Los Angeles Dermatology

The majority of moles and other blemishes are benign (not-cancer). They will never be a threat to the health of the person who has them. Spots or blemishes that warrant medical concern are those that do something out of the ordinary-those that act differently from other existing moles. This includes any spot that changes in size, shape or color, or one that bleeds, itches, becomes painful, or first appears when a person is past twenty.

Occasionally, a mole may become a cancerous growth. Therefore, it's best to get medical advice from a board certified plastic surgeon if you notice a mole that does not follow the normal pattern. your doctor may be able to assure you that the mole is harmless. To accomplish this, they may study a sample of it under a microscope for an accurate diagnosis. They would then remove the mole, or part of it, so that thin sections from the mole can be cut and examined under a microscope. This is a simple and harmless procedure. If the growth was only partially removed and it is found to be cancerous, then the entire lesion and an extra margin of safety will need to be removed.

A person may wish to get rid of moles that are in areas of trauma, where clothing can irritate them, or simply because they are unattractive. The most common methods of removal include numbing the spot and then shaving the mole off, or for some moles, cutting out the entire lesion and stitching the area closed.

Most procedures used to remove moles take only a short time and can be performed in our office. Sometimes a mole will recur after it is removed. If a removed mole does begin to reappear, the patient should consult their doctor.

Psoriasis is a persistent skin disease that got its name from the Greek word for "itch." The skin becomes inflamed, producing red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back. In some cases, psoriasis is so mild that people don't know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body. Doctors can help even the most severe cases.

Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every hundred people have psoriasis (four to five million people). Approximately 150,000 new cases occur each year.

The cause is unknown. However, recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. Because of the inflammation, the skin sheds too rapidly, every three to four days.
People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Flare-ups sometimes occur in the winter, as a result of dry skin and lack of sunlight.

There are several different lasers used for the treatment of warts. Laser therapy is used to destroy some types of warts. Lasers are more expensive and require the injection of a local anesthesia to numb the area treated.

Another treatment is to inject each wart with an anti-cancer drug called bleomycin. The injections may be painful and can have other side effects. Immunotherapy, which attempts to use the body's own rejection system is another method of treatment. Several methods of immunotherapy are being used. With one method the patient is made allergic to a certain chemical which is then painted on the wart. A mild allergic reaction occurs around the treated warts, and may result in the disappearance of the warts.

Warts may also be injected with interferon, a treatment to boost the immune reaction and cause rejection of the wart. There are some wart remedies available without a prescription. However, you might mistake another kind of skin growth for a wart, and end up treating something more serious as though it were a wart. If you have any questions about either the diagnosis or the best way to treat a wart, you should seek your dermatologist's advice.

Many babies have what are called "birthmarks" when they're born. In some cases they may appear within the first few weeks of life. They can be brown, tan, blue, pink, or red. More than 10 in 100 babies have vascular birthmarks. These are made up of blood vessels bunched together in the skin. They can be flat or raised, pink, red or bluish discolorations.

The exact causes of birthmarks are unknown. Most vascular birthmarks are not inherited, nor are they caused by anything that happens to the mother during pregnancy.

There are different kinds of vascular birthmarks. Sometimes, the birthmark must be watched for several weeks or months before the specific type can be identified. The most common types of vascular birthmarks are macular stains, hemangiomas, and port wine stains. There are also many rare types of vascular birthmarks.

Rosacea, (rose-AY-sha) is a common skin disease that causes redness and swelling on the face. Often referred to as "adult acne," rosacea may begin as a tendency to flush or blush easily, and progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin, and nose. It also may involve the ears, chest and back. As the disease progresses, small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads.

When it first develops, rosacea may come and go on its own. When the skin doesn't return to its normal color and when other symptoms, such as pimples and enlarged blood vessels, become visible, it's best to seek advice from a dermatologist. The condition rarely reverses itself and may last for years. It can become worse without treatment.

Many people with rosacea are unfamiliar with it and do not recognize it in its early stages. Identifying the disease is the first step to controlling it. Self-diagnosis and treatment are not recommended, as some over-the-counter skin applications may make the problem worse.

Our surgeons often recommend a combination of treatments tailored to the individual patient. Together, these treatments can stop the progress of rosacea and sometimes reverse it. Gels and creams may be prescribed by a dermatologist. A slight improvement can be seen in the first three to four weeks of use. Greater improvement is usually noticed in two months. Oral antibiotics tend to produce faster results than topical medications.

Cortisone creams may reduce the redness of rosacea. However, they should not be used for longer than two weeks and strong preparations should be avoided. It is best to use these creams only under the direction of your doctor.

The persistent redness may be treated with a small electric needle or by laser surgery to close off the dilated blood vessels. Cosmetics may offer an alternative to the more specific treatment. Green tinted makeup may mask the redness.

The injection method, a procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930's and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to thicken. Over a period of weeks, the vessel turns into scar tissue that is absorbed, eventually becoming barely noticeable or invisible.

A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. In any one treatment session a number of vessels can be injected.

The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. our dermatologist will choose a solution that is best for your particular case.

Occasionally larger varicose veins are underneath or associated with the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done by sclerotherapy, intravascular laser, or radiofrequency, followed by compression. After several treatments, most patients can expect a 50 percent to 90 percent improvement. However, fading is gradual, usually over months. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.

Several techniques can minimize a scar. Most of these are done routinely in the dermatologist's office. Only severe scars, such as burns over a large part of the body may require general anesthesia or a hospital stay.

Surgical scar revision can improve the way scars look by changing the size, depth, or color. However, no scar can ever be completely erased; and no magic technique will return the scar to its normal uninjured appearance. Surgical scar revision typically results in a less obvious mark. Because each scar is different, each will require a different approach.

The most important step in the treatment of scars is careful consultation between the patient and the dermatologic surgeon finding out what bothers a patient most about a scar and deciding upon the best treatment.

Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and rejoining the normal skin in a less obvious fashion. The surgical removal of scars is best suited for wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape. Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter. A technique of irregular or staggered incision lines, rather than straight-line incisions, to form a broken-line scar that is much more difficult to recognize may be used. Sometimes, a scar's direction can be changed so that all or part of the scar that crosses a natural wrinkle or line falls into the wrinkle, making it less noticeable. This method can also be used to move scars into more favorable locations, such as into a hairline, or a natural junction (for instance, where the nose meets the cheek). Best results are obtained when the scar is removed and wound edges are brought together without tension or movement (pull) on the skin.

MOHS micrographic surgery is a highly specialized procedure for the removal of skin cancer. It was originally developed in the 1930’s by Dr. Frederic MOHS and has been refined since, gaining substantial application only in the past decade. Although this procedure is very precise, its major drawback is that it is very time consuming and requires specialized training, personnel and equipment. Consequently, only a few major medical centers can provide this type of therapy.

There are three surgical steps to MOHS micrographic surgery:

By examining the edges and underside of the tissue, the physician can trace out and exactly locate any additional areas of cancer remaining. Before the tissue is examined, it is marked with colored dyes to distinguish top from bottom and right from left, and a detailed map of the excised tissue is made. By doing this, we can pinpoint the exact location of any remaining tumor during the microscopic examination. If more cancer is present, the procedure is repeated. We remove only the area of remaining cancer.

Using microscopic examination, the MOHS surgeon pinpoints areas involved with cancer and selectively removes only those areas. This way, we trace the skin cancer out to its “roots”. This results in preserving as much normal tissue as possible with the highest chance for a cure. Other forms of therapy have only a 50% to 70% chance for success in curing skin cancers that have previously been unsuccessfully treated.

Using the MOHS micrographic surgery techniques, the percentage of success is very high, often 97% to 99% even when other forms of treatment have failed. With this technique, an excellent chance of a cure is achieved. However, no one can guarantee a 100% chance of a cure.

MOHS micrographic surgery gives patients the highest chance for a cure of even complicated skin cancers with preservation of the maximum amount of normal tissue. This method is highly specialized, and not all medical centers in the United States are equipped with the personnel and training to offer this treatment.

A frequent reason for being referred for MOHS micrographic surgery is that other forms of treatment have failed. This does not mean that you are cancer prone or have a hopeless case. It merely means that the methods used to treat you in the past did not destroy all of your skin cancer cells. Because MOHS micrographic surgery uses complete systematic microscopic control to search out the “roots” of the cancer, it cures almost all patients-even those in whom skin cancer has persisted in spite of several other treatments.

Following MOHS surgery, Dr. Nassif will repair the defect creating the best result possible.

Dermatology procedures in Los Angeles.