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Leonard H. Kim, MD

Medical Dermatology

Mohs Surgery

Mohs surgery is a specialized type of skin cancer surgery that offers extremely high and superior cure rates. The tissue margins of the skin cancer are examined immediately in the office. This technique allows precise tumor clearance by the Mohs specialist and thus avoids taking too much healthy tissue. Mohs surgery is indicated for skin cancer of the head and neck area, previous treatment failure/recurrent skin cancer, aggressive, large, or unusual cancers (infiltrative basal cell skin cancers, skin cancers greater than 2cm, among others).

On the day of the surgery, after a local anesthetic, the skin cancer is excised with thin margins. The tissues is processed immediately in the office while the patient is in the waiting room (usually one hour). If the cancer is still present upon tissue examination, then another thin layer of tissue is taken. This process continues until the tumor is clear. The average patient requires just two layers, although this can vary from patient to patient. Once the cancer is clear, the surgeon will determine the best option for closure. These options include skin grafts and flaps and side-to-side closure.

 
Skin Cancer
 

Skin cancer is the most common form of cancer in the United States. The most common types are basal cell cancer and squamous cell cancer. The most common locations for these cancers are on the head, face, neck, hands and arms. Any growth that is not healing, bleeds, or is changing should be evaluated to rule out skin cancer. Most patients need yearly skin cancer screenings.

Melanoma is a less common but more dangerous form of skin cancer. Melanoma is usually characterized by asymmetry, irregular borders, uneven color, or large diameter. Melanoma can spread to lymph nodes and other internal organs. Early detection is important for a better prognosis. 

There are several treatment choices for the remaining skin cancers that are not indicated for Mohs Surgery. These options all have excellent cure rates and outcomes. Several of these options include surgical removal of the tumor (simple wedge excision), curettage and electro-dessication (tumor is scraped away and the area is cauterized), and radiation therapy. Dr. Kim will determine the appropriate treatment options based on the specific patient and type of tumor.

 
Acne

Acne is the term for the blocked pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules) that can appear typically on the face, neck, chest, back, shoulders and upper arms. Seventeen million Americans currently have acne, making it the most common skin disease in the country. While it affects mostly teenagers, and almost all teenagers have some form of acne, adults of any age can have it. Acne is not life-threatening, but it can cause physical disfigurement (scarring) and emotional distress.

 

Treatment for acne varies depending on the type and severity of lesions, as well as the patient's skin type, age and lifestyle. Options include: 

  • Topical Medications

  • Antibiotics

  • Accutane

  • Blackhead Extraction

  • Microdermabrasion

  • Topical Cleansers

Acne scarring can be treated in a variety of ways as well. These include:

  • Laser treatment for red scars

  • Laser treatment for surface scars

  • Microdermabrasion

  • Chemical Peels

  • Soft Tissue Fillers

 
Acne Scars

Acne scarring occurs when the skin's dermis is damaged from episodes of acne. When the body attempts to repair the dermis new elastin and collagen forms in an irregular pattern. Acne scarring can occur in the form of pigmentary inconsistencies, boxcar scars, ice-picked scars, and rolling scars. Fraxel Dual and Fraxel CO2 are excellent lasers to improve textural scar changes and Vbeam can address pigmentary inconsistencies. During your consultation, Dr. Kim will develop an efficient plan tailored to maximize the improvement in your acne scars.

 
Rosacea

Rosacea, frequently referred to as "adult acne", is a chronic skin condition involving inflammation of the cheeks, nose, chin, forehead, and/or eyelids. It is characterized by redness, broken blood vessels, and flushing of the face. Patients may also experience pimples, swelling, and a burning or stinging sensation. Rosacea is often seen in patients with lighter skin color although we do see it in all skin types. Triggers for rosacea include aclohol, caffeine, spicy foods, sunlight, and extreme temperature changes among others. There is no cure for rosacea, but fortunately, there are many treatment options.

Topical creams and gels, oral antibiotics, and laser treatment for broken blood vessels are just a few of these options available to our patients.

 
Moles

Moles or "nevi" are composed of groups of pigment producing cells called melanocytes. They are important to monitor because of their potential risk for turning into malignant melanoma. Dypslastic moles, which are clinically and microspically atypical in appearance, are putative precursor lesions of melanoma. Most people need yearly skin examinations to screen for melanoma and other skin cancers. People with numerous moles or a family history of melanoma should be carefully monitored with more frequent full skin examinations. It is important to watch for any change in color, size, or shape of exisiting moles and to let us know if these changes occur. Moles may be removed because they are clinically worrisome.

 
Warts

Warts are common growths that can appear anywhere on the body. They are caused by various strains of the Human Papilloma Virus or HPV. Warts can be extremely stubborn to treat but will ultimately resolve once your immune system mounts a response.

 

We offer a multitude of treatment options for warts. We find that what works best for one person may not work as well for another. We utilize a full arsenal of wart treatments including liquid nitrogen, canthacur, and surgical treatment among others. We also recommend over-the-counter salicylic acid treatments between office visits. We may also recommend prescription creams to boost your immune response. Warts can be extremely frustrating, but with a little persistence, we can help you make them disappear.

 
Eczema

About 15 million of people in the U.S. suffer from some form of eczema, including a large percentage of infants and children. Symptoms vary from person to person but often include dry, red, itchy patches on the skin. If untreated and chronically scratched, eczema can potentially become infected.

 

All eczema patients need to increase their use of moisturizing lotions and decrease the length and temperature of their shower or bath. Treatment options include corticosteroids creams and ointments, antihistamines, and non-corticosteroid creams and ointments such as protopic or elidel. Oral anbitiotics can be prescribed in cases of an infection. With a few lifestyle changes and treatment options, most cases of eczema can be well controlled.

 
Psoriasis

Psoriasis is an inflammatory skin condition that appears as silvery white scaly plaques. Over seven million men and women in the U.S of all ages have some form of psoriasis. The most commonly affected areas are the scalp, elbows, knees, hands, feet and genitals.

Psoriasis cannot be cured but it can be managed successfully. Treatment depends on the type, severity and location of psoriasis; the patients age, medical history, and the effect the condition has on the patient's quality of life. The most common treatments are topical medications, phototherapy, and oral or injectable medication (for severe cases)