In general, you should come for an appointment if you have a new growth, a changing spot, or a sore that will not heal.
There are several types of skin cancer. In general, you should come in to the office if you have a new growth, if a spot is changing, or have a sore that will not heal. Skin cancer is usually on sun-exposed skin, but not always. Be sure to check the bottom of your feet, between your fingers and toes, and ask someone to check your scalp (under your hair). If you see anything that concerns you, please come in.
There are several types of skin cancer. The most common type is basal cell carcinoma (BCC), which may appear as a shiny, flesh-colored translucent or pearly bump, a sore that does not heal or an irritated growth. It is most common on skin exposed to the sun. While these tumors very rarely spread to other parts of the body, early diagnosis and treatment is important.
Squamous cell carcinoma (SCC) may appear as a crusted, scaly lesion. It also usually appears on sun-exposed areas, but can also develop on the mouth and genitalia. SCC requires early treatment to prevent spread or metastasis to other areas of the body.
Melanoma is the most serious form of skin cancer, because it has the potential to grow and spread rapidly. Melanoma can develop from a changing mole or may be a new growth. With early detection and treatment, the cure rate for melanoma is very high. For advanced cases, we work closely with the Stanford Multidisciplinary Melanoma Clinic to coordinate treatment and follow up care. Melanomas can run in families, and it is important to have a yearly skin check if a family member has melanoma.
When looking at a spot on the skin, it can be helpful to apply the ABCDE rules: A is for asymmetry. Melanoma is often asymmetric, meaning one side is different from the other. B is for border. Melanoma often has an irregular border. It can look ragged, notched, scalloped, blurred or poorly defined. C is for color. Melanoma often has more than one color in the same lesion. It is most commonly some combination of black, brown, and tan, but melanomas can be white, grey-blue, and pink. D is for diameter. Melanomas are often bigger than a pencil eraser, but they definitely can be smaller. E is for evolving. In general, moles should not change or grow. Please come in if you notice any changes.
The “ugly duckling sign” can also be very helpful in diagnosing melanoma. Most people have one or several “types” of moles on their bodies, and their moles look like each other. A spot that looks different than the other spots on your body warrants a visit to the office. If you notice a mole that is different than the other moles on your body, or that changes, itches or bleeds (even if it is small), please come in.
Everyone in California gets some sun, even if it only when walking to your mailbox. Sun is not bad, but it is important to protect your skin from the harmful effects of sun. Apply a daily sunscreen every morning. It is best to do outside activities in the early morning or late afternoon. Peak sun is from 10am to 2pm, although these hours may be extending as the ozone thins. Wearing a hat and protective clothing is a good idea. Wearing a swim shirt (rash guard) is very helpful in the water. Sit in the shade. Apply a daily sunscreen every morning. If you plan to be outside for an extended period of time, apply sunscreen 30 minutes before going outside and reapply every 2 hours while out. Higher SPF sunscreen allows you to spend more time in the sun before you need to reapply. Use a sunscreen which specifically protects against both UVA and UVB rays.
Please come in for a personalized consultation with one of our dermatologists. Many minimally invasive procedures are available in our office, as well as various products. These include botulinum toxin, hyaluronic acid fillers, sclerotherapy, glycolic acid peels, Obagi skin care, laser hair removal, photofacial, and fractional laser. Your concerns will guide our recommendations. We look forward to meeting with you in a no-pressure consultation.
The doctors perform all procedures at GJD. This includes biopsies, surgical excisions, Botox, fillers, peels, sclerotherapy, and laser procedures.
Liquid nitrogen is a very cold liquid used to treat superficial skin lesions, such as keratoses, skin tags, and warts. It freezes the top layers of skin, causing the lesion to scab and fall off, usually within two weeks. Sometimes this treatment causes a blister or purple ‘blood blister’. This is normal. The process is somewhat painful, but usually very well-tolerated. Certain growths, especially warts, must be treated multiple times in order to remove them completely. There is no specific wound care needed after liquid nitrogen treatment. If the area becomes an open wound, it is best to apply topical antibiotic ointment and a bandaid every day. You do not have to keep the area dry.
A skin biopsy is removal of a piece of skin (from a mole, lesion, or rash). The piece of skin is then sent to a dermatopathology lab, where it is made into a slide and read by a dermatopathologist. A dermatopathologist is a pathologist who specializes in reading skin biopsies. The pathology report tells us what is going on in the skin. If the biopsy shows skin cancer, further surgery is often required to completely remove the skin cancer. A punch biopsy is done with a small round knife and requires sutures (stitches) to close the skin. The sutures will be removed in one or two weeks, depending on the body site. A shave biopsy is done with a blade to shave off a small piece of skin. Your doctor will decide which type of biopsy is needed depending on the lesion. All biopsies are done with local anesthesia.
A keratosis is a superficial scaly growth on the skin. These are very common and often increase in number with age. Seborrheic keratoses are benign waxy growths, usually brown or tan in color. Actinic keratoses are precancerous, usually in sun-exposed areas of the skin. If left untreated they may turn into a skin cancer. These are often pink, red, or brown and scaly. They can be tender. Liquid nitrogen is the main treatment for keratoses, or your doctor may discuss other treatment options with you.
Dandruff is flaking of the scalp. It is a type of seborrheic dermatitis (link). It can be itchy, and is often successfully treated with medicated shampoos. Dandruff is not associated with hair loss.
A wart is a growth caused by a virus. These are contagious and can spread. Various treatments are available, including over-the-counter salicylic acid plasters. Liquid nitrogen is the standard treatment for warts.