Skin Cancer - Screening & Surgery

- Including Mohs micrographic surgery

As you examine spots or growths on your skin, here are some important facts for you to consider: most growths that change are not skin cancer but you need to be sure. Skin cancer is treatable and usually curable when detected early. While most are not fatal, they can cause disfigurement, and other damage. According to the American Academy of Dermatology, one in five people will develop skin cancer in their lifetime. Risk factors include light complexion, family history of melanoma, frequent use of tanning salons, sunburns and long-term sun exposure. The most common skin cancers are:

• basal cell carcinoma - 80-85% of all skin cancers are basal cell carcinoma which affects cells anywhere on the skin. They are usually pinkish and shiny, but may have other colors and sometimes have a non-smooth surface.

• squamous cell carcinoma – Found less often is squamous cell carcinoma, which affects cells in the middle layer of the epidermis. They are thicker and have a hard-crusted (keratin) core or center. Squamous cell carcinomas, especially on the head and neck are potentially fatal and must be treated promptly.

• melanoma – Most threatening but least common is cutaneous (skin) melanoma. It is estimated that fair-skinned people have more than a 1 in 75 lifetime risk of developing melanoma, higher in those with atypical nevi, red-heads, and persons who use tanning salons. 20% of these tumors are hidden in areas not exposed to the sun. Melanoma is the leading cause of death from skin disease. Early detection and treatment are of utmost importance to reduce the risk.  

Skin cancers vary in shape, color, size and texture. Because of the common difficulty in precise diagnosis, any new, changing or unusual growths or rashes should be examined immediately by Dr. Graham. Early intervention is essential to prevent skin cancers from spreading. Dr. Graham is both a board-certified dermatologist and dermasurgeon. If skin cancer is detected and surgical intervention is necessary, Dr. Graham is skilled in derma surgical removal as well as cosmetic reconstructive repair of resulting scars. He also uses non-surgical methods, when indicated, such as topical immunomodulators.

Traditionally, tissue is sent to a lab after surgery is completed, to confirm complete removal of all cancer cells.  A specialized approach is Mohs micrographic surgery. It is the systematic removal and analysis of thin layers of tissue at the tumor site, continuing until the last traces of cancerous tissue have been eliminated. The simultaneous surgery and microscopic examination of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Only cancerous tissue is removed, minimizing both post-operative wound size and the chance of re-growth.

Mohs surgery is used for basal and squamous cell carcinomas that are large, have indistinct borders, are recurrent, or in sensitive areas where vital tissues must be spared. Occasionally it is used for other tumors. High precision makes Mohs surgery ideal for the elimination of cancers in areas where aesthetics are important, such as the face, nose, eyelids, ears, and lips. The Mohs technique is designed for specialized cases. It is necessary in only a small percent of surgeries. For more information on the Mohs procedure visit www.mohssurgery.org

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Mole & Melanoma Evaluation and Treatment

Moles are benign pigmented spots or patches of skin that are usually tan but can be ivory, pink, brown or black. Lesions red to purple in color are vascular growths, such as strawberry hemangiomas or port wine stains. Birthmarks can be any color, usually shades of brown. Most birthmarks are harmless but can develop into cancer.  It is recommended they be removed in the early teens if certain criteria exist. Moles exhibiting two or more of the following five ABCDE warning signs should be examined by Dr. Graham as soon as possible:

• A. Asymmetry: noted by one half not like the other.
• B. Border: irregular, notched or jagged.
• C. Color: varied with two or more shades or colors.
• D. Diameter: larger than 6 millimeters (pencil eraser).
• E. Evolving: changing in color, size, shape, symptoms or surface.

Two or more of the above factors suggests undesirable cells.  Dr. Graham will often recommend a biopsy or full removal with tissue examination by a pathologist.

Treatment for benign but unattractive birthmarks may take the form of laser, microdermabrasion or surgical excision.

Melanoma is potentially life-threatening. It has a fatality rate higher than those for basal cell and squamous cell cancers accounting for more than 80 percent of all deaths from skin cancer.  The risk factors include:

• Familial tendency to develop prominent or atypical (unusual-looking) moles.
• Presence of many freckles, large or atypical moles
• Previous personal history or family member with melanoma  
• Overexposure to ultraviolet radiation, especially sunbathing and tanning salons
• One or more blistering sunburns before age 18
• Caucasian ancestry with fair skin (although all races/skin tones are susceptible)
• Sun sensitivity / Poor tanning ability
• Immune system deficiency due to disease, medications, or organ transplantation

Treatment for melanoma depends on the tumor’s location, thickness and progression as well as the patient’s age, health, and medical history.  Dr. Graham usually performs a full biopsy to determine the extent of the tumor.  Most often, the appropriate treatment is surgery, with a more extensive surgical approach. While it may result in a longer scar, or graft, this is the standard of care for melanoma treatment. Dr. Graham has the capability to perform all surgeries in his surgical suite. Local anesthesia is usually all that is necessary; sometimes an oral sedative is added. You do not have to fear melanoma if you become informed, and act!

Early detection and treatment greatly increase the likelihood of total cure.  Self-examination in front of a mirror using the ABCDE system outlined above is the best way to find melanoma early.  If you think you have melanoma, see Dr. Graham, a board-certified dermatologist and dermasurgeon, immediately. We look forward to visiting with you.

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Skin Rejuvenation

- Rejuvenation by Laser, Microdermabrasion and Cosmeceuticals
- Filler for Lines & Wrinkles (Juvéderm™, Radiesse™)

Microdermabrasion improves mild to moderate sun damage, scarring, wrinkles and other superficial skin problems. A gentle stream of tiny particles exfoliates the outer layer of skin and provides a fresh, glowing, younger appearance. Only a small amount of skin is removed, so sensitive areas such as the face, chest, neck, arms and hands can be treated. Results are comparable to a light chemical peel and should be immediately visible. Microdermabrasion is often performed in conjunction with other skin renewal procedures, such as laser treatment and chemical peels. Multiple treatments are recommended for full effect.

Juvéderm™ is an injectable gel that gently reverses many signs of aging in the face, including fine lines and wrinkles, crow's feet, thinning lips and loosening skin. It can also "plump up" the lips, sculpt the cheeks, and restore a youthful oval shape to the face. It is made with hyaluronic acid, a natural substance found in the body that works with collagen and elastin to give volume and support to the skin. Because it is non-animal-based and highly biocompatible, no pre-treatment testing is needed. Juvéderm comes in three formulas optimized for the depth of the area being treated. Results last about 6-9 months and can be made to last even longer with a simple follow-up treatment a few weeks after the initial injection. Visit www.allergen.com for more information.

Radiesse™ is a synthetic injectable filler that reduces wrinkles, creases and scars by augmenting the body’s natural collagen supply. Composed of microspheres in a biocompatible gel, Radiesse is made from the same minerals found in our bones, so it carries little risk of allergic reaction. Radiesse can be used on many areas of the body, including the lips, nasolabial folds, peri-oral lines, depressed scars and oral commissures.

Treatments typically take 15 minutes and require only local anesthetic. Side effects such as swelling or bruising are minimal and should fade within a few days. Results are visible immediately after the injection and can last for months or years, although the procedure can be repeated as often as you wish. Visit www.radiessse.com for more information.