Fellowship-trained Mohs Surgeon @ Schneider Dermatology
UPDATE: Visit my new practice website at Pacific Crest Dermatology
MY SPECIALTIES: SURGERY
MOHS MICROGRAPHIC SURGERY
Mohs micrographic surgery is the gold standard technique used to treat many non-melanoma skin cancers primarily on the head and neck. The cancer is removed and 100% of the margin is checked under the microscope while you wait by the Mohs surgeon. Then, once the cancer has been confirmed as removed, the defect is repaired by the Mohs surgeon. Mohs surgeons are double-board certified in dermatology and Mohs surgery and are experts at the surgical removal, the examination under the microscope and the reconstruction at the end of the procedure.
EXCISIONAL SURGERY
Surgical excisions are procedures to remove various growths from the skin. Excisions can be performed to remove skin cancers in certain lower-risk locations like the arms, legs, abdomen or back. The cancer in this area would be removed with a standardized surgical margin and is still sent to the pathology lab for evaluation. Benign (non-cancerous) lesions can also be removed this way with variable safety margins. Common examples include cysts and lipomas.
BASAL CELL CARCINOMA
Basal cell carcinoma (BCC) is the most common skin cancer in the United States. It arises from the basal cells in the skin and causes a generally slow-growing but locally destructive cancer. It can present as a growth that is bleeding, itching or hurting. It can have multiple appearances on the skin, which is why it is important to see a board-certified dermatologist to evaluate any growing or changing spots on your skin.
SQUAMOUS CELL CARCINOMA
Squamous cell carcinoma (SCC) is the second most common type of skin cancer. It arises from the squamous cells in the skin which are neighbors to basal cells. It can present as a growth that is painful, itching or bleeding. If you have any new growths that you are concerned about, it is important to have it evaluated by a board-certified dermatologist.
MELANOMA
Melanoma is the third most common type of skin cancer but it is a more aggressive type of skin cancer. It can appear as a new brown, black or pink spot or as a changing mole. There are multiple appearances of melanoma so if you have concerns, it is important to have a board-certified dermatologist examine your skin. Whenever someone has a melanoma, the depth of the melanoma is measured under the microscope. This step occurs during the initial reading and interpretation of the biopsy (or the skin sample that was sent to the laboratory). The depth of a melanoma helps guide treatment options that can range from an excision with a safety margin to a referral to a surgical oncologist for lymph node testing or a medical oncologist for immunotherapy treatments. There have been many advances in the treatment of melanoma so if you have concerns, please make an appointment to ensure that you are getting the best and most appropriate treatment.
CYSTS
Cysts are collections of normal skin that are growing underneath the skin - almost like a balloon. Because they are growing in a place that they don't normal grow, they appear like a firm ball underneath the skin. That balloon of normal skin behaves like normal skin. The dead skin cells that normally just fall off of us now have nowhere to go which is why cysts can grow and shrink. Cysts are not cancers but they often do not go away on their own, which is why they can be removed with a benign excision.
LIPOMAS
Similar to a cyst, a lipoma is a collection of normal fat that grows in a clump underneath the skin. Because it grows in a group, a lipoma can generally feel like a softer mass underneath the skin's surface. Some lipomas can run in families. Lipomas can sometimes be tender or can continue to grow slowly over time. If bothersome, lipomas can be removed with benign excisions.
MY SPECIALTIES: COSMETIC
NEUROTOXIN
Neurotoxins (like Botox®) are used in the cosmetic world to help with wrinkles. Neurotoxins are an FDA-approved medication that blocks how the nerves communicate with the muscles in the areas that they are injected. Blocking this communications, prevents the muscles from contracting at their full strength. By blocking muscles in the forehead, the eyebrows, and around the eyes, you can smooth out the wrinkles that appear from facial expressions (called dynamic wrinkles). Because neurotoxins can prevent the muscles from moving to their full capacity, it is important to see a board-certified dermatologist with experience in neurotoxins for the optimal cosmetic outcome. In general, neurotoxins can last 3-4 months.
FACIAL FILLERS
Facial fillers are another type of injection used in the cosmetic industry. Facial fillers are generally used to help correct volume loss. When correcting volume loss, it will help with wrinkles as well. The most commonly used type of facial filler is a hyaluronic acid filler because we all have hyaluronic acid naturally in our body. Because we have this in our body naturally, our body also has the enzyme to break this down over time. There are different "strengths" of fillers that are used in different areas of the face to achieve different goals. Thicker fillers are used in areas like the cheeks, the temples or the chin to replace volume whereas thinner fillers would be used in areas with thinner skin like the tear troughs or the lips. Facial fillers can last between 1-2 years depending on the type of filler used.
MICRONEEDLING
Microneedling is a cosmetic procedure that helps improve skin texture, fine lines and wrinkles as well as some brown or red spots and more shallow scars (like certain acne scars). It works by physically poking small holes in the skin. This process stimulates the underlying collagen to remodel and helps tighten the skin, decrease the depth of certain scars and can help with brown or pink spots. Before proceeding with the treatment, the skin is numbed using a numbing cream to make it comfortable. There is minimal downtime with microneedling of about 1-3 days. Most people need multiple treatments with microneedling to see the best results.
CHEMICAL PEELS
Chemical peels also help with skin rejuvenation. There are many different types of peels and strengths of peels for different cosmetic goals. This is why it is important to see a board-certified dermatologist to received an individualized evaluation of your skin to receive the best treatment possible. Depending on the peel used and the depth of the skin that is treated, you could have a recovery time of 3-7 days.
PLATELET-RICH PLASMA (PRP)
Platelet-rich plasma is a technique where your own blood is used to create results. Platelets are a component of our blood that are full of nutrients and growth factors. This technique separates out this part of the blood and applies it to areas that are looking for rejuvenation. It can be used as injections in the scalp to help with hair loss. It can be used as injections into areas with volume loss to help with mild corrections. It can also be used with microneedling to help with skin rejuvenation and recovery after the procedure.
PRODUCT CONSULTATIONS
With any cosmetic regimen, a discussion of home skin care routines is critical. It is similar to the idea of going to the dentist. If you go to the dentist for cleanings but are not brushing your teeth at home, you will not have the same results as if you are doing some home care as well. The most important part of any home regimen is using sunscreen. UV-damage from the sun plays a significant role in photoaging and even small amounts of sun can result in taking steps away from your cosmetic goal. Speak with a board-certified dermatologist for other product recommendations to optimize your cosmetic outcomes.
SCAR REVISION
As a board-certified dermatologist and a board-certified and fellowship-trained Mohs micrographic surgeon, I have seen a lot of scars. There are many reasons to have scars including after Mohs surgery or after having acne. Treating a scar is an individualized process that may involve dermabrasion, microneedling, chemical peels, or surgical procedures to revise the scar.
MY SPECIALTIES: MEDICAL DERMATOLOGY
SKIN CANCER SCREENING
Skin cancer is an extremely common form of cancer in the United States. It is estimated that 1 in 5 adults in the United States will develop skin cancer by the age of 70. Skin cancer most commonly arises from damage to skin cells from UV-radiation. The three main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. All of these are highly treatable - especially when identified early. It is important to see a board-certified dermatologist for skin examinations to evaluate any new, growing or changing skin growths or if you have a personal or a strong family history of skin cancer. When you go for your skin cancer screening, it is most helpful if you do not wear any make-up or product on your skin as this can affect our ability to examine you fully.
ACNE
Acne is an extremely common skin condition that commonly affects adolescents but can affect adults as well. There are many different treatment options for acne ranging for medicated soaps and topical antibiotics to various types of pills such as antibiotics, vitamin-A pills (like isotretinoin) or even that affect hormones (like birth control pills or spironolactone). When left untreated, acne can become severe and even leave scars.
PSORIASIS
Psoriasis is a skin condition that can be genetic that leads to thick pink or red plaques with silvery scale. Psoriasis can be asymptomatic or can be very itchy depending on the person. It can affect almost any surface of the skin including the scalp, body, and even the nails. Psoriasis also does more than affect the skin. It can be associated with arthritis and with cardiovascular disease, which is why it is important to see a professional for a discussion of treatment options. Depending on the patient, there are a variety of treatment options including topical medications, pills or even injections or infusions.
ECZEMA
Eczema is a skin condition that leads to itchy red skin. It can present as a flat rash or as small plaques or even bumps. Eczema is part of the allergic triad which also includes asthma and seasonal allergies and it often runs in families. Many patients with eczema have times of the year that are worse for their skin. Over the last few years, there have been amazing advancements in the treatment of eczema. We will have topical medications that can help in mild disease but we now have an injection for eczema that can help patients with severe disease.
RASHES
There are many different types of rashes that can appear on the skin. Depending on the appearance and the history surrounding the rash helps your board-certified dermatologist arrive at a diagnosis. Sometimes a biopsy (or a skin sample) can be helpful to narrow down the cause of the rash and to help tailor treatment.
VITILIGO
Vitiligo is an auto-immune skin condition where the body attacks its own cells that make pigment. These cells are called melanocytes and they create each of our unique skin colors. When you have vitiligo, the body destroys those cells in certain areas leaving white patches (or areas of depigmentation). There have been significant advances in the treatment of vitiligo ranging from topical medications to oral antioxidants to newly approved immunomodulators such as JAK-inhibitors. Certain types of laser treatments can also help vitiligo as can certain surgical procedures to replace the melanocytes.
ALLERGIC CONTACT DERMATITIS
Allergic contact dermatitis refers to rashes due to products or chemicals that come into contact with the skin. These types of rashes can look like red itchy skin or breaks in the skin or bumps - it all depends. There are treatments to help with the symptoms but they key is identifying the cause of the eruption and coming up with strategies to avoid the allergen. This is done through skin patch testing by a dermatologist. Patches are taped to your back of the most common allergens in an effort to identify your trigger.
ALOPECIA (HAIR LOSS)
Hair loss is complicated. There are different types and causes. It can cause scarring on the scalp or can be non-scarring. It can be genetic and age related (androgenetic alopecia) or due to an autoimmune condition (alopecia areata). In order to help you with you specific cause of hair loss, it is important to see a board-certified dermatologist who can examine your scalp and provide in-person guidance. Treatments vary depending on the type of hair loss identified during the examination.
HIVES
There are multiple potential causes of hives (or urticaria). Sometimes the cause can be identified and about 50% of the time, it cannot be. Even still, there are treatments available that can help with relief of symptoms if you break out in hives.
RINGWORM
Ringworm is a common term for a fungal infection on the skin (called tinea). It can occur almost anywhere on the skin including the body, the scalp, the nails and the genitalia. Sometimes a microscope is used to confirm the diagnosis. This test can be done while you wait in the office. Depending on the location affected, there are different treatment options.
OTHER SKIN CONCERNS
As part of our training to become a board-certified dermatologist, we are trained in the common and the rare diseases that affect the skin. I have listed a few of the more common concerns that patients have but as a board-certified dermatologist, I have been trained in all areas of the skin.