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Moles

What are Moles?

A mole (also known as nevus, singular, or nevi, plural) is a raised section of discolored skin that is usually harmless and may contain a hair or hairs.

A mole is one of the most common skin conditions and can occur anywhere on the body. Moles are made of a cluster of melanocytes, the cells that cause pigmentation of the skin, hence the darker color. Most moles appear during adolescence; however, some may not be noticed until later in life when events such as hormonal changes may cause the pigment to darken and the mole to become more visible.

Moles can be either raised or flat and are generally less than ¼” in diameter. The surface of the mole can be smooth or wrinkled and some may contain hair. Though generally brown in color, moles may also appear tan, black, red or blue. As the body ages, moles may lighten in color, flat moles may become raised, and some moles may disappear. It is always a good idea to monitor any changes in a mole and bring them to the attention of a doctor.

Moles can be differentiated from other, more serious forms of skin aberrations if they do not change color, are more symmetrical in shape, and appear the same over time.

What causes Moles?

Anyone can develop moles. Ten to 40 moles is a common range for most people; however, some people may develop over 100 moles. Factors that may influence the presence and quantity of moles are:

  • Family history
  • Sun exposure
  • Hormonal changes (e.g., pregnancy)
  • Age

What can treat Moles?

There is no medical necessity for removing a mole. In the cases in which a mole causes irritation due to clothing or has cosmetic significance (for example, a prominent mole that appears on the face, neck or other visible area), your dermatologist may recommend one of the following outpatient treatment options:

Local surgical excision – Your dermatologist will cut out the mole and, depending on the size, close the resulting wound with stitches.

Surgical shave – Your doctor will use a sharp blade to remove the mole at the surface.

Malignant Melanoma

What is Malignant Melanoma?

Melanoma, also known as malignant melanoma, is a dangerous type of skin cancer that occurs in melanocytes, which are the cells that produce the skin pigment known as melanin. Though melanocytes are usually found in the skin, they are also present in the bowel, the eyes, and other areas of the body; however, the risk of melanoma in these areas is very low.

While melanoma is less common than other forms of skin cancer, it is the most deadly and is responsible for approximately 75% of all skin cancer deaths. Approximately 160,000 new melanoma cases are diagnosed in the U.S. each year. Of those, approximately 48,000 result in death.

What causes Malignant Melanoma?

Melanoma of the skin is caused by excessive ultraviolet light (UV) exposure without the appropriate amount of skin pigmentation, and is almost always preventable.

Because melanoma development is so closely related to the overexposure to ultraviolet (UV) rays, Caucasians are more susceptible to contracting the disease.

By gender, women commonly develop melanomas on their legs while in men they appear most often on the back and the back of the neck. Fair-skinned people and people who have experienced repeated sunburns are at greater risk of developing melanoma. Others who are at a higher risk include:

  • People who use tanning beds
  • People who live in high elevations
  • People who live closer to the equator
  • Family history of melanoma

What does Malignant Melanoma of the skin, look like ?

The most common symptom of melanoma is a change in an existing mole. In fact, this visible assessment is so common, health care professionals have created this simple alphabetical checklist:

  • Asymmetry – Varying shapes of lumps or moles, even within each mole
  • Borders – Irregular mole borders – scalloped, wavy or notched
  • Color – Uneven, either between different moles, or within the same mole
  • Diameter (greater than 6 mm (0.24 in), about the size of a pencil eraser) – Melanomas that are larger than ¼ inch in diameter and appear to be growing
  • Evolving – Changing in size, shape and/or color

Moles that itch, ooze or bleed are also suspect. It is important to remember, however, that melanoma can appear on normal skin tissue and does not always start as a mole.

These classifications do not apply to the most dangerous form of melanoma, nodular melanoma, which has its own set of symptoms and must be diagnosed by a qualified physician.

Malignant Melanoma treatment options?

Once melanoma has been confirmed through a biopsy and pathological examination, there are several treatment options available:

Mohs surgery – A highly effective procedure that is favored by many of our dermatologists.
Chemotherapy – Uses drugs, sometimes in combination, to destroy cancer cells. Though not as successful as Mohs surgery, chemotherapy may be appropriate in some cases.
Immunotherapy – As with chemotherapy, this option may be less effective, but immunotherapy may be a viable treatment option for some cases.
Radiation – Uses focused, high-powered radiation beams to eradicate cancer cells. Sometimes recommended after surgery to help reduce the rate of recurrence.
Biological therapy – Uses naturally-occurring substances to help boost the body’s immune system to fight the cancer cells.

Hives

What are Hives?

Hives are itchy skin rashes that are usually caused by an allergic reaction. Initially, hives appear as raised, red bumps. Hives can appear anywhere on the body, including the tongue or throat, and they range in size from as small as ¼” to 10”. The duration of an outbreak of hives may be as short as a few hours.

Hives develop when histamines are produced in the body as a reaction. Histamine production causes the tiny blood vessels, known as capillaries, to leak fluid. When the fluid accumulates under the skin, it causes the red bumps that are hives. Hives often itch uncomfortably.

There are several different types of hives, the most common of which include:

Caused by ingesting certain foods or medication or through infections. Insect bites may also be a cause.

Chronic urticaria and angioedema: Usually affects internal organs and the exact causes are unknown, except that it is allergy related.

Physical urticaria: Caused by direct physical stimulation of the skin, such as extreme heat or sun exposure, this form of hives develops in about an hour.

Dermatographism: Hives formed after aggressive stroking or scratching of the skin.

What are the symptoms of Hives?

The skin swellings associated with hives are called wheals and are usually round, pink or red bumps. The skin surrounding the wheals may also be red.

Symptoms of chronic urticaria and angioedema include muscle soreness, shortness of breath, vomiting, and diarrhea.

Who gets Hives?

Though allergic symptoms differ with each person, anyone who has allergic tendencies can get hives. There are no tests for hives, only for the allergens that may trigger them.

Hives Treatment Options

The best treatment for hives is to identify the allergic component and eliminate it from the patient’s lifestyle. In the case of medications, however, this may not be feasible. Antihistamines may provide temporary relief and seem to be preventive when taken regularly, not just when an outbreak occurs. For chronic hives, oral corticosteroids may be prescribed.

Eczema (Dermatitis)

What is Eczema?

Eczema, also known as atopic dermatitis, is a common skin condition characterized by the inflammation, swelling or irritation of the skin. Eczema affects as many as 35 million Americans. Eczema is not dangerous, but it can cause significant discomfort if the skin itches. When that happens, the condition may worsen if the eczema is scratched.

Atopic dermatitis, or atopic eczema, is the most common form of eczema and is often found in babies and children.

What causes Eczema?

According to the American Academy of Dermatology, up to 20 percent of children and one to three percent of adults will develop atopic eczema. Causes include:

  • An overreaction to environmental triggers by the body’s immune system
  • Family history of allergies or asthma
  • A defect in the skin which causes it to not properly regulate moisture and germs
  • Irritants – Environmental elements such as soaps, detergents and certain fabrics
  • Stress – Any form of stress, such as work, family or social issues, can trigger eczema
  • Climate – Dramatic decreases in humidity can trigger eczema and cold, damp conditions can hamper eczema treatments
  • Perspiration
  • Animal dander
  • Upper respiratory infections
  • Genetics

What does Eczema look like ?

The onset of eczema is often characterized by itchiness in the area of the skin that will be visibly affected. Eczema is not contagious and may develop in any other area of the skin as well. When eczema occurs it is characterized by dry, scaly, flaky or thickened skin that is reddish and may turn brown. Conversely, those people with darker skin may see the affected area become lighter in color. Eczema can be cyclical with intermittent flare-ups. Infants most often suffer from eczema on the face and scalp, although like adults, it may appear anywhere.

According to the National Eczema Organization, the most common symptoms of eczema are:

  • Dry, sensitive skin
  • Intense itching
  • Red, inflamed skin
  • Recurring rash
  • Scaly areas
  • Rough, leathery patches
  • Oozing or crusting
  • Areas of swelling
  • Dark-colored patches of skin

When symptoms occur, particularly in a repeat eczema incident, treatment results may be accelerated by a visit to a dermatologist for care.

Eczema treatment options?

Though there is no cure for eczema, its effects can be controlled through diligent care. Treatment options include:

Bathing follow-up. After bathing, applying a moisturizer on the affected area can help control eczema. In many cases, the most effective moisturizer is available only by prescription after a visit to a physician.

Topical steroids. These are a common and effective relief option for eczema. Topical steroids help reduce inflammation, soothe the skin to prevent soreness, reduce itchiness and allow the affected area to heal. As a naturally-occurring substance in our bodies, steroids regulate growth and immune functions. Of the many types of steroids that are available, corticosteroids are the type used to treat eczema. Corticosteroids are used because of their ability to control inflammation.

Non-steroid drugs. A topical calcineurin inhibitor (TCI) is a prescription drug that does not contain steroids. If you are concerned about the use of steroids to treat your eczema, ask your doctor about Elidel® and Protopi®, the two types of TCI that can provide effective alternatives.

Phototherapy. On occasion, eczema can be treated through the use of ultraviolet (UVB) light, known as phototherapy. In phototherapy, UVB rays are isolated and directed toward the affected areas. Phototherapy treatments should be applied under medical supervision.

Cold Sores

Cold sores are blistering sores typically close to the mouth. They begin with a tingling sensation and progress to clusters of painful blisters, then crusted sores that may heal with scarring. They are caused by the herpes simplex virus and are usually transmitted by direct contact (kissing, etc.). Even with treatment the virus is never cleared from the body completely. Therefore, treatment is aimed at preventing or minimizing outbreaks. This is done through oral antiviral medications such as acyclovir.

Basal Cell Carcinoma

What is Basal Cell Carcinoma?

Basal cell carcinomas are growths or lesions that appear on the skin surface in varying forms, including red patches of skin, pink growths, open sores and shiny bumps. Basal cell carcinomas are commonly caused by overexposure to ultraviolet (UV) rays. Basal cell carcinomas are rarely life-threatening, though their appearance can be highly unsightly.

What are the symptoms?

One common symptom of a basal cell carcinoma is a wound or sore that will not heal. Typically, the wound or sore may bleed or ooze and remain unhealed for an abnormal length of time before eventually healing. It will then reopen and start to ooze or bleed. This process can repeat itself several times.
Basal cell carcinomas present themselves as reddish areas of skin on the parts of the body that are exposed to the sun, including the face, neck, arms and legs. Itching is an occasional side effect.
Basal cell carcinomas can also appear as a scar, pink growths, or as shiny bumps that appear red, pink or white. These shiny bumps are often mistaken for moles.

Who gets it?

Almost three million people each year are diagnosed with basal cell carcinomas. Basal cell carcinomas appear most frequently in people whose lifestyles expose them to unsafe levels of UV rays. Though the average age of basal cell carcinoma patients is declining, it is still most frequent in people over age 40. People with fair skin, blond or red hair are also more susceptible as are people with blue, green or grey eyes. Men are also at higher risk.

Treatment Options

A biopsy is often used to confirm a diagnosis of basal cell carcinoma. Once confirmed, basal cell carcinomas can be treated through:

Mohs micrographic surgery – Uses local anesthesia to remove tumors. Advantages of Mohs surgery include its ability to spare healthy tissue and a high cure rate of approximately 90 percent.

Excisional surgery – Unlike Mohs surgery, this procedure calls for the removal of small areas of surrounding healthy tissue as a preventive measure. Cure rates average about 90 percent.

Electrodessication and curettage – Also uses local surgery. Here, the growth is scraped off and cauterized to destroy any remaining tumor cells and to stop bleeding. Usually not suitable for advanced cases or for growths in hard-to-reach areas.

X–ray – Over the course of several weeks, beams are aimed precisely at the tumor. This option has the risk of radiation exposure.

Cryosurgery – Destroys tumors through freezing with liquid nitrogen.

Topical ointments – There are also ointments available such as Imiquimod and 5-Fluorourcil – ask your Forefront Dermatology physician if these are a viable option for you.

Actinic Keratosis

What is Actinic Keratosis?

Actinic keratosis, also called solar keratosis or senile keratosis, is characterized by thick, scaly or crusty patches or lesions on the skin, usually on areas that receive excessive sun exposure, such as the face, ears, neck, lips, forearms and the back of the hands. It is considered a precancerous skin condition.

Actinic keratoses develop in range reaching to a quarter of an inch and may even disappear for a time. Their colors include red (most common), light or dark tan, pink or skin colored. Actinic keratoses may itch and may become inflamed and red and may even bleed.

What are the symptoms?

Actinic keratoses appear as rough, callous, scaly lesions or plaques on the skin’s surface. Although dry, rough patches are typical, actinic keratoses may also present as oozing lesions that do not heal or as thick, horny growths. Lesions may vary in color from light beige tones to dark brown and range in size from a small dot to approximately an inch in diameter. Actinic keratosis lesions may seem to appear and disappear periodically, or they may remain in place for a long period of time.

Who gets it?

The amount of sun exposure you may have had throughout your lifetime, having a light complexion, and having blond or red hair and blue or green eyes all put you at greater risk for actinic keratosis.

People who live in sunnier areas of the country and those who spend a significant amount of time outdoors because of their jobs may also be at higher risk for actinic keratosis. Actinic keratosis is most commonly observed in people age forty and older.

Treatment Options

There are several effective treatments for actinic keratosis. Your dermatologist will plan your treatment based on the type of actinic keratosis you have, your overall health and your age.

Skin Rejuvenation

Although it is not possible to turn back the hands of time, its effects can be dramatically slowed down and improved with the arsenal of procedures and techniques available to your dermasurgeon.

The natural aging process generally produces lines and wrinkles, age spots, splotches and pigmentation problems, broken capillaries, dull skin texture and color, and other skin flaws. Also, a once-attractive mole or birthmark may change into an unattractive protrusion, or a once unnoticeable scar may become more apparent when wrinkles form around it.
Sun-damage compounds the aging process. Ultraviolet light from the sun penetrates not only the outer layer of skin, but also those layers underneath which fortify the skin and lend it resilience.

Anti-aging creams and topical products are usually used to treat the milder symptoms of aging such as damage to the skin’s uppermost layers.

For more advanced signs of aging and sun-damage, your dermasurgeon will choose the surgical method or combination of methods best suited to your individual skin condition.

Sclerotherapy / Spider Vein Treatment

Sclerotherapy, “sclero”, is the treatment of choice for the small red and purple veins that accumulate on our thighs and legs. Treatment consists of injecting a sclerosing solution directly into the affected veins. The procedure is done in the office and requires no anesthetic. Several sessions are needed to achieve the best results. Once we get everything we can cleared up with the sclero, we can go after the remaining tiny little guys with a laser. For the injection we use Asclero (polidocanol) or if you prefer, we can use hypertonic saline. It is recommended that you start these treatments in the fall or winter. So don’t wait until its bathing suit weather to think about getting rid of those unattractive red/purple lines.

Chemical Peels

How does a Chemical Peel work?

A chemical peel is a skin treatment wherein a chemical solution is applied by a skincare specialist to the skin causing it to blister and peel, exposing a new layer and improving appearance.

They come in a range of strengths, from deeper phenol-based peels to more superficial peels like glycolic acid – your dermatologist will recommend the correct strength, and interval for your skin type.

What can a Chemical Peel treat ?

Chemical peels can reduce the appearance of skin conditions like:

  • acne scars
  • age spots
  • aging skin
  • crow’s feet
  • hyperpigmentation
  • rough or uneven skin texture
  • sun-damaged skin
  • wrinkles.

What is a Chemical Peel session like?

Your experience will vary depending on the strength of the peel, for light and medium peels you may receive a local anesthetic. For very deep chemical peels, you may require general anesthesia.

After your skin has been numbed, a chemical peel solution is applied to your face and is left to take effect. The amount of time left on your skin will depend on the specific type of peel, from a few seconds up to an hour, as determined by your dermatologist.

Some peels will be neutralized with water, and then a protective mask or layer of petroleum jelly is placed on your treated skin.

What results can be expected from a Chemical Peel ?

Chemical peels will vary in result, depending on the area, skin type, the type of peel and what kind of result you are expecting. It is strongly recommended that you consult a qualified dermatologist, to get the best results.