Cosmetic Surgical Excision of Cysts, Moles & Scars

A surgical excision is an in-office procedure in which a skin lesion is removed by a dermatologic surgeon. This technique involves the use of local numbing medicine which is injected into and around the target area and followed by sharp dissection of the lesion from surrounding normal tissue. The most common scenarios for utilization of this technique include: treatment of skin cancers, atypical or suspicious moles (nevi), and cysts.

Surgical Excision of Cysts

Cysts may remain asymptomatic, but if they continue to grow or become painful surgical excision is the treatment of choice. The cyst consists of a wall that makes the contents. To insure that the cyst does not return, it is best to completely excise it, including the wall, to prevent its recurrence.

Surgical Excision of Moles

Moles often become more raised over time. Occasionally they become irritated or are cut when shaving. A shave excision removes the raised portion of the mole. As a general rule, a complete excision is only performed if a mole is changing or when a complete excision will yield a better cosmetic result. Either of these treatments is performed under local anesthesia in our office. The shave excision takes less than a minute and a complete excision under a half hour. The functional and cosmetic results are excellent.

Surgical Excision of Scars

This option is typically for scars that are deeply pitted, raised, or for older surgical scars that did not heal properly. The scar tissue is removed, followed by careful stitching of the skin to leave a much smaller, thinner scar line or to change the scars shape and/or direction so it is less obvious.

Cosmetic Consultation Reimbursement Policy

Schedule an office visit to discuss your concerns and skincare goals with Dr. Robinson and the office visit cost will be applied to the future cost for the "consulted procedure". The "consulted procedure" must be completed within 30 days of your consult visit.

Lyme Disease

You're more likely to get Lyme disease if you live or spend time in grassy and heavily wooded areas where ticks carrying Lyme disease thrive. It's important to take common-sense precautions in tick-infested areas.

Risk factors

Where you live or vacation can affect your chances of getting Lyme disease. So can your profession and the outdoor activities you enjoy. The most common risk factors for Lyme disease include:

• Spending time in wooded or grassy areas. In the United States, deer ticks are found mostly in the heavily wooded areas of the Northeast and Midwest. Children who spend a lot of time outdoors in these regions are especially at risk. Adults with outdoor jobs also are at increased risk.
• Having exposed skin. Ticks attach easily to bare flesh. If you're in an area where ticks are common, protect yourself and your children by wearing long sleeves and long pants. Don't allow your pets to wander in tall weeds and grasses.
• Not removing ticks promptly or properly. Bacteria from a tick bite can enter your bloodstream if the tick stays attached to your skin for 36 to 48 hours or longer. If you remove a tick within two days, your risk of getting Lyme disease is low.

Early signs and symptoms

A small, red bump, similar to the bump of a mosquito bite, often appears at the site of a tick bite or tick removal and resolves over a few days. This normal occurrence doesn't indicate Lyme disease.

However, these signs and symptoms can occur within a month after you've been infected:

• Rash. From three to 30 days after an infected tick bite, an expanding red area might appear that sometimes clears in the center, forming a bull's-eye pattern. The rash (erythema migrans) expands slowly over days and can spread to 12 inches (30 centimeters) across. It's typically not itchy or painful but might feel warm to the touch.
• Erythema migrans is one of the hallmarks of Lyme disease, although not everyone with Lyme disease develops the rash. Some people develop this rash at more than one place on their bodies.

• Other symptoms. Fever, chills, fatigue, body aches, headache, neck stiffness and swollen lymph nodes can accompany the rash.
• Seek immediate treatment If the tick has been attached for more than 24 hours, or you see a red, bullseye spot emerge at the site or anywhere on the body or experience flu-like symptoms

Later signs and symptoms

If untreated, new signs and symptoms of Lyme infection might appear in the following weeks to months. These include:

• Erythema migrans. The rash may appear on other areas of your body.
• Joint pain. Bouts of severe joint pain and swelling are especially likely to affect your knees, but the pain can shift from one joint to another.
• Neurological problems. Weeks, months or even years after infection, you might develop inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement.

Less common signs and symptoms

Several weeks after infection, some people develop:

• Heart problems, such as an irregular heartbeat
• Eye inflammation
• Liver inflammation (hepatitis)
• Severe fatigue

When to see a doctor ...

If you've been bitten by a tick and have symptoms, only a minority of tick bites lead to Lyme disease. The longer the tick remains attached to your skin, the greater your risk of getting the disease. Lyme infection is unlikely if the tick is attached for less than 36 to 48 hours.

If you think you've been bitten and have signs and symptoms of Lyme disease — particularly if you live in an area where Lyme disease is common — contact your doctor. Treatment for Lyme disease is more effective if begun early. 

Visit your doctor even if signs and symptoms disappear — the absence of symptoms doesn't mean the disease is gone. Untreated, Lyme disease can spread to other parts of your body for several months to years after infection, causing arthritis and nervous system problems. Ticks can also transmit other illnesses, such as babesiosis and Colorado tick fever.

Prevention

The best way to prevent Lyme disease is to avoid areas where deer ticks live, especially wooded, bushy areas with long grass. You can decrease your risk of getting Lyme disease with some simple precautions:

• Cover up. When in wooded or grassy areas, wear shoes, long pants tucked into your socks, a long-sleeved shirt, fitted at the wrists, a hat, tuck in hair if possible and gloves.
• Wear white or light-colored clothing to make it easier to see ticks.
• Try to stick to trails and avoid walking through low bushes and long grass. Keep your dog on a leash.
• Wear shoes, no bare feet or sandals.
• Use insect repellents. Apply insect repellent with a 20% or higher concentration of DEET to your skin. We recommend Deep Woods Off. Parents should apply repellant to their children, avoiding their hands, eyes and mouth.
• Keep in mind that chemical repellents can be toxic, so follow directions carefully. Apply products with permethrin to clothing or buy pretreated clothing.
• Do your best to tick-proof your yard. Clear brush and leaves where ticks live. Mow your lawn regularly. Stack wood neatly in dry, sunny areas to discourage rodents that carry ticks.
• Check your clothing, yourself, your children and your pets for ticks. Be especially vigilant after spending time in wooded or grassy areas. Deer ticks are often no bigger than the head of a pin, so you might not discover them unless you search carefully.
• It's helpful to shower as soon as you come indoors. Ticks often remain on your skin for hours before attaching themselves. Showering and using a washcloth might remove unattached ticks.
• Don't assume you're immune. You can get Lyme disease more than once.
• Remove a tick as soon as possible with tweezers. Gently grasp the tick near its head or mouth. As close to the skin as possible. Don't squeeze or crush the tick, but pull carefully and steadily. Once you've removed the entire tick, dispose of it by placing it in a container marked with the name of its host, area location, and the place of attachment on the body. 
• Then call your physician to determine if treatment is warranted. Most doctors will send the suspect on to a state lab for analysis at no charge

Intralesional Steroid Injections

What is intralesional steroid injection used for?

Intralesional Steroid Injections, or Intralesional Kenalog is a common treatment used in dermatology & are a standard treatment for many skin diseases including: acne lesions, cysts, alopecia (bald spots) hair loss, eczema, abundant scar tissue (keloids, hypertrophic scars), psoriasis, lichen simplex chronicus, skin lupus, granuloma annulare, and more. Intralesional injections are extremely helpful, as they are able to bypass the outer defensive layers of the skin to reach an area that will make the greatest impact on your condition. It is common for a patient to need multiple injections, as different cases vary in severity. The goal of these injections is ideal for quick healing to reduce the inflammation within the skin, and relive pain and discomfort as well as improving the appearance. This treatment is usually reserved for tender, swollen acne nodules, or cysts that aren't responding to typical acne therapies. Prompt treatment with intralesional injections can often prevent scarring.

What are the side effects of Intralesional Steroid Injections?

• This injection is a form of steroid, which some may have an allergic reaction to. It is not very likely that you will be allergic, but it is possible may happen after injection.
• It is possible that the skin may become thinner in the area of injection (atrophy). This is not very likely, but could result in a dimpling of the skin. This tends to recover after some time.
• Bleeding may occur after any type of injection including intralesional steroids. It is also possible that the blood vessels surrounding the injection site may become more prominent after injection.
• Pigmentation can develop around the injection site.
• As with most injections, there is a chance that pain will be felt. Each area of the body has a different level of sensitivity for each individual, so discomfort is possible. Local anesthetics can be used if necessary to help with pressure or pain during the procedure.
• There is a slight possibility that a treatment may be ineffective, or that the condition may return after the injection.

Canthrone

Canthrone is an excellent treatment for warts, molluscum and other growths in the skin.  It is painless and therefore preferred by many of our pediatric patients and adults who are adverse to even a little discomfort.  It is usually applied with a Q-tip (for children we refer to it as a tickle stick) and then covered with paper tape or a bandaid.  Patients are instructed to wash it off between twenty minutes to one hour later.  Although several treatments may be required, Canthrone is the kindler and gentler treatment for these ailments.

Monkeypox

As the United States declares Monkeypox outbreak a public health emergency, NYC declares a local state of emergency due to the outbreak.  The American Academy of Dermatology & The World Health Organization have put together a Task Force to address the growing outbreak of Monkeypox (orthopoxvirus) in the US.  Monkeypox is a contagious disease caused by the Monkeypox virus. US Map and case count on the 2020 outbreak here ... 

Transmission:

Anyone can get Monkeypox.  It is primarily spread through close, physical contact between people.  In the current outbreak, the Monkeypox virus is spreading mainly during oral, anal and vaginal sex and other intimate contact, such as rimming, hugging, kissing, biting, cuddling and massage.

Previous outbreak experience elsewhere suggests that the elderly, those with weakened immune systems, pregnant people, and children under 8 years of age may be at heightened risk for severe outcomes. Smallpox vaccine may help protect you against Monkeypox. Although, immunity may wain with age, it is estimated that the smallpox vaccine can be over 80% effective in preventing Monkeypox. Howevver, the vaccine for smallpox was discontinued in 1972 when it was eradicated in the United States. So therefore, anyone who is 49 years of age or younger most likely did not receive a smallpox vaccine.

Prevention:

The best way to protect yourself from Monkeypox is to avoid sex and other intimate contact with multiple or anonymous partners. 

If you choose to have sex or other intimate contact, the following can help reduce your risk:

• Reduce your number of partners, especially those you do not know or whose recent sexual history you do not know.
• Ask your partners if they have Monkeypox symptoms or feel sick. If you or your partners are sick, especially if you or they have a new or unexpected rash or sore, do not have sex or close physical contact.
• Avoid sex parties, circuit parties and other spaces where people are having sex and other intimate contact with multiple people.
• If you choose to have sex or other intimate contact while sick, cover all rashes and sores with clothing or sealed bandages. This may reduce spread from contact with the rash or sores, but other methods of transmission may still be possible.
• Since it may be possible the virus can be transmitted through semen, use latex condoms during sex.
• Do not share towels, clothing, fetish gear, sex toys or toothbrushes.
• Wash your hands, fetish gear and bedding. Sex toys should be washed after each use or sex act.

How to Protect Yourself and Others from Monkeypox (PDF)

Symptoms:

Most cases are mild. Symptoms usually start within two weeks of exposure, but in some cases they may not appear for up to 21 days. If you have a new, unexplained skin rash or lesion(s)/bump(s) on your skin and you don’t know what caused it and think you may have Monkeypox, it is important to see your dermatologist quickly to prevent exposing more people. Eligible New Yorkers who may have been exposed to Monkeypox can now get vaccinated to stay safe and slow the spread.

Some symptoms include:

• Lesions on the face, hands, feet and body as well as inside the mouth, genitals or anus. They can be extremely itchy and painful and may interfere with daily activities. 
•  Some people also have flu-like symptoms. These symptoms can occur before or at the same time as the rash or bumps. Flu-like symptoms include: 
•  Swelling of the lymph nodes
•  Fever
•  Chills
•  Muscle aches
• Headache
• Back pain
• Weakness/Fatigue

If  You Have Symptoms:

A person is contagious until all sores have healed and a new layer of skin has formed, which can take two to four weeks.

If you start experiencing symptoms, isolate at home immediately, ideally stay in a separate area away from other family members and pets and talk to your dermatologist. 

The following may increase your risk for severe disease if you are infected: HIV; other conditions that weaken your immune system; and a history of atopic dermatitis or eczema. If you have one of these conditions, it is especially important to see a provider right away, if you have symptoms.

To protect others while you are sick:

• Avoid sex, being intimate or having skin to skin contact with anyone until you have been checked by your dermatologist.
• Stay home and separate from other people in your household. 
• If you cannot fully separate from others in your household and avoid physical contact. Wear clothing that covers your lesions when in shared spaces.
• If you must leave home for essential needs or medical care, cover your lesions with clothing.
• Do not share or let others touch your clothing, towels, bedding or utensils. Do not share a bed. 
• Do not share dishes, food, drink or utensils. Wash dishes with warm water and soap or in a dishwasher.
• Wash your hands frequently with soap and water and clean shared surfaces, such as countertops and doorknobs, often. Household members should also wash their hands often, especially if they touch materials or surfaces that may have come in contact with lesions.

Diagnosis -- Where To Get Tested:

Not every rash is Monkeypox. Dr. Robinson can make a diagnosis of Monkeypox by looking at the pattern on the skin and where the rash appears. Please let the office know ahead of your visit that you have a "new unexplained rash or lesions" and think you may have monkeypox. If Dr. Robinson suspects Monkeypox may be the cause of the rash, he will swab the rash and send it to a lab, where a polymerase chain reaction test will be performed.

Treatment:

There is treatment approved for Monkeypox. Most people get better on their own without treatment. However, antiviral medication(s) (TPOXX) may help. Your provider will help you find out if you are eligible for antiviral treatment. They may be able to prescribe medicine and provide information about symptom relief.

Vaccine Information:

Vaccination after possible exposure ... Eligible New Yorkers who may have been recently exposed to Monkeypox can get the JYNNEOS TM vaccine. Vaccine is free and available regardless of immigration status.  Information about eligibility for the vaccine and appointments can be found here.

Getting vaccinated after a recent exposure may reduce the chance of you getting Monkeypox and it can reduce the symptoms if you do get it. 

People should get two doses, at least four weeks apart. 

Information about eligibility for the vaccine clinic and appointments can be found here.

JYNNEOS Vaccine for Monkeypox: Frequently Asked Questions (PDF)

Additionally, here is a link to a letter published in the Journal of the American Academy of Dermatology (JAAD) that explains the symptoms and features of monkeypox. For more information about monkeypox, visit the AAD website.

Molluscum Contagiosum

Tips For Managing Molluscum Contagiosum

Molluscum Contagiosum bumps, as the name suggests, are very contagious.

​

Molluscum Contagiosum rarely causes pain and will eventually clear on its own if you have a healthy immune system.  They may go away without a trace, but this takes time, during which they can spread. On average, the bumps clear in 6-18 months without treatment. Sometimes, this takes longer and they can re-occur.

Avoid spreading molluscum to other parts of your body by:

• Avoid scratching and picking at the bumps. Scratching and picking can spread the virus to other parts of your body. If your skin breaks open, you are more likely to get an infection. This can be painful and require treatment.
• Treat the molluscum bumps if your dermatologist recommends doing so. If you try to remove the bumps on your own or squeeze out the fluid inside, you risk spreading the virus to other parts of your body, infection and scaring.
• Keep the bumps clean and wash your hands after touching the molluscum. Washing your hands helps to remove the virus and prevents you from your re-infecting other areas of your skin.
• Use 2 towels when drying off. When you or your child has molluscum, it helps to use 2 clean towels to dry off. You’ll use one towel to dry the skin with molluscum. Use the other clean towel to dry the skin without molluscum. This approach helps to reduce the risk of spreading the virus to other parts of the body. Use new, clean towels after each body washing.
• Skip shaving skin with molluscum bumps. Shaving can spread molluscum to other areas of your body. If you must shave the skin with molluscum, use two razors. Shave the skin with molluscum with one razor. The other razor you’d use to shave the skin without molluscum. One could also consider laser hair removal.
• Postpone electrolysis while you have molluscum bumps on your skin. Electrolysis can spread the molluscum from one area to another.

Until the molluscum bumps go away, take precautions to help prevent spreading the molluscum virus to others. Watch what the American Academy of Dermatology recommends here ... https://youtu.be/klkQ2YcJHaw

Dr. Robinson also recommends:

• Covering the bumps with clothing, a bandage, or medical tape during school or work. This helps prevent spreading the infection to other people. When you won’t be around others and before going to bed, remove bandages and medical tape.
• When a child has molluscum bumps, as the name suggests, this virus is very contagious. You can reduce the risk of another child getting molluscum by: 1) Bathing the children separately, and 2) Using different towels to dry each child.
• Wash your hands thoroughly after you touch your own molluscum bumps (or your child’s). You want to use soap and water, washing for as long as it takes you to sing the “Happy Birthday” song.
• Avoid shared baths, swimming pools, hot tubs, & saunas.
• Cover all molluscum bumps before participating in any sport. High school athletes get molluscum contagiosum during sports, such as wrestling, basketball, and football. To prevent spreading molluscum to others:
  • Cover all molluscum bumps with clothing or waterproof bandages.
  • Avoid sharing gear, such as pads, helmets, and baseball gloves. If it’s likely that a waterproof bandage will come off during a sport and expose someone else to the virus, such as during a wrestling match, stop the sport until the bumps clear.
• Let a child with molluscum sleep alone. It’s easy for the molluscum virus to spread when children sleep together in the same bed.
• Make sure children with molluscum have their own personal items, such as towels, washcloths, bedding, and clothes. This helps prevent spreading the virus from one child to another.
• Stop sharing personal items. People can get molluscum from skin-to-skin contact and when they touch infected items. When the person who has molluscum stops sharing clothes, razors, towels, washcloths, and other personal items, this reduces the risk of spreading the virus to others. 
• If molluscum bumps appear in the genital area, stop sexual activity and see a board-certified dermatologist.. In adults, molluscum is often spread through sexual contact — but not always. Treatment is usually recommended for anyone who has molluscum bumps in the genital area (on or near the penis, vulva, vagina, or anus). Your dermatologist can tell you when you can have sexual activity again.

Dr. Robinson offers these tips and others every day to help his patients feel more comfortable in their own skin.

How can I protect my
baby or toddler from the sun?

Ideally, parents should avoid exposing babies younger than 6 months to the sun’s rays.

The best way to protect infants from the sun is to keep them in the shade as much as possible, in addition to dressing them in loose fitting long sleeves, pants, a wide-brimmed hat that shields the face, ears, back of the neck and sunglasses with at least 99% UVA/UVB protection. If you can’t find shade, create your own using an umbrella, canopy, or the hood of a stroller. Make sure they do not get overheated and that they drink plenty of fluids. If your baby is fussy, crying excessively, or has redness on any exposed skin, take him or her indoors.

Minimize sunscreen use on children younger than six months old. However, if shade and adequate clothing are not available, The American Academy of Dermatology (AAD) recommends that all kids — regardless of their skin tone — wear sunscreen with an SPF of 30 or higher that is broad-spectrum and water resistant.

For babies older than 6 months, when outdoors, sunscreen should be applied to all areas of the body, but be careful around the eyes. If your baby rubs sunscreen into their eyes, wipe their eyes and hands clean with a damp cloth. Reapply sunscreen every two hours or immediately after getting out of the water. Sunscreens that use zinc oxide may cause less irritation and/or allergic reactions to their sensitive skin. If a rash develops please call our office.

Other elements of a sun safe strategy include: wearing clothing made with a tight weave. If you are not sure how tight a fabric’s weave is, hold it up to see how much light shines through, the less the better. You can also look for protective clothing labeled with Ultraviolet Protection Factor (UPF) and limiting your sun exposure between 10:00 a.m. and 4:00 p.m. when the UV rays are the strongest.  Remember to set a good example by practicing sun safety yourself.

The sun gives energy to all living things on earth, but it can also harm us. Its ultraviolet (UV) rays can damage skin and eyes and cause skin cancer. One-quarter of our lifetimes sun exposure happens during childhood and adolescence. Even one blistering sunburn in childhood or adolescence more than doubles your chances of developing Melanoma later in life. Since children spend a lot of time outdoors, especially in the summer, it's important to protect them from the sun. 

Talk with your dermatologist if you have any questions about sun protection for your child.

Psoriasis

Psoriasis is a common, chronic, long term, relapsing skin condition where the skin cells are made to quickly often resulting in itchy silvery scaling patches that causes a rash, most commonly on the knees, elbows, trunk and scalp. It can be painful, interfere with sleep and make it hard to concentrate. The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while. 

Symptoms

Common signs and symptoms of psoriasis include:

• A patchy rash that varies widely in how it looks from person to person, ranging from spots of dandruff-like scaling to major eruptions over much of the body
• Rashes that vary in color, tending to be shades of purple with gray scale on brown or Black skin and pink or red with silver scale on white skin
• Small scaling spots (commonly seen in children)
• Dry, cracked skin that may bleed
• Itching, burning or soreness
• Cyclic rashes that flare for a few weeks or months and then subside

Types of psoriasis

There are several types of psoriasis, each of which varies in its signs and symptoms:

• Plaque psoriasis. The most common type of psoriasis, plaque psoriasis causes dry, itchy, raised skin patches (plaques) covered with scales. There may be few or many. They usually appear on the elbows, knees, lower back and scalp. The patches vary in color, depending on skin color. The affected skin might heal with temporary changes in color (post inflammatory hyperpigmentation), particularly on brown or Black skin.
• Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe disease may cause the nail to crumble.
• Guttate psoriasis. Guttate psoriasis primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, drop-shaped, scaling spots on the trunk, arms or legs.
• Inverse psoriasis. Inverse psoriasis mainly affects the skin folds of the groin, buttocks and breasts. It causes smooth patches of inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
• Pustular psoriasis. Pustular psoriasis, a rare type, causes clearly defined pus-filled blisters. It can occur in widespread patches or on small areas of the palms or soles.
• Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover the entire body with a peeling rash that can itch or burn intensely. It can be short-lived (acute) 

Psoriasis triggers

Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:

• Infections, such as strep throat or skin infections
• Weather, especially cold, dry conditions
• Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
• Smoking and exposure to secondhand smoke
• Heavy alcohol consumption
• Certain medications — including lithium, high blood pressure drugs and antimalarial drugs
• Rapid withdrawal of oral or injected corticosteroids

Risk factors

Anyone can develop psoriasis. About a third of instances begin in childhood. These factors can increase the risk of developing the disease:

• Family history. The condition runs in families. Having one parent with psoriasis increases your risk of getting the disease. And having two parents with psoriasis increases your risk even more.
• Smoking. Smoking tobacco not only increases the risk of psoriasis but also may increase the severity of the disease.

Complications

If you have psoriasis, you're at greater risk of developing other conditions, including:

• Psoriatic arthritis, which causes pain, stiffness, and swelling in and around the joints
• Temporary skin color changes (post-inflammatory hypopigmentation or hyperpigmentation) where plaques have healed
• Eye conditions, such as conjunctivitis, blepharitis and uveitis
• Obesity
• Type 2 diabetes
• High blood pressure
• Cardiovascular disease
• Other autoimmune diseases, such as celiac disease, sclerosis and the inflammatory bowel disease called Crohn's disease
• Mental health conditions, such as low self-esteem and depression

When to see a doctor

If you suspect that you may have psoriasis, see your health care provider. Also seek medical care if your condition:

• Becomes severe or widespread
• Causes you discomfort and pain
• Causes you concern about the appearance of your skin
• Doesn't improve with treatment

What Does Psoriasis Look Like?

Basal Cell Carcinoma

Basal cell carcinoma is the most common form of cancer worldwide. In the vast majority of cases, it is thought to be caused by exposure to the harmful ultraviolet rays of the sun. It is becoming more common, perhaps because people may be spending more time outdoors. Some believe that the decrease in the ozone layer is allowing more ultraviolet radiation from the sun to reach the earth's surface. Basal cell cancer does not usually metastasize or travel in the bloodstream; rather it infiltrates the surrounding area destroying tissue. For this reason, basal cell cancer should be treated promptly by your dermatologist with dermatologic surgical techniques.

What does basal cell cancer look like?

Basal cell cancer most often appears on sun-exposed areas such as the face, scalp, ears, chest, back, and legs. These tumors can have several different forms. The most common appearance of basal cell cancer is that of a small dome-shaped bump that has a pearly white color. Blood vessels may be seen on the surface. Basal cell cancer can also appear as a pimple-like growth that heals, only to come back again and again. A less common form called morpheaform, looks like a smooth white or yellowish waxy scar. A very common sign of basal cell cancer is a sore that bleeds, heals up, only to recur again.

I think I have a basal cell cancer. What should I do next?

If you have a sore that doesn't heal, or that looks like any of the growths pictured here, you should make an appointment with your dermatologist for evaluation. After the dermatologist examines the growth, he or she will decide whether or not to perform a biopsy. A biopsy is a simple procedure done in the office under local anesthesia. The dermatologist will first inject a small amount of anesthesia similar to the type used by your dentist. After the area is numb, the dermatologist will remove a small sample of the growth or use a small cookie-cutter device to do a "punch" biopsy. A bandage will then be placed on the wound and you will receive instructions on how to care for the wound. The area will heal over five to seven days. There are several different kinds of basal cell cancer. The biopsy results will indicate whether or not you have a basal cell cancer and what kind of basal cell cancer it is. In some cases, if the basal cell cancer is very thin and present only on the surface of the skin, your dermatologist may choose to perform the biopsy and treat the skin cancer at the same time.

The biopsy shows that I have a basal cell cancer. What is the next step?

Your dermatologist will discuss with you the various dermatologic surgical options should your growth prove to be a basal cell cancer. Your dermatologist may use a method called electrodesiccation and curettage. In this procedure the surface of the skin cancer is removed and the base of the skin cancer is gently burned or "cauterized" with an electric needle. When this is done there is often no need for further treatment. Simple surgical excision, in which the skin cancer is cut out and the skin sewn together using dermatologic cosmetic surgical techniques will often be recommended. In this case, the specimen is examined under a microscope after the procedure to determine that all the skin cancer has been removed. Other treatment methods, such as cryosurgery, radiation therapy, and laser surgery may be used in specific circumstances. In certain situations, your dermatologist may refer you for a specialized technique called Mohs micrographically controlled surgery. In this method, performed by specially trained dermatologic surgeons, the skin cancer is removed under local anesthesia in an office setting and microscopic sections are prepared on slides while you wait. Your Mohs surgeon examines the slides to determine if most of the cancer cells have been removed. If not additional layers are taken until the cancer is completely excised. The advantage of this technique is that a minimum amount of tissue is removed and all the edges of the specimen are carefully studied. This method has a high cure rate, but is not required for all skin cancers. In general, most dermatologists agree that recurrent skin cancers, that is skin cancers that were previously treated and have come back, incompletely removed skin cancers, large skin cancers, and skin cancers in cosmetically important areas, may benefit from the Mohs technique. After the skin cancer has been removed using this method, it maybe allowed to heal naturally or reconstructive surgery using a skin flap or skin graft maybe performed.

Regardless of the technique used, will I be scarred?

Because the vast majority of skin cancers occur on the face, many patients are understandably concerned about the cosmetic outcome. If the skin cancer is small, conservative methods usually produce an excellent cosmetic result. If the skin cancer requires more specialized treatment such as Mohs surgery, reconstructive options are available that, in most cases, result in an excellent cosmetic outcome.

If basal cell cancer does not travel in the blood stream to other organs like other cancers why should I bother treating it?

Some people wonder whether it is worth treating basal cell cancer at all since it doesn't metastasize or travel in the bloodstream to other organs. It is important to remember that basal cell cancer is in fact a cancer, and will continue to grow locally unless treated. Basal cell cancer does not spontaneously go away on its own. In addition, if the skin cancer is located near important organs such as the eyes, ears, and nose, or is growing near a nerve, serious problems can arise if the skin cancer is neglected.

I have already had one basal cell cancer. Am I at risk for getting another?

If you have already had one basal cell cancer studies have shown that you are at a 40% risk of getting a second basal cell cancer within five years. It is important to follow closely with your dermatologist and be alert to any non-healing sores that develop on your skin.

I have had basal cell cancer. Am I at risk of developing other skin cancers, such as melanoma?

Individuals who have had multiple basal cell cancers or other skin cancers, such as squamous cell, are at an increased risk for melanoma. It is important to have a full body skin examination at least once a year to check for abnormal moles which could be precursors to melanoma or melanoma itself. It is also important to know that basal cell cancer does not turn into melanoma.

Is there anything I can do to prevent basal cell cancer?

Because basal cell cancer is caused by ultraviolet radiation from the sun in the vast majority of cases, proper sun protection may help to prevent the development of further basal cell cancers. Because 85% of lifetime sun exposure is acquired in childhood by age 18, careful sun protection in children may effectively prevent basal cell cancer later in life. Follow these simple steps from your dermatologist and dermatologic surgeon: 1. Apply sunscreen with a sun protection factor of 15 or greater while outdoors 2. Wear a broad-brimmed hat and sun protective clothing 3. Avoid the sun between 10:00 a.m. and 4:00 p.m.

Many people wonder how often they have to reapply sunscreen. In general, if you are active outdoors, it is quite reasonable to apply sunscreen every 1 1/2 hours. As long as you practice good sun protection habits and enjoy the sun in moderate amounts you should be able to minimize the chances of developing basal cell cancer.

Acne Treatments

Control of acne is an ongoing process given that acne can be a chronic problem. All acne treatments work to reduce current acne pimples but work better at preventing new acne breakouts. Acne treatments usually take 6 to 12 weeks to become fully effective. During that time existing blemishes may take time to heal and you may experience temporary worsening before improvement. Chemical peels and laser treatments can speed the time to improvement and often help clear pigmentation and scars. . Your treatment will vary according to the type of acne i.e. acne cysts, pustules, whiteheads or blackheads.

Occasionally, an acne-like rash can be due to another cause such as make-up or lotions, or from oral medication. It is important to help Dr. Robinson by providing an updated history of what you are using on your skin or taking internally. Many non-prescription acne lotions and creams help mild cases of acne. However, many will also make your skin dry. Follow instructions carefully.

Topicals

• Dr. Robinson may prescribe topical creams, gels, lotions with vitamin A acid-like drugs, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. They will advise you about correct usage and how to handle side effects.
• Before starting any medication, even topical medications, inform your doctor if you are pregnant or nursing, or if you are trying to get pregnant.

Special Treatments

• Acne surgery may be used by Dr. Robinson to remove blackheads and whiteheads. Do not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation, pigmentation and scarring may result.
• Lasers and microdermabrasion may be used to remove the upper layers of the skin improving irregularities in the surface, contour, and generating new skin.
• Light chemical peels with salicylic acid or glycolic acid help to unblock the pores, open the blackheads and whiteheads, stimulate new skin growth and improve pigmentation (dark spots).
• Injections of corticosteroids may be used for treating large red bumps (acne cysts). This may help them go away quickly and prevent scarring.

Oral

• Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline, or erythromycin are often prescribed for acne cyst or painful acne pimples.

Birth Control Pills

• Birth control pills may significantly improve acne, and may be used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. This is uncommon, but possible, especially if you notice break-through bleeding. As a precautionary measure use a second form of birth control.

Other Treatments

• In cases of unresponsive or severe acne, Accutane (isotretinoin) may be used. Patients using isotretinoin must understand the side effects of this drug. Monitoring with frequent follow-up visits is necessary. Pregnancy must be prevented while taking the medication, since the drug causes birth defects.
• Women may also use female hormones or medications that decrease the effects of male hormones to help their acne.
• Laser, microdermabrasion and chemical peels can be helpful in treating acne as well.

Dr. Robinson will evaluate your ance and suggest the best treatment regimes considering your age, sex, and the type of acne you have.

Treatment of Acne Scarring

Dr. Robinson can treat acne scars by a variety of methods. Skin resurfacing with laser, dermabrasion, chemical peels, or electrosurgery can flatten depressed scars. Soft tissue elevation with subcision or filling agents such as Radiesse, Restyene, Juvederm, Cosmoderm or Cosmoplast can elevate scars. Scar revision with microexcision and punch grafting can correct pitted scars. Combinations of these surgical treatments can make a noticeable difference in appearance.