Surgical Dermatology
In addition to the more complex cosmetic surgeries Dr. Harvey performs, she also performs many skin surgeries that are health-related as well as cosmetic. These include:
Mole Removal
Moles are very common and most adults with light skin may have as many as 40 moles. This is not considered abnormal or dangerous, and most moles need not be removed except for cosmetic reasons. You should be aware, however, that melanoma, a virulent form of skin cancer, can originate in or near a mole. For this reason, you should pay attention to changes in your moles, as these may be the first sign of a melanoma, and caught early, melanomas can be completely cured.
Methods of Mole Removal
When a patient needs or wants to have a mole removed, the doctor can usually remove it during an office visit, though in some cases the procedure may require two visits. There are two possible methods of mole removal, both of which are performed under local anesthesia:
Surgical excision is a procedure during which the doctor cuts out the entire mole and closes the wound with stitches. If the removed mole strikes the doctor as in any way suspicious, it will be biopsied — sent to a pathology lab for microscopic examination.
Surgical shave is most often used in places where scarring is particularly undesirable, like the face. During a surgical shave, the dermatologist uses a fine blade to remove the mole. No stitches are required. When the doctor suspects a possible skin cancer, tissue from a surgical shave will also be biopsied.
The doctor will instruct you about how to care for the wound during the first few days after either of these types of mole excision.
Cyst Removal
Skin cysts are self-contained pockets of tissue filled with fluid, pus, or other material. They are noncancerous, smooth, slow-growing and usually painless, but sometimes have to be removed because they are unsightly or become inflamed. Cysts feel like small balls under the skin and can appear anywhere on the body. They can develop because of an infection, clogged sebaceous glands, or around a foreign body like an earring.
Although cysts are typically only painful if they become infected or inflamed, and some disappear by themselves, some have to be drained in order to be removed. In order to drain a cyst, the dermatologist pierces the cyst with a sharp, pointed tool. At times, inflamed cysts are removed by simply injecting a shot of cortisone which causes shrinkage. If drainage or cortisone injections don’t work, cysts can be removed surgically.
Earlobe Repair
Though earlobes can be injured in physical fights, animal bites, or accidents, most often dermatologists are called upon to repair earlobe damage related to earrings.
Types of Earlobe Injuries
There are two common types of earlobe injuries: split earlobes and stretched or elongated earlobes. Stretched or elongated earlobes are usually caused by very heavy earrings; torn earlobes are usually the result of something snagging or pulling on the earring until the earlobe tears.
Surgical Techniques for Earlobe Repair
Surgical repair of split earlobes is an outpatient procedure, typically quick and painless. Your dermatologist numbs your ear by injecting a local anesthetic and performs an incision surrounding the split to remove the jagged edges. The doctor then sutures the wound carefully, closing the split and restoring the normal appearance of the earlobe.
Ear Gauging (Plugging)
In recent years, ear gauging, or plugging, once only used in certain tribal cultures, has become popular among some segments of the population. Since this fad tends to be most common among older adolescents and young adults, the desire for expanded ear holes often disappears as patients age. For this reason, dermatologists may be called upon to perform surgical repairs to close up the large holes created by gauging and restore the normal appearance of the earlobe.
Though patients should expect some discomfort and swelling after earlobe repair, for many patients the most difficult part of having surgical earlobe repair is having to forego wearing earrings for 6 weeks to 2 months. Usually, the stitches are removed after 2 weeks and though there may be minimal scarring, it will fade with time. If you are going to want your earlobe re- pierced after healing, you should discuss this before having the surgical procedure.
Skin Tag Removal
Skin tags are extremely common small growths of soft skin, typically appearing on the eyelids, neck, armpits, or anywhere skin touches skin. Though harmless, they can be unsightly, or irritating when they rub against clothing. Skin tags can be removed by being frozen with liquid nitrogen or burned off with an electric current. Most often, however, they are simply surgically snipped off with a scalpel or surgical scissors. A local anesthetic is applied to numb the area, but the pain is usually quite minimal. If there is any bleeding, the doctor will administer a topical coagulant. No scars are anticipated after skin tag removal.
Skin Cancer Removal
There are three basic types of skin cancer surgically treated by dermatologists: basal cell carcinoma, squamous cell carcinoma, and melanoma. Most often, dermatological surgeries for skin cancer take place in the doctor’s office on an outpatient basis under local anesthetic. In skin cancers with a high risk of spreading, most often melanomas, surgery must sometimes be followed by radiation or chemotherapy.
Types of Skin Cancer Surgery
Surgeries to remove skin cancer may differ depending on the type of skin cancer, its size and its location. These surgeries include:
Biopsy
During an excisional biopsy, the dermatologist cuts or shave some tissue from an area in which a skin cancer is suspected. The specimen is then sent to a pathology lab for microscopic examination to determine whether or not it is malignant.
Excision
An excision is similar to a biopsy except that the diagnosis has already been established. After administering a local anesthetic, the dermatologist cuts out the cancerous tissue
and some surrounding normal skin, then stitches the skin back together. There will be a smaller or larger scar depending on the size of the cancer.
Curettage and Electrodesiccation
During this procedure, the doctor removes the cancer by scraping it with a curette (a long slender instrument with a sharp, looped edge). An electrode is then applied to destroy any remaining cancer cells. Often, this process is repeated during the same visit. It may be a successful treatment for basal or squamous cell cancers that are superficial.
Mohs Surgery
Mohs surgery is used on highly visible or critical areas, such as the face, ears, hands, or near the eye. The goal is to save as much healthy tissue as possible. The surgeon
works delicately, removing a single layer of skin at a time, checking each sample under
a microscope until he or she reaches clean tissue. Though this can be a slow process, it preserves, as far as possible, the integrity of the skin.
Skin Grafting
There are times when after removing a relatively large basal or squamous carcinoma, it is impossible to stretch the nearby skin sufficiently to stitch the sides of the wound together (on the tight skin of the shin for example). In such cases, healthy skin can be harvested from another part of the body (such as the thigh) and used to graft over the wound.
Dr. Dyan Harvey of Unique Dermatology & Wellness Center is an excellent surgeon as well as a highly skilled dermatologist. When you are troubled by any type of skin problem that may require surgical intervention, you can rest assured that she is fully capable of handling it with expertise and sensitivity. Contact Dr. Harvey today with any of your skin care needs.
