Surgical / Skin Cancers
We care for patients of all ages, genders and skin types. Any ailment of the skin, hair or nails can be addressed through our office. The most common concerns that are managed include skin rashes, growths, acne, rosacea and skin cancer. In addition to thorough evaluation and management of general medical dermatology issues we offer specialized treatments to our patients.
Blu-U (blue light) acne treatments are an alternate to systemic antibiotics and isotretinoin (Accutane) for the treatment of moderate inflammatory acne. Treatments begin twice weekly for the first month. They are then tapered to once weekly for 2 months. There is no downtime, redness or irritation experienced from use of this light therapy.
Narrow Band UV B phototherapy employs a specific band of ultraviolet light for the treatment of a variety of skin conditions. This treatment is safe, effective and is often used when one wishes to avoid use of systemic medications. We utilize this treatment as there is no increased risk for development of skin cancers (as opposed to a standard tanning bed). The most common conditions treated with narrow band UVB are psoriasis, vitiligo, atopic dermatitis and generalized pruritus (itching).
Patch testing is used to evaluate for the presence of allergies to chemicals encountered by the skin (allergic contact dermatitis). Allergic contact dermatitis is a delayed type of hypersensitivity reaction which may make it difficult to know what is causing a rash. Patch testing is a simple process by which we apply the most common allergens to the skin and then evaluate for a reaction. The patches are typically placed on one’s back on a Monday, removed and evaluated on Wednesday with a final evaluation done on that Thursday or Friday.
PDT is also known as “blue light”. It is used for the treatment of actinic keratoses (AKs). AKs are pre-cancerous lesions which are usually pink and rough like sandpaper. If left alone they have the potential to develop into squamous cell carcinoma. In an effort to remove these lesions and prevent skin cancer development PDT can be used. It is beneficial when one would like to treat an entire affected area. It can clear the precancerous changes while providing a cosmetic improvement in the appearance of the skin.
How does it work?
PDT involves the application of a photosensitizer to the skin. This is a cream that is placed on the area to be treated (usually the face, neck, scalp, forearms or hands) and then left to “incubate”. This incubation period can vary depending on the patient and location being treated, however it is typically 2-3 hours. After the cream is applied in the office you may leave and then return after the specified incubation period. During this incubation period the cream that was applied is absorbed by the AKs and is converted into a light sensitive by-product. We then activate this chemical by placing you under the blue light for 16 minutes and 40 seconds.
What should I expect?
- During the blue light treatment you should expect some discomfort and burning. This is alleviated by use of a handheld fan and usually improves after about 6 minutes. Once the treatment is finished you will wash the treated area and apply sunscreen.
- The treatment area should become red and start to peel that evening. This peeling may last for 1-2 weeks. It may be a mild or significant reaction. Given that some reactions will be significant with peeling lasting for up to 2 weeks we recommend that one has no significant social or work events in the 2 weeks after the treatment.
- As the areas peel you should avoid scrubbing the area. Instead gently cleanse with soap and water then apply Vaseline or Aquaphor to the healing areas several times daily.
- It is necessary to exercise strict sun avoidance for 48 hours after the treatment. The photosensitive chemical remains in the skin for about 40 hours after it is applied. UV light as well as strong overhead lights will continue to activate the cream for the first 2 days, eliciting a burning sensation.
- Cold sores (also known as fever blisters or herpes simplex infections) can occur after PDT in people that are prone to them. It is important to tell your provider that you may be predisposed to cold sores prior to the treatment so that anti-viral prophylaxis is used.
- One can expect an improvement in the precancerous changes as well as the appearance of the skin following PDT. It removes many of the imperfections caused by UV light exposure over time leading to a brighter smoother complexion. Some patients will require 2 or more treatments.
At Morgan Dermatology we are focused on cancer prevention and early detection. We provide thorough skin cancer screenings and utilize dermoscopy to find melanoma at its earlies stages.
When a skin cancer is found we also provide expert medical and surgical care. There are many options for the treatment of skin cancers including Mohs micrographic surgery (see below), excisional surgery, electrodessication and curettage, topical therapy (creams), radiation as well as oral medications. We utilize each of these therapies in the appropriate situation.
There are many treatment options for cutaneous malignancies. When used in the appropriate situations, Mohs Micrographic Surgery provides the highest cure rates while minimizing the amount of skin removed. This ideally allows the smallest scar while achieving up to 97-99% cure rates.
The procedure involves removing skin cancers with a small margin of normal tissue surrounding the lesion. The tissue is then processed in such a way that the entire margin is evaluated under the microscope. This determines whether or not the skin cancer has been removed. If the cancer has been removed, then the wound is then closed or it is allowed to heal on its own. If there is still skin cancer remaining, then further skin is removed in the area(s) where the cancer remains. This allows small and focal areas to be removed in staged excisions. This preserves as much normal skin as possible. The process is done all in the same day. Each time a piece of skin is taken and processed may take up to 2 hours. Thus, one must expect to be in the office for at least the entire morning.
Some things to keep in mind if you have been scheduled for Mohs Micrographic Surgery….
1. The day of the surgery…
– Be sure to eat breakfast and take any medications that you normally take (unless you have been advised otherwise)
– Be prepared to be in the office for many hours. Bring paperwork, books, snacks etc. Expect to be bored. We have no way to be sure how large a skin cancer will be until the lesion is removed and looked at under the microscope. Most cases are cleared in 1 -2 stages but every lesion has the potential to spread farther microscopically than one can appreciate with their eyes alone.
2. Blood thinners
– If you take any blood thinners that have not been prescribed by your doctor we prefer that they be held 1 week prior to the procedure. This includes aspirin, ibuprofen, NSAIDS, fish oils, Vitamin E, garlic supplements and alcohol. If you have been prescribed any blood thinners by your physician we prefer that you discuss holding these medications with your health care professional, and not stopping without their advice. If these medications are medically necessary, then they should be continued. In the case that you are on coumadin (warfarin), we would like to see a blood level (INR) done within 48 hours of the procedure. The INR level should be less than 3.
– If you are a smoker you should quit smoking. This impairs wound healing and increases the risk for wound infections as well as failure of skin grafts and flaps. If you have trouble quitting, we prefer that you not smoke for 6 weeks before and after the surgery to optimize results and minimize scarring.
– Although Mohs Micrographic Surgery provides the highest cure rates and minimizes the amount of skin removed, it will leave a scar. There is no way to remove a skin cancer that does not leave some sort of scarring. We make every effort to provide the nicest looking scars. We also offer the option of seeing a plastic surgeon for closure of the wound following Mohs Micrographic Surgery. If you would like to see a plastic surgeon following removal of the cancer please let us know so that we can coordinate this in advance.
5. Driving home
– We advise all patients to have a driver. Please plan accordingly or have a ride available.
– This procedure is performed under local anesthesia (injection into the area with a numbing agent). No general anesthesia or sedation is used in the office.
– The surgery takes place in the office. Once the lesion is removed you will return to the waiting area until it has been examined under the microscope. If additional stages (pieces of skin) need to be taken then you will return to the procedure room for this.
At Morgan Dermatology we use liquid nitrogen to treat a variety of skin conditions. This involves the freezing of superficial skin growths such as actinic keratoses, seborrheic keratosis, lentigines, warts and other skin growths. This liquefied gas is negative 196 degrees Celcius (minus 321 degrees Fahrenheit). It essentially causes frostbite to the skin treated, thus destroying the targeted tissues and allowing new normal skin to take its place.
What should I expect?
One can expect some degree of discomfort with cryosurgery. This typically involves a transient stinging or burning sensation that resolves momentarily. In some cases, especially on the fingers, a throbbing sensation may last a few hours. Swelling and blistering may occur during the first 24 hours following treatment. A scab will form, which will fall off by itself in 1 to 3 weeks. New healthy skin will take its place.
Are there any adverse effects?
The most common adverse effects are discoloration, swelling and blistering. The discoloration may be darker but is usually in the form of lighter colored areas of skin that persist following the treatment. This is more commonly seen with darker skin tones.
Does the treated area require any special care?
No, typically the care of an area treated with liquid nitrogen involves just leaving it be. If a blister develops it is recommended that it be left alone. The blister roof serves as a natural wound dressing. If the blister pops or if crusting develops, then a thin film of Vaseline ointment may be applied 2 times a day until this resolves.
Note: Often, more than one treatment is required to adequately remove a skin growth, especially when treating larger warts. If you have any concerns about the treated area or questions about cryosurgery, please call the office.
Excisional surgery is used to remove a variety of skin lesions. It is the method of choice when removing certain skin cancers, precancerous moles, cysts and lipomas. Most excisional procedures will take about 30 minutes and are done in the office. We do recommend that blood thinners be held whenever possible. See the form labeled Care of Sutured Wounds for information on what to expect and how to care for the wound following the procedure.
There are many facets of skin rejuvenation. Laser and intense pulsed light treatments are used to eliminate unwanted brown and red spots. Chemical peels, Hydrafacial treatments and the Venus Viva are used to improve skin tone and textural changes. Botox and fillers are used to augment the appearance of lines and enhance the cheeks, jawline and lips. The Venus Legacy can help tighten the skin of the face, neck, chest, abdomen, thighs and buttocks.
Botox and filler usage is on the rise. We aim to enhance your natural features, not change the way you look. When considering Botox or fillers please avoid blood thinners for 1 week prior to your appointment. We also provide numbing cream to those who would like a much more comfortable treatment.
Considerations for Botox injections
- Botox is indicated for dynamic wrinkles. These are lines that are formed by the movement of muscles of facial expression. Examples include the glabella (11 lines), crow’s feet and forehead.
- Botox will take 4 – 14 days to take effect. This lasts for an average of 3 months.
Considerations for Fillers
- Various fillers are used to “fill” unwanted lines and to augment the lips, cheeks and jawline. Different fillers last for different amounts of time and are chosen based upon the desired effect.
- One can expect some swelling in the first 2 days following the procedure and bruising may last for 2 weeks.
Intense Pulsed Light (IPL) uses multiple wavelengths of light to target specific lesions. This treatment is ideal for skin rejuvenation. We use the device to treat brown and red spots. When performing skin rejuvenation with IPL we treat the entire affected area such as the face, neck, chest or hands. If you are considering IPL for skin rejuvenation there are several things to know before you have the treatment.
- Sun avoidance is absolutely necessary for several weeks before and after the treatment to minimize the chance of any adverse effects.
- Downtime is expected. Red spots and brown spots will look worse initially. This is to be expected and will last 1- 2 weeks. Makeup can be worn over the treated areas.
- Mild discomfort is to be expected during the treatment. This discomfort is tolerable for most people. If you are concerned about the discomfort a topical anesthetic can be applied to minimize this discomfort.
- Multiple treatments are often required to achieve lasting desired results.
- Treatment is considered cosmetic and not covered by insurance.
Hair loss is a distressing situation. A thorough evaluation is necessary to determine the cause of the hair loss and to determine the appropriate remedy. In addition to a physical examination, labs are often ordered to ensure there is no internal cause of alopecia. After a diagnosis is made the treatment options will be discussed. In addition to standard medical therapies for hair loss we provide the most up to date treatments for people with male and female pattern hair loss. These treatments include low level laser therapy and PRF (platelet rich fibrin) injections.
Sunetics Low Level Laser Therapy
The Sunetics International Low Level Laser Therapy is FDA cleared for the treatment of male and female pattern hair loss. This safe and effective therapy treats androgenetic alopecia without pain or chemicals. This involves 20 – 30 minute sessions under a red laser. This laser increases blood flow to the scalp, removing dihydrotestosterone from the scalp and stimulating energy production in the hair follicles. This is performed twice weekly for 3 months, then once weekly for 3 month and then every other week for 6 months. We recommend monthly maintenance treatments thereafter.
Platelet Rich Fibrin
Platelet Rich Fibrin injections involves drawing blood from the patient. This blood is then spun in a centrifuge separating out different layers. The layer known as platelet rich fibrin (PRF) is removed and then injected into the scalp. This PRF contains a variety of growth factors. These growth factors when released into the skin can stimulate hair growth. These treatments are performed on a monthly basis for 3 months then every 6 months thereafter. We recommend an evaluation by our providers prior to scheduling PRF treatments.
What is the difference between PRP and PRF
Platelet Rich Fibrin is a second generation PRP (platelet rich plasma) therapy that contains high concentrations of white blood cells, fibrin and stem cells found circulating in our bloodstreams. PRF is a 100% natural and unmodified autologous solution meaning from one’s own blood. By the proprietary preparation using low centrifugation method, PRF has several advantages over PRP. In comparison to PRP, PRF has a higher concentration of platelets, stem cells, and leukocytes leading to more growth factors. Growth factors are substances that simulate growth and proliferation, cell differentiation and aid in wound healing. PRF is free of any additives like sodium citrate or heparin leading to the 100% natural solution. This allows the creation of a fibrin matrix leading to a much slower release of growth factor and cytokines. This method keeps cells active longer. Growth factors are released on average of 10-12 days in contrast to PRP which are released for about 1-3 days after the procedure. PRF is injected directly into the scalp in which the growth factors stimulate angiogenesis, further release of stem cells resulting in increased hair count and density.
HydraFacial are a phenomenal way to brighten the texture and tone of the skin. Treatments can be tailored to your skin type with optional boosters and light treatments. Dermaplaning is also incorporated into each HydraFacial treatment.
Eliminate unwanted body hair with laser hair removal. We use the Cutera Prowave LX to achieve permanent hair reduction in lighter skin types. The Cutera 1064nm Nd:YAG laser provides a safe means to remove unwanted hair in those with darker skin types. It typically takes 6-8 treatments to achieve permanent hair reduction. Strict sun protection and avoidance must be used while undergoing these treatments.
The Venus Legacy provides skin tightening as well as non-invasive fat and cellulite reduction. This machine incorporates multi-polar radiofrequency and electro-magnetic pulses to increase collagen production, promote fibroblast activity, and heat fat cells leading to reduction in fat, improvement in cellulite and tightening of the skin with no pain and no downtime. This is an ideal treatment for loose skin of the abdomen following a pregnancy. It is also often used to tighten the skin on the legs, buttocks, chest and neck.
The SkinPen microneedling device is ideal for patients of all skin types. It helps to improve skin texture, wrinkling and acne scarring. The treatment works by creating numerous controlled non-thermal injuries to the skin’s surface (microchannels). This induces the body to respond through the formation of new elastin and collagen fibers (neo-collagenesis) as well as new capillaries for an improved blood supply (neo-angiogenesis) in the treated area. We suggest adding the use of Platelet Rich Fibrin (PRF) to the treatment to enhance the rejuvenation effect.