during the waiting process. The Mohs surgeon looks at the removed skin cancer under the microscope, and if there are any remaining cancer cells, another layer of skin is prepped for removal. This process is repeated until there are no remaining cancer cells visualized.

Once the skin cancer is cured, the Mohs surgeon will repair the open area taking into consideration what will provide the best cosmetic outcome. The great team providing care during the procedure will ensure that all the wound care instructions are discussed in detail with scheduled follow up care for optimal outcomes and well-being.

Metastatic skin cancer can’t be treated with local therapy. Options include targeted therapy, chemotherapy, immunotherapy and clinical trials.
- The primary skin cancer is surgically excised.
- Radiation and chemotherapy are adjuvant treatments used to kill remaining cancer cells after surgery or in other metastatic locations.
- Immunotherapy may be recommended to boost the patient’s immune system to fight the cancer.
- Drug therapy is targeted therapy to attack the cancer cells without causing harm to normal cells.

Basal cell carcinoma (BCC) treatments
When BCC is localized (has not metastasized/spread) treatment options include simple excision, Mohs micrographic surgery, radiation therapy, electrosurgery, photodynamic therapy, topical chemotherapy or immunotherapy. However, simple excision can cause significant scarring and possibly loss of function. Therefore, when BCC is found in a location where excision would cause disfigurement, Mohs surgery will be recommended to spare healthy tissue, reduce scarring and preserve function.

Squamous cell carcinoma (SCC) treatments
Localized SCC can be treated with simple excision, Mohs, radiation therapy, and electrotherapy. SCC in situ in certain circumstances may be treated with photodynamic therapy. When SCC spreads beyond the localized tumor treatment options also include chemotherapy and immunotherapy.

Metastatic melanoma treatments
Melanoma in situ, which is confined to the most superficial layer of skin and has not spread, is treated with surgery.

Depending on the stage of melanoma, discussed in the Skin Cancer Types section, treatment may include surgical excision, lymph node removal, immunotherapy, chemotherapy and/or radiation to kill any remaining cancer cells and lower the risk of recurrence.

What are skin growths?
Skin growths are a common complaint presented to the dermatologist and can range from benign lesions, such as, seborrheic keratoses, cysts, warts, lipomas, and benign moles to malignant lesions, such as, actinic keratoses, nonmelanoma skin cancers, and malignant melanomas. Noncancerous or benign skin growths often are confused with their malignant counterparts. They may be flat or raised, dark or skin-colored, grow slowly or rapidly. Benign skin growths can be caused by viruses, genetics and environmental factors. Below are descriptions of the most common benign skin growths.

Sebaceous hyperplasia
Sebaceous hyperplasia produces small shiny, flesh-colored to yellow benign bumps. They are caused by trapped sebum and dead skin cells inside enlarged oil glands, typically on the face, forehead and nose. They are common in people with fair skin, and are linked with high testosterone, sun exposure and genetics. Treatment is primarily for cosmetic purposes.

Lentigines (a.k.a. age or liver spots)
Lentigines are hyperpigmented patches that may look like a mole. They are usually tan to brown and affect light-skinned adults with age. They are caused by longterm sun exposure and therefore, appear on sun-exposed skin. Lentigines are generally benign. Treatment is primarily for cosmetic reasons.

Cherry angiomas
Cherry angiomas are benign overgrowths of capillaries (small blood vessels) that are very common. They typically affect people over the age of 30 and multiply as we age. They are most often red and flat, but can be slightly raised. They are most commonly found on the trunk and extremities and can also be found on the face, chest and neck. They are harmless and cause no symptoms but can bleed if picked. Electrotherapy or laser therapy may be recommended for cosmetic improvement.

Skin tags
Skin tags are flesh-colored to brown soft growths that appear on a stalk. They are commonly found on the neck, under the arms and in the groin where skin is constantly under friction. They are harmless but can become irritated by clothing and jewelry. They can be removed with simple excision or electrosurgery.

Milia
Milia are small white and yellow cystic growths on the face caused by accumulation of dead skin cells. They are dome-shaped bumps that often occur in newborns and on women’s faces. Milia do not normally cause symptoms and are harmless lesions. They can be treated for cosmetic purposes by electrosurgery or simple excision.