Surgical Dermatology



Basal Cell Carcinoma

Basal cell carcinoma is a type of skin cancer and is the most common form of cancer in the United States.

BCC starts in the top layer of the skin, called the epidermis. It is a slow-growing and painless lesion. One should be alert to any new skin growth that bleeds easily or does not heal well. It usually occurs in areas of skin exposed to sunlight or UV rays.

Your risk for basal cell skin cancer is higher if you have: fair-colored skin and fair complexion, blond or red hair, or have a history of exposure to x-rays or other forms of radiation. BCC, if left untreated, may grow into nearby tissues and bone.

Symptoms of basal cell carcinoma may be very subtle. Cancer may appear as a skin bump or growth that is pearly or waxy white or light pink, flesh-colored or brown. The skin may be just slightly raised or even flat. Pay close attention if an area of skin bleeds easily, if there is a sore that does not heal, if there is oozing or crusting spots in a sore, if a lesion looks like a scar, if there are irregular blood vessels in the lesion or around it, or if the area of a sore has a depressed (sunken) area in the middle

Squamous Cell Carcinoma

More than 700,000 new cases of squamous cell carcinoma (SCC) are diagnosed every year. That makes it the second most common skin cancer (after basal cell carcinoma).

This form of skin cancer arises in the squamous cells that make up most of the skin’s upper layers (epidermis). Squamous cell carcinomas may occur on all areas of the body, including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, bald scalp, neck, hands, arms and legs. Often the skin in these areas reveals telltale signs of sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity.

The majority of skin cancers in African-Americans are squamous cell carcinomas, usually arising on the sites of preexisting inflammatory skin conditions or burn injuries. Though naturally dark-skinned people are less likely than fair-skinned people to get skin cancer, it is still essential for them to practice sun protection. Chronic exposure to sunlight and frequent use of tanning beds causes most cases of squamous cell carcinoma.

Malignant Melanoma

Malignant melanoma is the deadliest type of skin cancer. It arises from the melanocyte cells of the skin. Melanocytes are cells in the skin that produce a pigment called melanin. Malignant melanoma develops when the melanocytes no longer respond to the normal control mechanisms of cellular growth. They may then invade nearby structures or spread to other organs in the body (metastasis), where again they invade and compromise the function of that organ.

Predisposition to malignant melanoma can be environmental or genetic. The environmental factor is excessive sun exposure. There are also genetically transmitted familial syndromes that lead to melanoma.

A positive family history of one or two first-degree relatives having had melanoma substantially increases the risk. A family tendency is observed in 8% to 12% of patients. There is a syndrome known as the dysplastic (atypical) nevus syndrome that is characterized by atypical moles with bothersome clinical features in children under age 10. Such individuals have to be observed closely for the development of malignant melanoma.

An excellent way of identifying changes of significance in a mole is the ABCDE rule:

· Asymmetry
· Border irregularity
· Color variegation
· Diameter greater than 6 mm (0.24 in)
· Elevation above surrounding tissue.

Notice that three of the criteria refer to variability of the lesion (color variegation refers to areas of light color and black scattered within the mole). Thus small, uniform regular lesions have less cause for concern. It is important to realize that change in a mole or the rapid development of a new one are very important symptoms.


None of the clinical signs or symptoms discussed above are absolute indications that a patient has malignant melanoma. The actual diagnosis is accomplished by biopsy, a procedure that removes tissue to examine under a microscope. It is important that the signs and symptoms are used to develop a suspicion of the diagnosis, because the way the biopsy is performed for melanoma may be different than for other lesions of the skin.

The doctor may also use a dermatoscope to examine the mole prior to removal. The dermatoscope, which can be used to distinguish between benign moles and melanomas, is an instrument that resembles an ophthalmoscope.


The key to successful treatment is an early diagnosis. Patients identified with localized, thin, small lesions (typified by superficial spreading subtype) nearly always survive. For those with advanced lesions, the outcome is poor in spite of progress in systemic therapy.

Mohs micrographic surgery is a specialized technique for the removal of certain types of skin cancer.  The skin cancer is removed one layer at a time and analyzed microscopically while you are in the office.


Though it is difficult to prove that sunscreens statistically reduce the frequency of malignant melanoma at this time, most authorities recommend their use as protection from ultraviolet light (which is considered a major factor in the development of melanoma). Avoidance of severe sunburns is recommended.

Why Khrom Dermatology?

We at Khrom Dermatology understand every aspect of general dermatology, which is a relief for so many of our patients who always rely on us for diagnosis and treatment. No issue is too big or small to have the complete one-on-one attention of Dr. Khrom and our physician assistants – because that’s what it takes to build a dynamic practice.

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