Bruce P.Robinson, MD

Non-Invasive Treatment of Skin Cancer

Fractional Non-Ablative Laser Treatment For The Treatment of Skin Cancers

Dr. Robinson is improving skin cancer prognosis and treatment with little to no-downtime, scarring, or bleeding and functional & cosmetic results that are superior to cold steel excision & MOHS.

Patients on anticoagulant therapy do not have to stop their medication before treatment, therefore not increasing their risk for stroke and/or heart attack, quick healing, & no risk of post-operative complications!

This treatment is especially great for actors/actresses or professionals in the public eye who can't afford downtime or a scar, athletes or weekend warriors who want to continue their workouts unencumbered and helpful with infirm or older patients who are not able to perform extensive wound care and withstand the rigors of a skin flap or graft.

Fraxel Laser, at adaptive settings, offers a gentle approach to treating pre-cancerous skin growths and therefore help prevent future skin cancer by 60-70%. Given that skin cancer is the most prevalent cancer in the United States, affecting more than 3 million Americans a year, just two Fraxel Laser Treatments 2-4 weeks apart provides a major advancement in skin cancer prevention. In addition, given the likelihood of future basal or squamous cell carcinomas in individuals with a history of a prior skin cancer, Fraxel Laser Treatment dramatically reduces the risk of subsequent skin cancer and skin cancer recurrence.

Fraxel has already demonstrated remarkable success with minimal downtime & discomfort as a gentle yet effective treatment of actinic keratosis (AK), the most common type of pre-cancerous skin conditions. Other benefits to FRAXEL Laser is it's ability @ ameliorating photo damage, utilizing precise photothermolysis to stimulate collagen and elastin production, promote dermal wound healing, improving hyperpigmentation (brown spots) skin tone, skin laxity, and roughness. Now we can add the Fraxel Laser as the up and coming gold standard to the treatment of certain skin cancers!

Shingles

SIGNS, SYMPTOMS DIAGNOSIS & TREATMENT

Shingles causes a painful, blistering rash on your skin. If you get shingles, you may notice the following three stages:

Before the rash appears: For 1 to 2 days before the rash appears, you may have pain, burning, or tingling on an area of skin where the rash will develop. Some people have described an “electrical sensation” on their skin before getting the rash.

Rash appears: A painful, blistering rash appears. It usually appears on one side of your body, often on the torso; however, it can appear anywhere on your skin. Some people get more blisters after the rash appears, so it can seem that the rash is spreading.

Rash starts to clear: As the rash clears, the blisters may crack open, bleed, and scab over. For most people, the rash will clear within 2 to 4 weeks.

If you have a rash of blisters on your skin or a rash that looks like those shown below, schedule an appointment immediately for a diagnosis. If you have shingles, it’s important to get treatment, preferably within 1 to 3 days.

If you’ve had the rash for longer than 2 to 3 days, it’s still important to schedule an appointment!

Other signs and symptoms of shingles:

Along with a painful, blistering rash, some people can also have one or more of the following:

  • Fever
  • Headache
  • Muscle aches
  • Stomach pain
  • Vomiting

How do dermatologists treat shingles?

Rash: PLEASE call our office to schedule an appointment immediately or other health-care provider within 3 days of getting the rash. When treatment is started within 3 days, treatment can prevent possible complications, such as long-lasting nerve pain.

Receiving treatment after 3 days still has benefits, so you should still schedule an appoointment to see your doctor if you’ve had the rash for longer than 3 days.

Before taking any medication, it’s important to make sure that you have shingles.We will prescribe an antiviral medication. One of three antiviral medications is usually prescribed—acyclovir, famciclovir, or valacyclovi to:

  • Reduce the amount of time that you have a shingles rash
  • Decrease how severe the rash becomes
  • Lower your risk of developing long-lasting nerve pain and other health problems

Pain: Over-the-counter medication(s) can help, such as:

  • Acetaminophen
  • Ibuprofen

If you have severe pain, we may prescribe a medication that reduces inflammation, such as a corticosteroid.

Prevention:

Talk with your doctor about getting the shingles vaccine, Shingrix. You can get shingles again. A shingles vaccine that the U.S. Food and Drug Administration (FDA) approved in 2017 can greatly reduce your risk of developing shingles again. You can learn more about this vaccine at, Shingles Vaccine, CDC.

The CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix (recombinant zoster vaccine) to prevent shingles and the complications from the disease. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of Shingrix, as they have a higher risk of getting shingles and related complications.

Prevent others from getting sick:

Until the shingles rash clears, you are contagious.

Anyone who has not had chickenpox (or the vaccine for chickenpox) can catch the virus. This could cause chickenpox. To avoid infecting others, who could get chickenpox and later shingles, dermatologists recommend that you do the following until the rash clears:

  • Cover the rash
  • Avoid touching and scratching your rash
  • Stay away from pregnant women, babies 12 months old or younger, anyone who is sick, and everyone who has not had chickenpox

Pictures of a shingles rash

Having a shingles rash on your face is a medical emergency.
Even if the rash isn’t on your eye, it could still affect your eyesight. Immediately seeing a doctor for treatment could save your eyesight.

PRO-NOX Nitrous Oxide

Breeze through pain-free, anxiety free cosmetic treatments with ProNox.

We are pleased to introduce ProNox™ in our practice, a patient controlled, inhaled analgesia for in-office use. We want our patients to achieve their cosmetic goals worry-free. Patients say that it has made all the difference in moving forward with many cosmetic procedures.

The use of nitrous oxide in Medical, Cosmetic & Laser Dermatologic procedures is becoming more common. Our goal is to provide each patient with a pain-free experience and to work with their varied anxiety levels. While we have excellent topical numbing options for pain control, nitrous oxide can help calm the patient who is nervous or anxious and also help with pain relief.

Pediatric Dermatology

Dr. Robinson was a pediatric resident @ NYU / NYC Health & Hospitals / Bellevue prior to pursuing dermatology. He enjoys seeing pediatric patients and specializes in difficult to diagnose rashes, birthmarks, acne, warts, molluscum and eczema.

Hair & Nail Disorders

Most people know that dermatologists are experts in skin, but did you also know we specialize in hair and nails? Hair and nail disorders can be complex and multifaceted. Our job is to help identify underlying problems that lead to these disorders. From hair loss to nail fungus, we have many more modalities than ever before to treat these diseases.

Skin Cancer Screenings

We recommend annual skin cancer screenings for almost everyone. Essentially all skin cancer can be cured if detected early, and an annual skin cancer screening is the best way to find them at this early stage. Patients with a skin cancer history usually require screening every 3 to 6 months. Skin cancer screenings are truly life saving! Don’t be shy—make your appointment today! Contact us today to schedule an appointment.

What To Expect During My Skin Exam

Dr. Robinson offers a full 20-30 minute thorough skin exam. You'll be given a gown and asked to take off everything but your undergarments. The gown and undergarments can be moved in ways to keep areas of your body covered during the exam and to protect your privacy. Your appointment will involve a thorough examination of your skin — from the top of your scalp to the bottoms of your feet — by a board-certified dermatologist. Remove any nail polish, this will allow us to fully examine your fingers, nails, and nail beds. We will look for suspicious spots that could be cancerous.

Warts

Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin. Viruses that cause warts are called human papillomavirus (HPV). The types of HPV that cause common warts, plantar warts, or flat warts are usually different from the types of HPV that cause genital warts. A vaccine is available to help protect against the types of HPV that cause genital warts (and increase a person's risk of certain types of cancer).

How many kinds of warts are there?

There are several different kinds of warts including:

  • Common warts
  • Foot (Plantar) warts
  • Flat warts
  • Genital warts

Common warts usually grow on the fingers, around the nails and on the backs of the hands. They are more common where skin has been broken, for example where fingernails are bitten or hangnails picked. These are often called "seed" warts because the blood vessels to the wart produce black dots that look like seeds.


Foot warts usually appear on the soles (plantar area) of the feet and are called plantar warts. When plantar warts grow in clusters they are known as mosaic warts. Most plantar warts do not stick up above the surface like common warts because the pressure of walking flattens them and pushes them back into the skin. Like common warts, these warts may have black dots. Plantar warts are uncomfortable and painful, feeling like a stone in the shoe.

Flat warts appear as small, smooth usually skin colored, pink or brown bumps on the skin. Common places for flat warts are the face, top of the hands, top of the feet, arms, and legs.

Genital warts (warts in the genital area, also called "condyloma acuminatum"

Prevention

To prevent warts from spreading, dermatologists recommend the following:

  • Do not pick or scratch at warts
  • Wear flip-flops or pool shoes in public showers, locker rooms, and pool areas
  • Do not touch someone’s wart
  • Keep foot warts dry, as moisture tends to allow warts to spread

When a dermatologist can help

While you can often clear a wart at home, some warts can be stubborn. If the person has a weakened immune system, it can be difficult to get rid of warts. Sometimes, what looks like a wart turns out to be a callus or another type of growth.

A board-certified dermatologist can help by:

  • Making sure that you or a family member has warts
  • Treating stubborn warts

Sometimes, warts can be stubborn, so they don’t clear with treatment that you can buy without a prescription. A dermatologist can create an effective treatment plan.

Vitiligo

Vitiligo is a skin condition resulting from the loss of pigment which produces white patches. Any part of the body may be affected. Usually both sides of the body are affected. Common areas of involvement are the face, lips, hands, arms, legs, and genital areas.

Who Gets Vitiligo?

Vitiligo affects one or two of every 100 people. About half the people who develop it do so before the age of 20; about 1/5 have a family member with this condition. It may be an autoimmune process (the body makes antibodies to its own pigment cells). Most people with vitiligo are in good general health, although vitiligo may occur with other autoimmune diseases such as thyroid disease

What Determines Skin Color?

Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white

How Does Vitiligo Develop?

Typical vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch, or a border of darker skin may circle an area of light skin.

Vitiligo often begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn't change, may continue indefinitely.

It is rare for skin pigment in vitiligo patients to return on its own. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. Although their skin is all one color, they still have vitiligo.

The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo and suntanned skin in the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment all over the body. There is no way to predict how much pigment an individual will lose.

How is Vitiligo Treated?

Sometimes the best treatment for vitiligo is no treatment at all. In fair-skinned individuals, avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable because the (no pigment) white skin, of vitiligo has no natural protection from sun. These areas are easily sunburned, and people with vitiligo have an increased risk to skin cancer. A sunscreen with a SPF of at least 30 should be used on all areas of vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns.

Disguising vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available. Stains that dye the skin can be used to color the white patches to more closely match normal skin color. These stains gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance. Micropigmentation tatooing of small areas may be helpful.

If sunscreens and cover-ups are not satisfactory, your doctor may recommend other treatment. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). None of the repigmentation methods are permanent cures.

Treatment of Vitiligo in Children

Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored. PUVA, an ulta-violet therapy, is usually not recommended until after age 12, and then the risks and benefits of this treatment must be carefully weighed.

Repigmentation Therapy

Topical Corticosteroids — Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist's care.

PUVA

PUVA is a form of repigmentation therapy where a type of medication known as psoralen is used. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. Sometimes, when vitiligo is limited to a few small areas, psoralens can be applied to the vitiligo areas before UVA treatments. Usually, however, psoralens are given in pill form. Treatment with PUVA has a 50 to 70% chance of returning color on the face, trunk, and upper arms and upper legs. Hands and feet respond very poorly. Usually at least a year of twice weekly treatments are required. PUVA must be given under close supervision by your dermatologist. Side effects of PUVA include sunburn-type reactions. When used long-term, freckling of the skin may result and there is an increased risk of skin cancer. Because psoralens also make the eyes more sensitive to light, UVA blocking eyeglasses must be worn from the time of exposure to psoralen until sunset that day to prevent an increased risk of cataracts. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women, or in individuals with certain medical conditions.

Narrow Band UVB (NBUVB)

This is a form of phototherapy that requires the skin to be treated two, sometimes three, times a week for a few months. At this time this form of treatment is not widely available. It may be especially useful in treating children with vitiligo.

Grafting

Transfer of skin from normal to white areas is a treatment available only in certain areas of the country and is useful for only a small group of vitiligo patients. It does not generally result in total return of pigment in treated areas.

Other Treatment Options

Other treatment options include a new topical class of drugs called immunomodulators. Due to their safety profile they may be useful in treating eyelids and children. Excimer lasers may be tried as well.

Depigmentation Therapy

For some patients with extensive involvement, the most practical treatment for vitiligo is to remove remaining pigment from normal skin and make the whole body an even white color. This is done with a chemical called monobenzylether of hydroquinone. This therapy takes about a year to complete. The pigment removal is permanent.

Is Vitiligo Curable?

At this time, the exact cause of vitiligo is not known, however, there may be an inherited component. Although treatment is available, there is no single cure. Research is ongoing in vitiligo and it is hoped that new treatments will be developed.

Venous Lake

Time To Smile Again ... A venous lake is a benign, soft, compressible blue bump usually found on or around the lips caused by a dilated vein. While it is benign it can be cosmetically unsightly. With the use of the Nd:YAG laser a venous lake can be treated within seconds and resolved without scarring.

What To Expect:

  • Procedure Time: Literally Seconds
  • Back To Work: Immediately
  • Anaesthetic: Not Required
  • Sensitivity Period: One Week +
  • Visible Results: 4 - 6 weeks
  • Number of Treatments: 1 -2 
  • Possible Side Effects: Soreness, Blistering, Swelling
  • Duration of Results: Permanent

FAQ's:

Is It Safe? The Nd:YAG laser is clinically proven to be both safe and effective.

How Does It Work? Treatments target the blood in the venous Lake lesion, causing it to regress.

Is The Treatment Suitable For Me? This procedure can be used on all skin types and treatment is suitable for most people.  However, prior to treatment please review our cosmetic reimbursement policy. 

Hives | Urticaria

Urticaria, also known as hives, are localized, pale, itchy, pink wheals (swellings) that can burn or sting. They may occur singularly or in groups on any part of the skin. They are part of an allergic reaction and are very common. Approximately 10-20 percent of the population will have at least one episode in their lifetime. Most episodes of hives disappear quickly in a few days to a few weeks. Occasionally, a person will have them for many months or years. New hives may develop as old ones fade. Hives can vary in size from as small as a pencil eraser to as large as a dinner plate, and may join to form even larger swellings.

Hives are produced by blood plasma leaking through tiny gaps between the cell lining small blood vessels in the skin. Histamine is a chemical released from cells in the skin called mast cells; which lie along blood vessels. Allergic reactions, chemicals in foods, or medications may cause hives; sometimes it is impossible to find out the cause. When hives form around the eyes, lips, or genitals, the tissue may swell excessively. Although frightening, the swelling usually goes away in less than 24 hours. Severe cases of hives may cause difficulty in breathing or swallowing and emergency room care is required.

Acute Urticaria

Acute urticaria lasts less than six weeks. An underlying cause can be frequently identified and eliminated. The most common causes for acute urticaria are foods, drugs, or infections. Insect bites, internal diseases, pressure, cold, or sunlight also may be responsible.

Foods

The most common foods that cause urticaria are: nuts, chocolate, shellfish, tomatoes, eggs, berries, and milk. Fresh foods cause hives more often than cooked foods. Food additives and preservatives may also cause hives.

Hives may appear within minutes to several hours after eating, depending upon the site within the digestive tract where the food is absorbed.

Drugs

Almost any medication -- prescription or over-the-counter -- can cause hives. Antibiotics, pain medications, sedatives, tranquilizers, diuretics (water pills), diet supplements, antacids, arthritis medication, vitamins, herbal supplements, eye and eardrops, laxatives, vaginal douches, or any other non-prescription item can be a potential cause of urticaria. It is important to inform the dermatologist of ALL prescription and over-the-counter medications being used to help find the cause of the hives.

Infections

Many infections can cause urticaria. Viral upper-respiratory tract infections (colds) are a comon cause in children. Other viruses, including hepatitis and a number of bacterial and fungal infections, may cause urticaria.

Chronic Urticaria

Chronic urticaria lasts more than six weeks. The cause of chronic urticaria is more difficult to identify and is found only in a small percentage of patients. The dermatologist reviews a patient's medical history, asks extensive questions, and conducts a thorough physical examination. Testing, such as blood work or a biopsy, may be necessary.

Physical Urticarias

Physical urticaria may be caused by sunlight, heat, cold, water, pressure, vibration, or exercise. Solar urticaria forms within minutes of sun exposure and typically fades within one to two hours. Cold urticaria appears when the skin is warmed after exposure to cold. Urticaria, which forms in response to the cold or the water when swimming, for example, can produce wheezing, flushing, generalized hives, and fainting.

Dermatographic Urticaria (Dermatographiulesm)

Dermatographic urticaria forms after firmly stroking or scratching the skin, and can often occur with other forms of urticaria. It affects about five percent of the population. Most people with this condition are otherwise healthy. Dermatographism may last for months or even years.

Treatment

The best treatment for urticaria is to find and eliminate the cause whenever possible. Antihistamines are prescribed to provide relief and work best if taken on a regular schedule to prevent hives from forming. There are many antihistamines available. No one antihistamine works for everyone. The dermatologist may use combinations to control the urticaria. In severe cases, an injection of epinephrine (adrenalin) may be needed. Cortisone may also bring dramatic relief, but its use must be limited to short periods of time.

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