Frequently Asked Questions

A dermatologist is a physician who has completed four years of medical school, one year of internship, and three years of specialized training to become an expert in diagnosing and treating conditions specific to your skin.

Ask at your dermatology office if your physician is board-certified. It is illegal to claim board certification if it is not true. You can look up the board status of any physician at the American Board of Medical Specialties. You can also check the status of a specific dermatologist by calling the American Board of Dermatology at 1-866-ASK-ABMS (275-2267). Our physicians are board-certified.

You should visit your dermatologist at least once each year for a thorough skin examination. If you have issues between your yearly visit, including acne, suspicious areas that do not heal, a rash, or an infected nail, you should see your dermatologist immediately. Many skin conditions can be treated easily with a dermatologist’s diagnosis and treatment.

Whether or not you need a referral from your primary doctor is dependent on your insurance. Please call your insurance carrier if you aren’t sure to avoid any payment disputes.

If you have a spot or area on your skin that is constantly irritated, bleeds for no reason, or has changed in size, shape, and/or color, it needs to be examined by a dermatologist within a month. Know your body and perform regular checks.

Bacteria that normally live on the top of the skin can enter clogged pores and become infected. This causes the skin to become swollen, red, and painful. Acne is most common among teenagers, although it can occur in adults, especially women. It’s also more likely to afflict people whose parents had acne. Acne can be exacerbated by oil from skin products, grease in the workplace, environmental irritants, touching or squeezing the blemishes, hard scrubbing of the skin and more.

Everyone’s acne must be treated individually. If you have not gotten good results from the acne products you have tried, consider seeing a dermatologist. Your dermatologist will decide which treatments are best for you.

The time for improvement depends upon the product being used, but in almost all cases it is more a matter of weeks or months instead of days. Most dermatologists would recommend the use of a medication or combination of medications daily for 4 to 8 weeks before they would change the treatment. It is very important for patients to be aware of this time frame so they do not become discouraged and discontinue their medications.

When using Accutane to treat acne, it’s important to discontinue all other acne medications, including over-the-counter creams and washes. Take your medication as directed and with a fatty meal. Acne below the surface may erupt faster initially, then decrease in amount and severity over 2-6 months. Most patients see improvement over the course of treatment, but about 1/3 will have some recurrence of acne at some point in the future.

Skin cancer is a disease in which malignant (cancerous) cells form in the tissues of the skin. Most skin cancers develop on the visible outer layer of the skin, the epidermis, particularly in sun-exposed areas such as the face, head, hands, arms, and legs. They are usually easy to detect by examining the skin, which increases the chances of early treatment and survival.

Risk factors for skin cancer include: Fair skin or skin that freckles, easily turns red, or quickly becomes sensitive after sun exposure, blue or green eyes, blond or red hair, a family history of skin cancer, exposure to the sun at work or play and sunburns, especially early in life.

For a quick way to assess your level of risk for skin cancer, try our Skin Cancer Risk Assessment.

Yes. The most common type of skin cancer is basal cell carcinoma (sometimes referred to as basal cell epithelioma). Approximately 1,000,000 new cases are diagnosed each year in this country. Another common skin cancer is squamous cell carcinoma. The third most common skin cancer is malignant melanoma.

The two most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, are rarely life threatening. These tumors replace normal surrounding tissue and generally do not spread to other areas. The third most common skin cancer, malignant melanoma, can be life threatening if treated late. When discovered and treated early, malignant melanoma is curable. Basal cell carcinomas and squamous cell carcinomas never “turn into” malignant melanoma.

There are several effective treatments for these tumors. Therapies such as freezing with liquid nitrogen, burning with electric current, surgery and radiation therapy are successful.

• More than 1.4 million cases of skin cancer are diagnosed every year in the United States and are a direct result of sun exposure.
• Skin cancer is a disease that affects men and women of all ages, in a variety of ways.
• One does not necessarily have to sunbathe in order to develop skin cancer.
• Most cases can be cured with early detection.

The most common types of skin cancer treated with Mohs surgery are basal cell carcinoma and squamous cell carcinoma.

These are the two most common types of skin cancer in America. Other more rare types of skin cancer are also often treated with Mohs surgery. Some early, superficial types of melanoma are treated with a modification of the Mohs surgery technique.

There are several effective treatments for these tumors. Therapies such as freezing with liquid nitrogen, burning with electric current, surgery and radiation therapy are successful. However, for tumors that have recurred following treatment or for tumors in difficult-to-treat sites, a technique of skin cancer treatment known as Mohs surgery offers the best chance for total removal.

Dr. Frederic Mohs developed this technique about 60 years ago. The procedure has been modified and refined over the years. Practitioners of the technique have kept Dr. Mohs’ name in respect for his contribution. Mohs surgery has other names including Mohs chemosurgery, Mohs microscopically controlled surgery, and Mohs micrographic surgery.

Mohs surgery is a technique of skin cancer treatment in which the cancer is surgically excised, and the specimen is processed immediately so that the surgeon can examine the tissue under the microscope. If the cancer has not been completely removed, then additional tissue is excised and reviewed again under the microscope. Once the skin cancer is totally removed, the wound is closed.

• Make sure to eat breakfast and take your medications as usual, unless otherwise directed.  .
• You will meet with your Mohs surgeon, who will go over your planned procedure with you and numb the area with small injections.
• Once the skin cancer is removed, you will wait while the tissue is processed and examined. It may take up to one and a half hours for your tissue to be processed.
• If any cancer remains, you will return to the procedure room for more tissue to be removed in the appropriate area.
• Once all edges are clear of cancer, the physician will close up the area or confirm your appointment later that day or the next with a plastic surgeon to do so.

Most reconstructions in our office are performed on the same day as your Mohs surgery.

It is difficult to predict how long your surgery day will be as it will depend on how many times tissue is taken to completely remove the skin cancer and the amount of surgery that is required for the closure. Most surgeries take half a day, but sometimes it can take the better part of a day. It may be best to the leave the rest of your day unscheduled, so you can allow yourself time to recover.

Melanoma is a cancer that is treated surgically. When the melanoma is thin (has not penetrated deeply into the skin), surgical removal is usually the cure.

The difference is what happens to the tissue after it is removed. After complete removal of the obvious tumor, the surgeon removes a thin layer of normal appearing skin surrounding the tumor. A map is made of the specimen. It is then processed in the laboratory for approximately one hour. The surgeon then examines the specimen under the microscope. If cancer is present in the specimen, the Mohs surgeon marks its location on the map and then returns to the patient and removes more tissue in that area. This step is repeated, if necessary, until the tumor is completely removed.

Mohs surgery has the smallest wound possible, which minimizes the scar. Additionally, the margins are evaluated right there while you wait, so if some skin cancer remains, it can be removed right away. Once the procedure is complete, you will know that the margins have been checked for cancer and are clear.

There are two primary advantages. First, by using the microscopic examination of the tissue as a guide, the Mohs surgeon is better able to remove all of the skin cancer. Secondly, by carefully mapping out the tumor, the surgeon removes cancerous tissue and leaves behind as much normal skin as possible.

The size of the scar depends on the size of the tumor. It is often difficult to predict the size of the tumor prior to surgery.

There are three main ways your surgical wound may be handled:

• Direct closure of the wound: in most instances, surgical wounds are sutured (sewn) closed.
• Skin graft: In some instances, it is necessary to remove skin from some other site and graft it over the wound.
• Second intention healing: The body has an excellent capacity to heal open wounds. This healing period is approximately three to six weeks depending on the size of the wound. It requires regular wound care. In addition to wound size and location, the surgeon considers other factors to determine how your wound will be handled. This will be fully discussed with you on the day of surgery.

No. The surgery is well tolerated with local anesthesia. Because the surgery may be time-consuming, the risk of prolonged general anesthesia is avoided.

The length of surgery depends on the extent of the tumor. Often surgery lasts half a day or longer. Much of the time is spent waiting for tissue to be processed. Bring reading materials, needlework, etc., with you to help pass the time.

We encourage you to bring someone with you. We will give you wound care instructions after your surgery and can answer any questions. Even with minor procedures, some patients may feel anxious or nervous. Due to the limited space in the waiting room, please try to limit family or friends to one or two persons. This will insure your comfort as well as the comfort of other patients who will also be having surgery the same day.

You should wear a shirt that buttons down the front. Often you will need to change into a gown for surgery, and surgical rooms can be chilly, so you may want to bring something with a little warmth.

You should avoid wearing jewelry the day of your surgery.

Yes. Breakfast is recommended.

Yes. Take your regular medications as they have been prescribed.

No.

You may be prescribed a pre-operative antibiotic. It is important that you discuss all medical conditions with your physician prior to surgery so that a specific treatment can be prescribed for your individual medical situation.

Bleeding and infection are the two primary complications. Both of these are uncommon. We will discuss how to recognize and deal with these problems on the day of surgery.

The average cost of Mohs surgery depends on the size of the tumor, the number of tissue layers to be removed, and subsequent wound management.

Under most circumstances your carrier will pay for surgery. Out-of-pocket costs may vary from patient to patient. If you are in doubt about your particular coverage, please check with your insurance representative prior to your appointment. If you have specific questions regarding insurance or billing matters, please contact our office.

If you are uninsured, you may qualify for a cash discount. Please let us know if cost is a barrier for you to get the care recommended by your doctor.

Your wound will require daily care during the weeks following surgery. Typically, patients will have sutures, which are removed a week or two after surgery. Full healing of the wound takes several weeks and sometimes even months. You should plan on wearing a bandage and refraining from any strenuous activity for several days.

If your surgery is on a site where there is a lot of movement (back, neck, legs, arms), you may be asked to avoid strenuous activity for two weeks. You will be given detailed instructions on your post-procedure care. It is very important that you follow these instructions to ensure proper healing.

Most patients experience minimal discomfort or pain. It is normal to experience a feeling of tightness and pulling at the surgical site as healing occurs. Skin cancer sometimes involves nerves, and it may take months before sensation returns to normal in the affected area. Sometimes numbness may be permanent.

Any type of surgery will leave a scar. However, Mohs micrographic surgery aims to minimize scarring by preserving as much healthy tissue as possible. You should be aware that it will take several months for your scar to mature. Redness can take a year to fade, and any lumpiness can take several months to resolve.

Most likely, your physician will perform the closure. However, occasionally the wound from Mohs surgery may involve a critical structure or be quite large or complex. In those cases, the physician will involve the expertise of another surgical specialist (for example, a plastic surgeon or an ear, nose and throat doctor).

At your surgery planning appointment, your physician will discuss whether another surgical specialist might be needed and they will coordinate your care with that office.

Botox has been used for 11 years to treat various medical conditions. For cosmetic purposes, any adult may be a candidate for Botox. Your physician can determine if Botox is right for you.

Botox is injected into the affected muscle(s). Some people report minor, temporary discomfort from the injection.

There can be side effects from Botox. The most common side effect is localized pain and tenderness and bruising of the injected area. Your doctor will explain and possible side effects with you before the procedure.

The effects of the treatment will be visible within 3-5 days. The treatment usually lasts 3-4 months. Because symptoms can change over time, the amount and duration of relief you’ll experience can vary. Consult your doctor who can best determine the frequency of Botox injections.

Procedures of a cosmetic nature are not covered by insurance, If you are using Botox to treat a medical condition, there may be insurance coverage.

You can return to work the same day and resume all regular activities after 24 hours. Vigorous exercise is not recommended immediately following a Botox treatment.

Most adults are candidates for Restylane treatment

Restylane is injected into the skin usually in skin folds below the nasal area. An ultra fine needle is used, resulting in minimal discomfort. Your physician may anesthetize the treatment are for comfort.

The most commonly reported side effects are temporary redness and swelling at the injection site.

Studies show that the average treatment lasts 6 months.

Procedures of a cosmetic nature are not covered by insurance.

There are no restrictions on activity. The injection site should not be touched until the Restylane has completely filled the injection site.

Most people may be treated. Often microdermabrasion treatments are used in conjunction with IPL treatments and chemical peels.

Treatment involves the use of aluminum oxide crystals deposited on the skin surface under pressure, similar to mild sandblasting and suctioned away. Dead epithelial cells on the surface of the skin and oily plugs in pores are removed. Collagen formation is stimulated by the mild, controlled suction.

Immediately after treatment, the skin appears flushed and feels soft and smooth. Normal activities may be resumed immediately.

Generally, treatments vary depending upon the needs of the patient. It is most commonly recommended at two week intervals for five sessions. It can be used in conjunction with IPL treatment and chemical peels.

Treatments of a cosmetic nature are not covered by insurance.

Normal activities can be resumed immediately.

Laser Hair Removal uses laser or light (thermal) technology that targets pigment in the follicle of unwanted hair. Laser Hair Removal is the best way to remove hair quickly and permanently. It is less time consuming and less painful than waxing or electrolysis.

Any one with unwanted brown or black hair. Any child under the age of 18, must have parental consent. All skin types can be treated for hair removal, but deeply tanned skin is not recommended. Ethnic skin types are safely treatable.

The area to be treated is shaved and cleansed of any oils or lotions. A laser is passed over the skin where the hair is to be removed. Multiple hairs are affected with each flash of the laser resulting in a feeling of a slight snap or pinch. Individuals with extremely dense hair may require an anesthetic cream before treatment.

Treatment areas must be protected from the sun during treatment to avoid skin discoloration. In rare instances, there may be mild crusting or burning.

In most cases, the majority of hair will be removed with 3-5 treatments at 4-6 week intervals. After a laser treatment, it takes 1-3 weeks for the affected hairs to fall out of the skin. You may continue to shave between treatments. Once the initial series of treatments has been completed, 1-2 touch-up sessions per year may be required to maintain results.

Procedures of a cosmetic nature are not covered by insurance.

Vigorous physical activity should be avoided for 24 hours following treatment when large areas have been treated. Your aesthetician will advise you regarding activity.

While skin cancers are almost always curable when detected and treated early, the surest line of defense is to prevent them in the first place. Do skin self-examinations monthly and if you have indications of skin irregularities consult with your dermatologist who may suggest a full body screening exam.

• More than 1.4 million cases of skin cancer are diagnosed every year in the United States and are a direct result of sun exposure.
• Skin cancer is a disease that affects men and women of all ages, in a variety of ways.
• One does not necessarily have to sunbathe in order to develop skin cancer.
• Most cases can be cured with early detection.

A study in The Journal of the National Cancer Institute showed that skin self-exams could reduce the risk of advanced disease among melanoma patients and potentially decrease melanoma mortality by up to 63 percent. Physicians’ and dermatologists’ skin exams are likewise effective: The Journal of the American Medical Association reported that melanomas found by physicians tend to be thinner (thus at an earlier stage, and more easily cured) than those found by patients.

Dermatologists have special training that includes the diagnosis and management of skin cancers.

Examining your skin means taking note of all the spots on your body, from moles to freckles to age spots. Skin cancer can develop anywhere on the skin and is one of the few cancers you can usually see on your skin. Ask someone for help when checking your skin, especially in hard to see places.

• Examine body front and back in mirror, then right and left sides, arms raised.
• Examine back of neck and scalp with a hand mirror. Part hair for a closer look at your scalp.
• Bend elbows, look carefully at forearms, back of upper arms, and palms.
• Check back and buttocks with a hand mirror.
• Finally, look at backs of legs and feet, spaces between toes, and soles.

You are looking for moles that looks different than others (asymmetrical, an irregular or scalloped border), itches or bleeds, or changes in size, shape or color. Any of these are reason to contact your dermatologist. For more details, read our page on skin cancer symptoms.

When you see a dermatologist for a complete skin checkup you should expect:

• a 10-15-minute visit
• a review of your medical history
• a head-to-toe skin examination.
• to ask about any spots you are worried about; your dermatologist can educate you about what to look for, such as any changes in the size, color, borders, or shape of a mole.

Virtually any notable change in a mole should be checked out. Typically, a spot that the doctor or dermatologist suspects is cancerous will be biopsied. During a biopsy, a sliver of tissue is removed for evaluation by a pathologist, who confirms (or refutes) the dermatologist’s suspicions.

At the least, your primary care physician should evaluate your skin during your annual health examination. If you have a question about your skin that he or she cannot answer, a referral to a dermatologist is appropriate.

At least once a year. If you have a history of skin cancer or numerous moles, it is important to see a dermatologist for regular skin examinations at intervals ranging from three months to annually. If you have issues between your yearly visit, including acne, suspicious areas that do not heal, a rash, or an infected nail, you should see your dermatologist immediately. Many skin conditions can be treated easily with a dermatologist’s diagnosis and treatment.

An obvious skin cancer preventative measure is sun safety habits. Smart sun habits should be part of everyone’s daily health care.

Here are some important tips:

• Seek the shade, especially between 10 a.m. and 4 p.m.
• Do not burn.
• Avoid tanning and UV tanning booths.
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
• Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day.
• For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
• Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours, or immediately after swimming or excessive sweating.
• Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
• Examine your skin head-to-toe every month.
• See your dermatologist every year for a professional skin exam.

Intense Pulsed Light is also known as photorejuvenation. IPL technology is a non-invasive treatment used to treat the visible signs of aging. IPL can be used to diminish slight skin surface imperfections such as large pore size, fine wrinkles and elastic skin changes. IPL improves the appearance of facial redness caused by superficial capillaries and most brown pigments including sun-induced freckles and melasma. With a series of treatments, IPL can improve overall skin tone and color giving the skin a more youthful appearance.

Most people, including children, may be treated. However, your doctor and aesthetician should determine if your condition is suitable for the treatments. This may require a consultation visit.

Treatment involves a pulsed light, similar to the flash of a camera. A cold gel is applied to the area to be treated and you will be given dark glasses or goggles to protect your eyes from the bright light. The smooth glass surface of the IPL handpiece is gently applied to your skin and pulses of light are applied. You may feel a slight pinch or snap. An anesthetic topical gel is available prior to treatment.

You may experience some short-term side effects. This may include slight reddening of the skin or local swelling which goes away within a few days. In rare instances, there may be bruising that will last one-two weeks.

Freckles, age spots, and sun spots often clear up after three to five treatments. Each session generally lasts 30-45 minutes. Your aesthetician will determine how many sessions are required. Often, microdermabrasion is also used following and IPL treatment.

Treatments of a cosmetic nature are often not covered.

You can return to work the same day and resume all regular activities after 24 hours. Vigorous exercise is not recommended immediately following the IPL procedure. You should limit your exposure to the sun and sun block is mandatory.