What Is Dermatology?

Due to its size, the skin is the largest human organ, it is one of the most vulnerable organs of the human body. An average adult's skin is approximately 20 square feet, and because its external location it is susceptible to not only the aging process, but a number of diseases, disorders, discolorations, and growths.

Skin abnormalities can vary widely in regards to severity and appearance. Many can be removed and improved upon with minimum discomfort and risk using skin surgery within the comfort of a dermatologist's office.

Indications For Skin Surgery

Dermatologists cite three reasons for performing skin surgery:

  • 1. To prevent or provide early control of disease.
  • 2. To improve the skin's appearance by removing growths, discolorations, or damaged skin caused by aging, sunlight, or disease.
  • 3. To establish a definite diagnosis.
A change in a nevus (mole) or an unexplained growth can indicate a serious problem. A dermatologist should be seen if a nevus or skin lesion becomes larger, changes color, or develops an irregular border. Large nevi that are present at birth have a higher rate of cancerous change, which may necessitate excision. Extensive and potentially disfiguring surgery can often be averted by prompt surgical removal, by specialized freezing, or by treatment with chemicals applied to the diseased tissue.

Improving The Skin's Appearance

Many blemishes that occur on the skin, such as age or brown spots, birthmarks, nevi (moles), warts, wrinkles, and scars, can be eliminated or at least improved by an appropriate dermatological surgical procedure.

Age or brown spots are large freckles which develop on the face, back, and chest, as well as on sunexposed areas. They can be minimized by using a sunscreen and respond well to treatment with chemical peeling, cryosurgery, or laser surgery.

Birthmarks are areas of red brown color which come in all sizes and shapes and can occur all over the body. Most are flush with the skin's surface, but a few are raised. Port wine stains are deep wine colored, and the VPL or pulsed dye laser is the preferred form of treatment if they are treated. Strawberry vascular birthmarks will often increase in size in the early months of life but usually spontaneously disappear by the age of six or so. Oral medicines can be used to diminish the strawberry birthmarks if they become disabling.

Nevi (moles) are common skin growths which are usually small and tan or brownish, are sometimes raised, and may occasionally change shape or color. Dermatologists remove nevi to improve appearance, to prevent the nevus from enlarging, or changing into cancer. Large nevi that are present at birth may have a higher rate of cancerous change. These nevi have a potential for early removal. One method of removal is surgical excision, which is done in stages over a period of several months.

Warts are caused by virus and consist of piled-up layers of skin. They may develop on any location on the skin and may occur in people of all ages. Although topical medication, either over-the-counter or prescription, may cause resolution of warts, some warts are resistant and require prescription medication, cryosurgery, curettage, electrosurgery, injection with chemicals, or perhaps laser therapy.

Scars resulting from acne, chickenpox, accidents, or previous surgery may be improved by laser resurfacing. With dermabrasion, the skin is frozen with a spray medication, after which a high speed rotary abrasive wheel is used to remove the outer layers of skin and soften the irregular edges of the scar. Laser resurfacing consist of using a Erbium laser to vaporize areas of the scar. Some scars that are more depressed can be made to appear more natural using filling agents such as collagen or other types of synthetic preparations. Raised scars can be surgically leveled or flattened with steroid injections. Any operation results in some scar formation; however, a dermatologic surgeon places incisions so that the resulting scar will be minimal.

Wrinkles and deep expression lines can be partially erased with dermabrasion and laser resurfacing although the benefit does not last indefinitely. Topical chemical peeling with dilute acids can be used to minimize sun-induced wrinkles and yellowing, resulting in a more youthful appearance.

Actinic keratoses are thick, warty, rough, reddish growths which appear on the sun-exposed areas of the body. They sometimes develop into squamous cell cancer and are usually treated with cryosurgery.

Seborrheic keratosis are raised, tan or brown growths and are removed in a manner similar to actinic keratosis. They often become itchy and irritated by clothing. They do not turn into skin cancers.

Cysts are small closed sacs that contain fluid or solid material. Infection often necessitates that the dermatologist drain the contents. Surgical excision is the preferred method for complete removal of the cyst.

In The Dermatologist's Office

During the patient's office visit, the dermatologist will discuss the person's medical history, examine and diagnose the skin problem, explain what could happen if it is not treated, and then describe treatment options and follow-up care. In most cases, the dermatologist will select and carry out the appropriate treatment procedure at that time. However, if the examination indicated a likelihood of cancer, the dermatologist may take a biopsy and schedule the patient for surgery at a later date. Typically, consultations are required before cosmetic surgical procedures are performed. During the consultation, the dermatologist will explain the procedure to be done and how much discomfort, if any, will result, outline any postoperative restrictions, and answer any pertinent questions the patient may have. The patient should always feel free to discuss any operative procedure and its cost with the physician.

© Copyright 1984, revised 1987, 1999 American Academy of Dermatology