Dermatologic and Laser Surgery

Boils

Boils, or skin abscesses, can form as a result of a bacterial infection inside a cut or break in your skin. Boils are usually red, tender, painful, and filled with pus. Usually, boils appear near hair follicles or sweat glands that are exposed to friction. Boils can be quite painful and appear on your face, neck, armpits, under the knees, and on the buttocks.

At Advanced Dermatology, Mohs & Laser Surgery Center, we are committed to helping treat your boils. Our board-certified dermatologists and physician assistants are highly trained experts that will assess your skin, educate you about your treatment options, and treat your skin condition effectively.

Causes of Boils

Anyone can get a boil. Boils grow quickly and are quite painful for many, especially when draining them. They can form as a result of friction and/or in areas of the face and body that are exposed to extra oils. People with weakened immune systems are more susceptible to boils than the general population.

Types of Boils

Cystic Acne

These boils are situated more deeply into skin tissue than the more superficial forms of acne. It typically occurs among teenagers.

• Acne

Furuncle or Carbuncle

These abscesses are caused by the Staphylococcus aureus bacterium. A furuncle is an individual boil; carbuncles are deep clusters of boils that most often form on the back of the neck, shoulders or thighs.

Pilonidal Cyst

An infected hair follicle around the buttocks area caused by long periods of sitting. Pilonidal cysts almost always require medical treatment.

Hidradenitis Suppurativa

These are multiple abscesses that form from blocked sweat glands in the armpits or groin areas.

Treatments

Many boils respond well to home remedies and will naturally come to a head and burst open, allowing the pus to drain and the skin to heal. Apply hot compresses to your boil to encourage healing. Make sure to keep the area clean, apply over-the-counter antibiotics (if neccesary) and then cover with gauze (after the boil has bursted). It’s very important to keep boils clean because they can lead to further infection.

If your boil does not go away within two weeks, is accompanied by a fever or is painful, contact us to schedule an appointment with one of our dermatologists or physician assistants. At your appointment, we will clean, lance and drain your boil and prescribe an antibiotic to alleviate the infection.

Granuloma

Granuloma is a generic term that refers to a small nodule (or growth) on the skin. It can be any type of nodule, from benign to malignant. Granulomas occur throughout the body. There are two types of granuloma that apply expressly to the skin.

Causes of Granuloma

Granuloma can form as a result of a variety of different causes. The causes and triggers of Granuloma include, but are not limited to:

• Bacterial, fungal, or viral infections
• Environmental triggers
• Stress or trauma to the skin
• Sun exposure (UV)
• Animal (or insect) bites
• Drugs

Types of Granuloma 

Pyogenic Granuloma

Pyogenic granuloma looks like small, reddish bumps on the skin that tend to bleed. It is caused by an injury to the skin. It is most frequently found on the hands, arms and face. In some cases, the nodule will spontaneously disappear. More often, the lesions need to be removed by surgery. There may be some scarring as a result of these treatments.

Granuloma Annulare

This type of nodule can occur in any person, but is more common in children and young adults. It is characterized by a ring-shaped lesion that is round and firm; red, white or purple skin around a clear crater of normal skin. It can appear individually or in groups. Most often, it appears on tops of hands and feet, elbows and knees. Most people have no other symptoms, but some may experience itchiness at the site of the lesion.

Granuloma Annulare can be localized, generalized, or under the skin. “Localized,” the most common form of Granuloma Annulare, involves circular bumps that can appear on the hands, feet, ankles, and wrists. “Generalized” involves itchy, red bumps on most of the body. Granuloma can also appear under the skin although it is very rare.

Treatments

Granuloma annulare usually resolves itself and might disappear over time without treatment. However, if the incidence is widespread or aesthetically undesirable, we might prescribe you steroids (cream or injection) to speed healing. Another successful treatment is PUVA, in which a medication called psoralen is given and then the area is treated with ultraviolet light. When you come in for your appointment, your dermatologist or physician assistant will assess your skin, diagnose you, and then develop a treatment just for you.

Seborrheic Keratosis

Seborrheic keratoses are small, brown (or black) noncancerous skin growths that tend to appear on the head, neck, chest or back. These growths start out as small, rough areas but can develop into a thick growth.  Although these growths look like melanoma to an untrained eye, they are not harmful and usually a product of aging skin. If you think you have a seborrheic keratosis or any irregular growths, you should schedule an appointment for a full-body skin check to ensure that you don’t have any form of skin cancer.

Common Symptoms

• Round or oval shaped growth that is flat or slightly raised
• Brown, beige, or black in appearance.
• Itchy

Causes of Seborrheic Keratosis

Seborrheic keratoses can form as a result of a variety of different causes. The causes and triggers of these skin growths include, but are not limited to:

• Heredity
• Aging skin
• Sun exposure (UV)

Treatments

Seborrheic keratoses are harmless growths and usually do not require treatment. If they are of cosmetic concern, we offer a wide range of leading laser treatments to help you achieve your aesthetic goals. If you think you have a seborrheic keratosis or any irregular growths, you should schedule an appointment with one of our board-certified dermatologists or physician assistants for a full-body skin check to ensure that you don’t have skin cancer.

Moles

Moles are brown or black growths, usually round or oval, that can appear anywhere on the skin. Moles can be rough or smooth, flat or raised, single or in groups. Moles occur when cells that are responsible for skin pigmentation, known as melanocytes, grow in clusters instead of spreading out across the skin.

Generally, moles are less than one-quarter inch in size and rarely develop into skin cancer. Most moles appear by the age of 20, although some moles may appear later in life. Although most moles are harmless, a change in size, shape, color or texture could be indicative of a cancerous growth. If your mole or growth seems irregular, you should schedule an appointment with one of our dermatologists or physician assistants immediately.

Types of Precancerous Moles

Although there are many types of Moles, these types of  moles have a higher chance of becoming cancerous.

Congenital Nevi

Moles present at birth. The larger their size, the greater the risk for developing into a skin cancer.

Atypical Dysplastic Nevi

Irregularly shaped moles that are larger than average. They often appear to have dark brown centers with light, uneven borders.

• Skin cancer

Monitoring Moles

People with fairer skin tend to get more moles. If you have 50 or more moles, you are at greater risk for developing skin cancer. In some cases, abnormal moles may become painful, itchy, scaly or bleed. It’s important to keep an eye on your moles so that you can catch any changes early. We recommend monthly full-body skin checks to monitor your moles. If you develop skin cancer, we can catch it early.

Use the American Academy of Dermatology’s ABCDEs as a guide for assessing whether or not a mole may be becoming cancerous:

American Academy of Dermatology’s ABCDEs

Asymmetry: Half the mole does not match the other half in size, shape or color.

Border: The edges of moles are irregular, scalloped, or poorly defined.

Color: The mole is not the same color throughout.

Diameter: The mole is usually greater than 6 millimeters when diagnosed, but may also be smaller.

Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape, or color.

Treatments

We recommend monitoring your moles using the American Academy of Dermatology’s ABCDEs and frequently getting full-body skin checks . If your moles appear irregular, please make an appointment to see one of our dermatologists or physician Assistants at your nearest convenience.

Our Mohs micrographic surgeon, Dr. Sabatino Ciatti, might biopsy your mole to determine whether the growth is cancerous or not. We are looking forward to treating you.

Skin Cancer

In the United States, skin cancer is the most commonly diagnosed form of cancer. With an estimated 1,000,000 new cases every year, skin cancer is highly common and can affect anyone. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.

If you suspect you have skin cancer or a precancerous growth,  please make an appointment to see one of our dermatologists right away. We may do a biopsy of the mole to determine if it is or isn’t cancerous or may surgically remove it. Mohs micrographic surgery is an advanced surgical technique that offers the highest cure rate for skin cancer. Mohs surgery is primarily used in the removal of basal cell and squamous cell carcinomas.

Basal Cell Carcinoma

This is the most common form of skin cancer. Basal cells reside in the deepest layer of the epidermis, along with hair follicles and sweat ducts. When a person is overexposed to UVB radiation, it damages the body’s natural repair system, which causes basal cell carcinomas to grow. These tend to be slow-growing tumors and rarely metastasize (spread).

Signs of Basal Cell Carcinoma

Basal cell carcinomas can present in a number of different ways:

• Raised pink or pearly white bump with a pearly edge and small, visible blood vessels.
• Pigmented bumps that look like moles with a pearly edge.
• A sore that continuously heals and
• A flat scaly scar with a waxy appearance and blurred edges.

Despite the different appearances of the cancer, they all tend to bleed with little or no cause. Eighty-five percent of basal cell carcinomas occur on the face and neck since these are areas that are most exposed to the sun.

Risk Factors

Risk factors for basal cell carcinoma include having fair skin, sun exposure, age (most skin cancers occur after age 50), exposure to ultraviolet radiation (as in tanning beds) and therapeutic radiation given to treat an unrelated health issue.

Diagnosing Basal Cell Carcinoma

Diagnosing basal cell carcinoma requires a biopsy which usually involves an excision or an incision. During an excision, the entire tumor is removed along with some of the surrounding tissue. During an incision, only a part of the tumor is removed (used primarily for large lesions).

Treating Squamous Cell Carcinoma

1. Simple excision (Cutting and Suturing)
2. Curettage and electrodessication (Scraping and burning with an electric needle)
3. Mohs micrographic surgery (microscopically controlled excision).
4. Radiotherapy (x-ray)

Although any of the above methods can be used to treat basal and squamous cell carcinomas, Mohs micrographic surgery is by far the most superior. Mohs surgery offers the highest cure rate (up to 99%), the lowest chance of regrowth, the lowest potential for scarring and disfigurement, and the most exact and precise means of removal (only skin cancer is removed, normal tissue is spared). Melanomas are almost always treated by wide-excision. However, some melanomas in sensitive cosmetic areas can be treated with Mohs surgery.

• Mohs
• Dr. Ciatti

Squamous Cell Carcinoma

Squamous cells are found in the upper layer (the surface) of the epidermis. They look like little fish scales under a microscope and present as a crusted or scaly patch of skin with an inflamed, red base. They are often tender to touch. It is estimated that 250,000 new cases of squamous cell carcinoma are diagnosed annually, and that about 1 percent of these cases are fatal.

Signs of Squamous Cell Carcinoma

Squamous cell carcinoma can develop anywhere, including inside the mouth and on the genitalia. It most frequently appears on the scalp, face, ears and back of hands. Squamous cell carcinoma tends to develop among fair-skinned, middle-aged and elderly people who have a history of sun exposure. In some cases, it evolves from actinic keratoses, dry scaly lesions that can be flesh-colored, reddish-brown or yellow black, and which appear on skin that is rough or leathery. Actinic keratoses spots are considered to be precancerous.

• Actinic Keratosis

Risk Factors

Risk factors for squamous cell carcinoma include having fair skin, sun exposure, age (most skin cancers occur after age 50), exposure to ultraviolet radiation (as in tanning beds) and therapeutic radiation given to treat an unrelated health issue.

Diagnosing Squamous Cell Carcinoma

Diagnosing squamous cell carcinoma requires a biopsy which usually involves an excision or an incision. During an excision, the entire tumor is removed along with some of the surrounding tissue. During an incision, only a part of the tumor is removed (used primarily for large lesions).

Treating Squamous Cell Carcinoma

1. Simple excision (Cutting and Suturing)
2. Curettage and electrodessication (Scraping and burning with an electric needle)
3. Mohs micrographic surgery (microscopically controlled excision).
4. Radiotherapy (x-ray)

Although any of the above methods can be used to treat basal and squamous cell carcinomas, Mohs micrographic surgery is by far the most superior. Mohs surgery offers the highest cure rate (up to 99%), the lowest chance of regrowth, the lowest potential for scarring and disfigurement, and the most exact and precise means of removal (only skin cancer is removed, normal tissue is spared). Melanomas are almost always treated by wide-excision. However, some melanomas in sensitive cosmetic areas can be treated with Mohs surgery.

• Mohs
• Dr. Ciatti

​Melanoma

Malignant melanoma is a skin cancer that can be life threatening if it is not diagnosed and treated early. Although melanoma is the least common type of skin cancer, it is by far the most dangerous. Melanoma is actually the most common form of cancer among young adults aged 25 to 29. Melanocytes are cells found in the bottom layer of the epidermis. These cells produce melanin, the substance responsible for the pigment of your skin. That’s why melanomas often look like little dark brown or black spots on the skin.

Melanomas can spread rapidly to internal organs and the lymph system, making them quite dangerous. When melanomas are discovered and treated early, they are nearly 100% curable. For all of our patients, we recommend frequent full body skin checks.

Signs of Melanoma

• Large brown spots with darker speckles located anywhere on the body.
• Dark lesions on the palms of the hands and soles of the feet, fingertips toes, mouth, nose or genitalia.
• Existing moles that begin to grow, itch or bleed.
• Brown or black streaks under the nails.

Melanomas look like irregular moles and can grow inside existing moles. That’s why it is important for you to conduct regular self-examinations of the skin in order to detect any potential skin cancer early, when it is treatable.

American Academy of Dermatology’s ABCDEs

Asymmetry: Half the mole does not match the other half in size, shape or color.

Border: The edges of moles are irregular, scalloped, or poorly defined.

Color: The mole is not the same color throughout.

Diameter: The mole is usually greater than 6 millimeters when diagnosed, but may also be smaller.

Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape, or color.

Risk Factors

Risk factors for squamous cell carcinoma include having fair skin, sun exposure, age (most skin cancers occur after age 50), exposure to ultraviolet radiation (as in tanning beds) and therapeutic radiation given to treat an unrelated health issue.Most melanomas are caused by overexposure to the sun beginning in childhood. This cancer also runs in families.

Diagnosing Melanoma

Diagnosing melanoma requires a biopsy which usually involves an excision or an incision. During an excision, the entire tumor is removed along with some of the surrounding tissue. During an incision, only a part of the tumor is removed (used primarily for large lesions)

Treatments for Skin Cancer

1. Simple excision (Cutting and Suturing)
2. Curettage and electrodessication (Scraping and burning with an electric needle)
3. Mohs micrographic surgery (microscopically controlled excision)
4. Radiotherapy (X-ray)

Although any of the above methods can be used to treat basal and squamous cell carcinomas, Mohs micrographic surgery is by far the most superior. Mohs surgery offers the highest cure rate (up to 99%), the lowest chance of regrowth, the lowest potential for scarring and disfigurement, and the most exact and precise means of removal (only skin cancer is removed, normal tissue is spared). Melanomas are almost always treated by wide-excision. However, some melanomas in sensitive cosmetic areas can be treated with Mohs surgery.

Warts

Warts are small, harmless growths that appear most frequently on the hands and feet. Sometimes they look flat and smooth, other times they have a dome-shaped or cauliflower-like appearance.

Warts are highly contagious growths caused by different forms of Human Papilloma Virus (HPV). They occur in people of all ages, can spread from person-to-person, and can hop from one body part to another. Warts are benign (noncancerous) and usually painless.

Types of Warts

The location of a wart is often the key to diagnosing what kind of wart it is.​

Common warts

Common Warts can appear anywhere on the body, although they most often appear on the back of fingers, toes and knees. These skin-colored, dome-shaped lesions usually grow where the skin has been broken, such as a scratch or bug bite.

Facial warts (Filiform warts)

Filiform warts look like a long, narrow, flesh-colored stalk that appears alone or in groups around the eyelids, face, neck, or lips. They are sometimes called facial warts. They may cause itching or bleeding, but are easy to treat with over-the-counter medications.

Flat warts

Flat warts appear on the face and forehead. They are flesh-colored (or white), are usually slightly raised, and they usually appear in multiples. Flat warts are more common among children and teens than adults.

Genital warts

Genital warts, which are the result of Herpes Simplex Virus 2, appear around or inside the genital and pubic areas. The lesions, which usually grow in clusters, start small and soft but can become quite large. Genital warts are both sexually transmitted and highly contagious. In fact, you should avoid sex with anyone who has a visible genital wart. Genital warts should always be treated by a physician.

• Herpes

Plantar warts

Plantar warts appear on the soles of the feet and can be painful since they are on weight-bearing surfaces. Plantar warts have a rough, cauliflower-like appearance and may have a small black speck in them. They often appear in multiples and may combine into a larger wart called a “mosaic wart.” Plantar warts can spread rapidly.

Subungual warts and Periungual warts

Subungual and periungual warts appear as rough growths around the fingernails or toenails. They start as nearly undetectable, pin-sized lesions and grow to pea-sized with rough, irregular bumps with uneven borders. Subungual and periungual warts can mess with healthy nail growth. Because of their location, they are difficult to treat and should be assessed by your dermatologist.

Treatments

Most warts respond well to over-the-counter treatments, like Non-prescription freezing products (dimethyl ether) and salicylic acid. Salicylic acid dissolves the keratin protein  that makes up the wart and the thick layer of skin that covers it. It comes in gels, pads, drops and plasters and takes 4 to 6 weeks to eradicate the warts.

Some warts will require medical attention and treatment.

Cryotherapy: Cryotherapy freezes off the wart using liquid nitrogen or nitrous oxide.

Electrosurgery:  Electrosurgery sends an electric current through the wart to kill the tissue.

Laser surgery: Laser surgery involves heating up the wart with a laser until the tissue dies and the wart eventually falls off. Dr. Ciatti is a highly trained laser surgeon.

If over-the-counter treatments don’t resolve your warts, schedule an appointment with one of our dermatologists or physician assistants to see your treatment options.