DERMATOLOGY SERVICES

SKIN CANCER

Skin cancer is the most common cancer in the world. In fact, over 2 million cases of skin cancer were diagnosed in the United States alone this year. One in five Americans will develop skin cancer at some point in their lives. If caught early, skin cancer can be easily cured.  However, people who have had skin cancer are at a higher risk of developing a new skin cancer, which is why regular self-examination and doctor visits are imperative.

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WHAT ARE THE DIFFERENT TYPES OF SKIN CANCER?

Basal cell carcinoma – Accounts for 75% of all skin cancers. They usually appear as small pink or pearly bumps on the skin. They predominantly develop in areas exposed to the most sun such as the face, head, neck, hands, arms and shoulders. They are most commonly found in people with light-colored eyes, hair and complexion. They are slow growing and are rarely life-threatening. Squamous cell carcinoma – Accounts for about 20% of all skin cancers. They also develop most commonly on the sun-exposed areas and present as scaly patches of skin or as pink crusted nodules. This form of skin cancer is more aggressive than basal cells. It can spread to other ares of the body, but if caught early, is easily cured. Melanoma – Accounts for approximately 5% of all skin cancers but is responsible for 73% of all deaths from skin cancer. Melanomas originate in melanocytes or the pigment producing cells in the skin. They often resemble a mole or can begin as a mole that turns cancerous which then spreads quickly throughout the body. They most commonly develop on the back, face, legs and arms but can develop anywhere on the body including the soles of the feet, nail beds, vagina or even in your eye. Risk factors for melanoma include: a family history of melanoma, early childhood sunburns, many freckles, > 50 moles, history of dysplastic or atypical moles, tanning bed use.



HOW CAN I TELL IF I HAVE SKIN CANCER?

It is important to examine your skin on a regular basis. You should see a dermatologist right away for a skin cancer check if you see anything on your skin that lasts for 2 weeks or longer and is growing, changing shape, or bleeding or itching. It can be difficult to distinguish between a mole and a melanoma. When examining your skin, you should look for the ABCDEs of melanoma. (borrowed from AAD website) A = ASYMMETRY One half is unlike the other half. B = BORDER An irregular, scalloped or poorly defined border. C = COLOR Is varied from one area to another; has shades of tan, brown or black, or is sometimes white, red, or blue. D = DIAMETER Melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller. E = EVOLVING A mole or skin lesion that looks different from the rest or is changing in size, shape or color.



HOW IS SKIN CANCER DIAGNOSED?

The best way to find out if you have a skin cancer is to get a skin cancer screening. At that appointment, our doctors perform a thorough head to toe examination of the skin. At Natural Image we are skilled with the use of a device called a dermoscope which shines light on and magnifies the skin. This technology allows us to more closely examine a mole or growth to see if it needs to be biopsied. Many times it eliminates the need for the mole to be tested. However, if a suspicious lesion is identified, a biopsy may be performed. This is generally a quick, safe and easy procedure with minimal risk or discomfort.



HOW IS SKIN CANCER TREATED?

There are many treatments for skin cancer and multiple factors are taken into account when developing the treatment plan including: the type of skin cancer, the location of the skin cancer, the stage of the skin cancer as well as the age and health of the patient. The options include surgical removal of skin cancers including simple excisions, curettage and electrodessication (which involves scraping out the cancerous cells and cauterizing the base) and Mohs surgery. Mohs surgery may be recommended if the skin cancer is in a sensitive area or is a more aggressive skin cancer. It is a specialized surgical technique for removing skin cancers with the highest cure rate and can often help to minimize surgical scars. It is performed as an outpatient under local anesthesia. The Mohs surgeon will examine the cancerous tissue as it is excised to ensure complete removal. Other treatments for skin cancer may involve topical chemotherapy, cryotherapy, photodynamic therapy, radiation, or even creams that stimulate your own immune system to fight the cancerous cells.



WHAT IS A PRECANCEROUS SKIN LESION?

In our office, we see 2 common precancerous skin lesions – Actinic Keratoses and Dysplastic Nevi. Actinic Keratoses – An actinic or solar keratosis is a common precancerous skin condition caused by excessive exposure to ultraviolet light. They are characterized by rough, dry, tan-to-pink-colored blemishes that most often appear on parts of the body with the most sun exposure such as the face, scalp, ears, and hands. They are most common in fair-skinned, middle-aged or elderly individuals, who may have a single or numerous lesions. Actinic keratoses can lead to a more serious squamous cell carcinoma if left untreated. It is estimated that 20-40% of SCCs begin as actinic keratosis. There are multiple treatments available for actinic keratoses including cryosurgery, curettage (scraping), photodynamic therapy, or topical chemotherapy and creams that stimulate your own immune system to fight the cancerous cells. The choice of treatment depends on the location of the lesion, how many there are, and the preference of the patient. Dysplastic Nevi – Although most moles are benign, about 30% of the population has moles called dysplastic nevi, or atypical nevi which tend to be larger than ordinary moles (most are 5 mm across or larger), have irregular borders, and are various shades or colors. Individuals who have dysplastic nevi plus a family history of melanoma (a syndrome known as FAMM) are at a high risk for developing melanoma at an early age (younger than 40). It is important that these patients especially come at least once yearly for a full skin cancer screening.



HOW CAN SKIN CANCER BE PREVENTED?

These are skin cancer prevention tips recommended by the American Academy of Dermatology and the Skin Cancer Foundation:

  • Avoid prolonged sun exposure between the hours of 10 AM and 4 PM
  • Wear sun protective clothing including a broad-brimmed hat and UV-blocking sunglasses.
  • Use a broad spectrum sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum sunscreen with an SPF of 30 and above. Apply 1 oz or 2 tablespoons of sunscreen to your entire body 30 minutes before going outside and reapply every 2 hours or immediately after swimming or excessive sweating.
  • Avoid tanning and UV tanning booths.
  • Do not burn.
  • Perform a self-exam every month.
  • Get a once yearly skin cancer screening by a dermatologist.



ECZEMA (ATOPIC DERMATITIS)

Atopic Dermatitis, or eczema, is a common skin disease affecting over 15 million American adults and children. It is a chronic skin condition that predominantly affects infants and young children but may last through adolescence and adulthood. It is characterized by itchy, red and irritated patches. In severe cases the skin can blister and weep, however eczema can also be dry and scaly or even cause a thickening of the skin. Atopic Dermatitis can occur anywhere on the body but often affects the skin folds, the arms and legs, and especially in adults, the hands.

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WHAT CAUSES ATOPIC DERMATITIS?

It is an inherited condition but certain environmental triggers can exacerbate the condition. Some of these include diet, stress, allergens or irritants, temperature extremes or acute infections.



HOW IS ATOPIC DERMATITIS TREATED?

The most important aspect of the management of eczema is consistently following a good skin care routine. It is important to take brief baths or showers with lukewarm water, avoiding irritants (as determined by your doctor) and harsh soaps, minimizing stress and most important- applying an emollient daily. Other treatments involve topical steroids, topical immunomodulators, oral antibiotics and antihistamines, and in severe cases phototherapy or other oral anti-inflammatory agents.



SKIN ALLERGY/CONTACT DERMATITIS

Contact dermatitis is a condition in which the skin becomes red, itchy, and inflamed after direct contact with a substance. The best known example of a contact dermatitis is poison ivy but the same type of rash can occur from exposure to compounds that we come in contact with every day.

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WHAT CAUSES ATOPIC DERMATITIS?

It is an inherited condition but certain environmental triggers can exacerbate the condition. Some of these include diet, stress, allergens or irritants, temperature extremes or acute infections.



HOW IS ATOPIC DERMATITIS TREATED?

The most important aspect of the management of eczema is consistently following a good skin care routine. It is important to take brief baths or showers with lukewarm water, avoiding irritants (as determined by your doctor) and harsh soaps, minimizing stress and most important- applying an emollient daily. Other treatments involve topical steroids, topical immunomodulators, oral antibiotics and antihistamines, and in severe cases phototherapy or other oral anti-inflammatory agents.



HAIR LOSS/ALOPECIA

Everyone loses hair. In fact, it is normal to lose about 50-100 hairs per day. However, if you feel that your hair is coming out in handfuls or you are noticing bald patches, you could be experiencing hair loss or alopecia.  Anyone — men, women and children — can experience hair loss.

 

WHAT ARE THE DIFFERENT TYPES OF ALOPECIA?

  • Telogen Effluvium – A sudden physical or emotional stress may cause an abnormal amount of hair throughout your scalp to shed (called Telogen effluvium). It is often common to experience clumps of hair falling when you shampoo, comb, or run your hands through your hair. The hair loss often occurs weeks to months after the stressful event. The hair shedding generally normalizes over 6 – 8 months. Cause of this type of hair loss are:

  • High fever or severe infection
  • Childbirth
  • Major surgery, major illness, sudden blood loss
  • Severe emotional stress
  • Crash diets, especially those that do not contain enough protein
  • A number of medications, including retinoids, birth control pills, beta-blockers, certain antidepressants, NSAIDs (including ibuprofen) and calcium channel blockers
  • Medical conditions such as thyroid disease
  • Androgenetic or male-pattern/ female-pattern baldness – The most common cause of hair loss is a medical condition called hereditary hair loss or androgenetic alopecia. About 80 million men and women in the United States have this type of hair loss. In women, the hair generally thins more diffusely on the scalp but the hairline is maintained. This is in contrast to male pattern baldness where often times the hair line recedes or a bald spot develops on the crown of the head.
  • Alopecia Areata– is characterized by a sudden loss of hair in one area resulting in well-defined bald patches. This condition is most common on the scalp, but can occur anywhere on the body including the beard and sometimes even the eyebrows or eyelashes. This form of hair loss is common in children and adults.
  • Scarring alopecia – can be caused by many conditions including autoimmune and inflammatory conditions such as lupus, trauma to the scalp (including that from burns, tight hair styles or harsh chemical treatments to the scalp), continual hair pulling or bacterial and fungal skin infections.



HOW IS ALOPECIA DIAGNOSED?

In addition to a thorough medical history and physical examination, our doctors may determine that blood work or possibly even a biopsy of the scalp is necessary to help identify the type of hair loss that is present.



HOW IS ALOPECIA TREATED?

Not all alopecia is treated the same. The treatment plan developed by our doctors will depend on the type of alopecia diagnosed and individual characteristics and preferences. The main goal of therapy is to identify all reversible forms of hair loss and address any underlying condition or prevent further trauma that may be causing the alopecia. Additionally, some treatments include topical minoxidil, topical and intralesional (injected) corticosteroids, or hair transplantation.



ACNE 

Acne is the most common skin disorder in the United States. Many people assume that it is a normal part of adolescence and feel there is no reason to treat the condition. However,  there are many reasons to treat acne. In teenagers, acne can be psychologically distressing and improving one’s complexion can improve self esteem. Also, acne can cause permanent scarring if not treated early and aggressively.

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Also, acne does not just affect teenagers. In fact, acne is on the rise in adult women- affecting them in their 30’s, 40’s 50’s and beyond. Whatever the age, there are many effective treatments for acne. Our dermatologists specialize in topical, systemic, and cosmetic therapies for this condition. In addition to the traditional therapies, we are skilled in cosmetic treatments including peels, Hydrafacials, laser, microdermabrasion and Blu-U treatments for acne and its associated scarring.

 

ROSACEA 

Rosacea, an associated condition, is often mistaken for acne. It also causes inflammation on the skin and is characterized by easy flushing, redness, and acne-like lesions. Other symptoms include pronounced blood vessels on the face (or telangiectasias), irritated or bloodshot eyes (ocular rosacea), or even a red and bulbous nose (also known as rhinophyma).

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Rosacea can cause significant psychological distress but there are many ways to manage the condition. For starters, there are some well known triggers of rosacea. Some of these include: heat, sun, wind, emotional stress, alcohol, hot beverages and spicy foods. The doctors at Natural Image can help determine which of these might be affecting you and also help manage/avoid them. Also, there are many over-the-counter and prescription medications that are effective in treating rosacea. These include many of the same that are used for acne such as topical and oral antibiotics, azeleic acid, topical retinoids and sulfur based compounds.

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Rosacea also responds well to laser therapy, specifically, persistent redness and dilated veins on the face. Various lasers can be used to treat rosacea. These include the pulsed-dye laser and intense pulsed light treatment. Many patients see a dramatic improvement after one session but several treatments are often necessary to complete the treatment. We also now offer Hydrafacials as a cosmetic service to those who struggle with Rosacea.

 

PSORIASIS

Psoriasis is a chronic skin disease affecting nearly 5-7 million people in the US. It consists of raised red patches covered in silvery colored scales. It most commonly occurs on the lower back, knees, elbows, and scalp. However, it can be widespread or also involve the nails and joints (psoriatic arthritis).

 

WHAT ARE THE DIFFERENT TYPES OF ALOPECIA?

  • Telogen Effluvium – A sudden physical or emotional stress may cause an abnormal amount of hair throughout your scalp to shed (called Telogen effluvium). It is often common to experience clumps of hair falling when you shampoo, comb, or run your hands through your hair. The hair loss often occurs weeks to months after the stressful event. The hair shedding generally normalizes over 6 – 8 months. Cause of this type of hair loss are:

  • High fever or severe infection
  • Childbirth
  • Major surgery, major illness, sudden blood loss
  • Severe emotional stress
  • Crash diets, especially those that do not contain enough protein
  • A number of medications, including retinoids, birth control pills, beta-blockers, certain antidepressants, NSAIDs (including ibuprofen) and calcium channel blockers
  • Medical conditions such as thyroid disease
  • Androgenetic or male-pattern/ female-pattern baldness – The most common cause of hair loss is a medical condition called hereditary hair loss or androgenetic alopecia. About 80 million men and women in the United States have this type of hair loss. In women, the hair generally thins more diffusely on the scalp but the hairline is maintained. This is in contrast to male pattern baldness where often times the hair line recedes or a bald spot develops on the crown of the head.
  • Alopecia Areata– is characterized by a sudden loss of hair in one area resulting in well-defined bald patches. This condition is most common on the scalp, but can occur anywhere on the body including the beard and sometimes even the eyebrows or eyelashes. This form of hair loss is common in children and adults.
  • Scarring alopecia – can be caused by many conditions including autoimmune and inflammatory conditions such as lupus, trauma to the scalp (including that from burns, tight hair styles or harsh chemical treatments to the scalp), continual hair pulling or bacterial and fungal skin infections.



HOW IS ALOPECIA DIAGNOSED?

In addition to a thorough medical history and physical examination, our doctors may determine that blood work or possibly even a biopsy of the scalp is necessary to help identify the type of hair loss that is present.



HOW IS ALOPECIA TREATED?

Not all alopecia is treated the same. The treatment plan developed by our doctors will depend on the type of alopecia diagnosed and individual characteristics and preferences. The main goal of therapy is to identify all reversible forms of hair loss and address any underlying condition or prevent further trauma that may be causing the alopecia. Additionally, some treatments include topical minoxidil, topical and intralesional (injected) corticosteroids, or hair transplantation.