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Sunscreen – Friend or Foe?

By Dr. Samantha Stoler

Suncreen at AboutSkin DermatologyHave you read articles declaring that sunscreen is dangerous?

The media has tricked people into questioning the safety and benefits of sunscreen and claim there is “The sunscreen dilemma” – it’s not really a dilemma at all.

Ultraviolet light is a proven carcinogen.  Daily use of zinc or zinc and titanium based sunscreens effectively reduce exposure to the damaging effects of Ultraviolet Light.

What we know from scientific data:

  • UV exposure undoubtedly increases the risk of basal cell and squamous cell carcinoma. These are skin cancers that can occur in cosmetically devastating areas.  They often need to be surgically removed.  Melanoma causes are multi-factorial.  UV exposure is included and tanning beds increase the risk of melanoma tremendously.  Melanoma can kill.
  • Sunscreen definitively reduces the amount of sun damage to skin cells.  DAILY use with reapplication minimizes the effects of photo-aging.  These signs include: hyperpigmentation (sun spots), wrinkling and thinning of the skin, and broken blood vessels.  You do not need to be getting burned to be damaging and mutating your DNA.  The damage is cumulative.
  • Chemical sunscreens may stimulate estrogen receptors and cause more skin cancer if you are a rat and are force-fed hundreds of times the amount of sunscreen that humans apply to their skin over a lifetime.
  • Physical blockers are better anyway.  As single agents they offer a broad spectrum of coverage against both UVA and UVB.  They do not absorb into the cells and negate the chemical “fear.”  Zinc oxide and titanium dioxide (physical blockers) are also more hypo-allergenic.  These are the best sunscreens for both kids and adults!

Take oral Vitamin D.  There is no “safe” 10 minutes a day.  This is especially true in Colorado living at high altitude and enjoying many sunny days.

Skin Cancer Screening

Skin cancer prevention and screening in Englewood/South Denver and Lone Tree

Skin cancer is among the most common forms of cancer in the United States, affecting approximately one out of every five individuals at some point in life. Over three thousand people die from non-melanoma cancers, and over nine thousand die from melanoma every year. A heartbreaking fact is that most of these tragedies could have been prevented. Approximately 80 to 90 percent of skin cancers are attributed to UV exposure, which is avoidable. Additionally, most skin cancer can be treated successfully if detected in the early stages.

How to protect yourself
The team of board-certified dermatologists and other skin care experts at AboutSkin Dermatology and DermSurgery, PC, is dedicated to fighting these statistics, and helping their patients in Englewood/South Denver and Lone Tree stay healthy. Protecting yourself from skin cancer is a three-phase process:

  • Be sun-smart (wear broad-spectrum sunscreen and protective clothing; seek shade in the brutal midday sun) and don’t use indoor tanning.
  • Perform a self-exam at least once a month. Awareness of your own skin, and of any changes that occur, are crucial for detecting cancer as well as other skin conditions early.
  • Visit us for cancer screening at least once a year. According to an extensive population based study, which was published in the JAAD (Journal of the American Academy of Dermatology), cancer screening by physicians reduced melanoma deaths by 50 percent.

What to look for during a self-exam
Any unexplained changes in your skin may be cause for concern. It is important to familiarize yourself with the marks and growths on your skin, so that you will notice any changes. The most common warning signs include:

  • Any lesion that increases in size or changes shape, texture, or color
  • Large (over .25 inches) moles or other lesions
  • Moles with an irregular shape or jagged edge
  • New moles that develop after the age of 21
  • Lesions that persistently crust, ooze, bleed, hurt, or itch
  • Open sores that don’t heal within three weeks

The best rule of thumb is, “when in doubt, have a professional check it out.” If you haven’t had a cancer screening in the last 12 months, or if you notice anything suspicious during your self-exam, call 303.756.SKIN (7546) and schedule an appointment at AboutSkin. We have two convenient locations in Englewood/South Denver and Lone Tree.

Skin Cancer Surgeon

Choosing a qualified surgeon for Mohs skin cancer treatment in Englewood/South Denver and Lone Tree

Skin cancer is an unfortunately common condition, which has deadly potential. Like other forms of cancer, early treatment is the key to a good outcome. In most cases, surgical removal of the tumor is the best option, though there are several techniques. Standard methods, such as excision, cryosurgery, or electrosurgery, may be used for small tumors, which are not deemed likely to recur. Large or aggressive cancers, and those in cosmetically sensitive areas, are usually best treated with Mohs Micrographic Surgery.

Mohs is the most advanced, and the most effective, skin cancer treatment available today. It has the highest cure rate, even when treating cancers that have returned after being removed by another method. Although many physicians are legally qualified to perform Mohs surgery, it is a delicate, intricate procedure. Only select physicians have completed the rigorous training required to complete ACMS (American College of Mohs Surgery) fellowship training.

Dr. Joel Cohen, founder of AboutSkin Dermatology and DermSurgery, PC, in Englewood/South Denver and Lone Tree, is among the select group of fellowship trained Mohs surgeons. He is one of only a handful of full-fellowship-trained Mohs surgeons in Colorado who has done the full-training of the American College of Mohs Surgery. What does that mean?

  • Advanced training – The fellowship program includes 12 to 24 months of rigorous training. Before beginning the program, a physician must complete the appropriate training and residency requirements for his or her chosen specialty, and then pass a highly selective qualification process.
  • Qualified instructors – If you want to be the best, learn from the best. In keeping with this belief, ACMS fellowship training is conducted at only select, approved training centers, and each student works closely with an accredited, seasoned Mohs surgeon who serves as a mentor and teacher.
  • Extensive experience – Before completing the fellowship program, a physician must participate in a minimum of 500 Mohs cases, and demonstrate his or her skill and accuracy in the diagnostic, surgical, and reconstructive aspects of the procedure.
  • Commitment to excellence – As you can see, Mohs fellowship training is not designed for doctors who are looking for an easy way to bulk up their credentials. Only those with a serious commitment to providing excellent care would take on such an endeavor, and only the most talented and highly skilled succeed.

Dr. Cohen has published and lectured extensively on skin cancer, suturing techniques for skin cancer lesions, as well as lasers to help minimize the prominence of skin cancer scars. At this point, he has published over 130 articles and is the co-author of an upcoming 2014 textbook on skin cancer reconstruction.

If you’ve been diagnosed with, or believe that you may have skin cancer, call AboutDerm at 303.756.SKIN (7546), and schedule an appointment to find out if Mohs Micrographic surgery is the right solution for you.

Squamous Cell Carcinoma

Englewood/South Denver and Lone Tree skin health: What is squamous cell carcinoma (SCC) ?

AboutSkin Dermatology and DermSurgery, PC provides a comprehensive range of cosmetic and medical dermatology services at their offices in Englewood/South Denver and Lone Tree. Perhaps the most important services they offer are skin cancer screening and removal. Like most forms of cancer, early detection and prompt treatment are essential.

There are several types of skin cancer, with squamous cell carcinoma being the second most common. It is caused by abnormalities (mutations) in the squamous cells, which comprise a large percentage of the cells in the epidermis (upper layer of the skin). Cancerous squamous cells grow and multiply at a dangerous, uncontrollable rate. The cell abnormalities leading to squamous cell carcinoma usually result from the damaging effects of cumulative ultraviolet light exposure, either from tanning beds or natural sunlight. However, ultraviolet exposure is only one of the risk factors; genetic factors, immune suppression, smoking, and viruses like genital wart viruses can also be responsible.

Squamous cell carcinoma can develop on any area of your body, even the genitals and oral mucous membranes. However, it is most common on areas that receive frequent or extended exposure to the sun, such as the heads, hands, face, neck, arms, and legs. The appearance of these cancerous lesions may vary, depending on several factors. Signs of squamous cell carcinoma include:

  • A crusted or bleeding lesion
  • An elevated skin growth that has a depression in the center
  • A skin ulcer (open sore)
  • Red, scaly patches of skin
  • A warty-like growth

Although anyone is susceptible to squamous cell carcinoma, it is most common in people with light hair, fair skin, and gray, green, or blue eyes. Some people are genetically predisposed, due to a hereditary condition called xeroderma pigmentosum, which increases one’s sensitivity to UV radiation. Additionally, your risk is greater if you have had other types of skin cancer like basal cell carcinoma.

In most situations, the best treatment for any kind of skin cancer is removal. There are several common methods, surgical removal for skin cancers. For those located in aesthetically sensitive areas (such as the central face etc), Mohs Micrographic Surgery is often recommended especially if the skin cancer is ill-defined. This advanced surgical technique is only available from select physicians. Dr. Cohen is one of only a hand-full of full fellowship-trained Mohs College surgeons in Colorado, and he is very active nationally teaching courses and young physicians. He also just completed co-authoring a Mohs skin cancer and reconstruction textbook with 2 other well-known US Mohs surgeons that will be available in early 2014.. The American College of Mohs surgery has the most stringent requirements in Mohs surgery training. The Mohs College requires a full-fellowship of at least a year where at least 500 cases need to be performed by the physician training under direct supervision of their preceptor physician. Dr. Cohen completed this Mohs College training in 2001.

If you have been diagnosed with skin cancer, or you have noticed a suspicious skin lesion call us at 303.756.SKIN (7546) and schedule an appointment.

Mohs Surgery

Mohs Surgery in Greenwood Village

Skin cancer is a serious and potentially deadly condition. Early diagnosis is a key component for effective treatment. Although dermatologists and other medical professionals work diligently to spread the word about sun protection and cancer prevention, it continues to be an unfortunately common problem. If you have been diagnosed with skin cancer, it is important to choose the right physician, and the right treatment. At AboutSkin Dermatology, you will only see a Board-Certified Dermatologist for your skin evaluations.

What is Mohs?

The most advanced technique for skin cancer removal currently available is Mohs Micrographic Surgery. It offers a higher cure rate, and smaller scars than any other method of surgical removal, making it ideal for large tumors, ill-defined tumors, recurrent tumors, or tumors located in highly visible areas, especially on the face. The skin is processed so that the surgeon can look at the ENTIRE edge of the margins (much like looking at the entire crust of a pie) rather than just samples of the edge (like slices of bread from a loaf). It is a sophisticated and delicate procedure, requiring considerable skill and training. Dr. Joel Cohen of AboutSkin Dermatology and DermSurgery, PC in Englewood/South Denver and Lone Tree is one of a select few board-certified dermatologists in Colorado who has completed a full-Fellowship training from the American College of Mohs Surgery.

What to expect

The first step is to take a small tissue sample (biopsy) to determine if you have cancer. Although an experienced dermatologist, such as those at AboutSkin, can often recognize cancer on sight, the diagnosis is confirmed by a dermatopathologist through laboratory testing before moving forward with treatment.

If it is determined that you are a good candidate for Mohs, an appointment will be arranged. You should plan on spending a large portion of that day in our office—with the experience often requiring a patient to be in the office for 3-4 hours (though most of the time is spent waiting for the frozen sections samples to be processed). The process is completed in several stages, removing a thin layer of tissue and evaluating it before continuing. The location of cancerous cells in each layer of tissue is used as a guide for precision accuracy in removing the next layer. Depending on how large the tumor is under the microscope, this can be time consuming. Although it would be faster to remove a large amount of tissue at once, the Mohs technique minimizes the risk of recurrence, because removal is confirmed by looking at the entire pie-crust margin. It also leaves the healthy surrounding tissue undisturbed, making cosmetic reconstruction simpler and more effective.

To learn more, or to schedule an appointment at Aboutskin Dermatology, call 303.756.SKIN (7546).

Skin Cancer Treatment

Skin cancer treatment in South Denver-Englewood and Lone Tree

If you suspect that you may have skin cancer, it is imperative to see a doctor right away. In the best-case scenario, you can put your fears to rest knowing that you have been medically cleared. If your concerns prove to be valid, early detection is the key to successful removal, as well as the best possible cosmetic outcome.

Choosing a doctor

For the sake of your physical health, it is important to choose a respected, experienced Denver dermatologist who can provide quality care. For the sake of your emotional health, you will want to see a caring, compassionate doctor who understands how frightening this experience is, and will be a friend as well as physician. Don’t worry; you don’t have to choose between the two.

The exceptional team at AboutSkin Dermatology and DermSurgery, PC, is composed of dedicated professionals with one common priority, and that is you. In our offices, your health, comfort, convenience, wellbeing, and cosmetic concerns are of utmost importance. We have four highly trained dermatologists, including Dr. Joel Cohen, fellowship trained Mohs surgeon.

Diagnosis and treatment

Experienced dermatologists, such as those at AboutSkin, can often identify a suspicious lesion through visual examination. However, the doctor’s suspicions must be verified through a skin biopsy and testing before a diagnosis is made.

If skin cancer is identified, we will discuss your treatment options. There is no single right answer for every situation. The best choice will depend on many factors, including the size and location of the tumor, the subtype of skin cancer, how fast it is growing, as well as your health. In the majority of cases, the cancer is surgically removed, using one of several techniques.

Non-aggressive skin cancers that are small in size or located on the arms, legs, trunk or less cosmetically sensitive facial areas can be treated by standard excision, curettage and dessication, or topical prescription medication, depending on the particular tumor type. However, if the tumor is large, aggressive, or located on cosmetically sensitive parts of the face, Mohs Micrographic Surgery will likely be recommended. This advanced technique has the highest cure rate of the skin cancer surgeries and minimizes the removal of healthy tissue, especially important for tumors on or near vital structures like the nose.

Choose a dermatology practice where you will receive the quality care you need and the compassion you deserve. Call us at 303.756.(7546) (South Denver-Englewood), or 303.799.(4260) (Lone Tree) and schedule an appointment today.

Basal Cell Carcinoma Denver

Five signs of basal cell carcinoma in South Denver-Englewood and Lone Tree

Skin cancer is an unfortunately common condition, caused by rampant development of abnormal skin cells. It begins with mutated (damaged) DNA, usually associated with UV exposure. There are several types of skin cancer, with basal cell carcinoma (BCC) being the most common.

Basal cells are an important part of your skin, lining the epidermis (outer skin layer). Basal cell carcinoma is a cancerous growth developing in these cells. It is rarely life threatening, because it usually does not spread (metastasize) to other areas of the body and organs. However, without treatment they continue to grow in size, destroying healthy skin tissue. Advanced basal cell carcinoma can be quite disfiguring.

We all develop the occasional mysterious lump, bump, or spot. It might be as minor as a harmless insect bite, or as serious as cancer. How do you know when it’s time to see a doctor? Here are the top five symptoms of basal cell carcinoma. A lesion may display one or several of these characteristics.

  1. Recurring sore. It might bleed, ooze, or crust over, often staying open for several weeks. It may appear to heal, only to open up again, and begin bleeding.
  2. Irritated or red patch. In some cases, it may crust over or itch; in other cases, it does not cause discomfort. This is most common on the arms, legs, chest, shoulders, and face.
  3. Shiny nodule (lump). This may look like a shiny mole. It is usually white, red, or pink, but it can also appear black, brown, or tan. The nodule is typically translucent or pearly looking.
  4. Pinkish growth. The growth usually has raised edges that appear to be rolled, and an indentation in the center. You may notice crusting in this indentation, and as the tumor grows, fine blood vessels can develop on the surface.
  5. Scar-like patch. The skin may look as though it is stretched too tight, causing a waxy or shiny area without clear borders. This may be a sign of an invasive tumor, which is actually larger than it looks at the surface.

When in doubt, follow the wisdom of the old idiom, “better safe than sorry.” In other words, if something is concerning you, have it checked. Call 303.756.(7546) (South Denver-Englewood), or 303.799.(4260) (Lone Tree), and schedule an appointment at AboutSkin Dermatology and DermSurgery, PC, today.

Skin Cancer Treatment Englewood

Choosing the most appropriate skin cancer treatment from your Englewood dermatologist

At AboutSkin Dermatology, we take great care with all of our patients. Those who are facing skin cancer are given the special consideration their diagnosis warrants, with specific focus provided to treatment options. While there are several acceptable ways to approach skin cancer treatment such as standard surgical removal, scraping and burning, freezing (cryosurgery), or laser surgery, Mohs treatment stands above any other and is regularly used in our Englewood and Lone Tree offices.

Mohs is known for having the highest success rate among all available procedures, regardless of the type of skin cancer being treated. All other treatments’ success is dependent on the surgeon’s ability to estimate the extent of the treatment area, which leaves a large margin for error simply due to the inability to visualize the extent of damaged tissue immediately. In addition to the precision of Mohs, this form of treatment is flexible and ideal in scenarios such as:

  • Recurrent skin cancer after previous treatment
  • The treatment of skin cancer on highly visible areas where aesthetics preservation is key
  • Skin cancer within existing scar tissue
  • Large areas of damaged tissue
  • Cancer with ill-defined margins
  • Rapidly growing skin cancers

Mohs is a procedure that is now performed by a great number of physicians around the world, as board certification is not a requirement. Dr. Cohen, however, has completed the strenuous, extensive training program with The American College of Mohs Surgery to perform this intricate and delicate procedure most precisely, leading to the highest possible success rate for every patient.

This training, intended for the ultimate benefit of the patient, is available to those physicians who have completed a dermatology residency, or one in a related field, and have successfully completed a highly competitive selection process. Upon acceptance, these physicians complete a training program of one to two years, taking them through a rigorous curriculum, which includes both non-operative and operative education as well as other important aspects of Mohs.

When your concern is the elimination of skin cancer and its possible complications, Mohs surgery with a fully trained Mohs surgeon allows you the best potential. With the help of Dr. Cohen and the AboutSkin Dermatology staff, you can feel confident in your skin cancer treatment.

Contact us to learn more or to schedule your appointment at AboutSkin Dermatology.

Mohs Skin Surgery Englewood CO

Determining if Mohs is the right skin surgery – details from your Englewood CO dermatologist

The diagnosis of skin cancer can be frightening. During this time, gathering information is the key to facilitating a smooth process through treatment and recovery, as this step will help you determine the path best suited to your needs. At AboutSkin Dermatology, we incorporate the latest technology and technique, using Mohs skin cancer surgery, performed by a full fellowship-trained Mohs College surgeon, in our Englewood and Lone Tree, CO facilities.

This surgical procedure, although not used by all dermatologists, has been used for well over fifty years. Today, it is viewed as the most advanced approach in the diagnosis and treatments of skin cancer, incorporating extreme precision. Through Mohs surgery, Dr. Cohen reaches cancerous skin cells effectively, without posing harm to the skin of the surrounding area. There is no estimating how much tissue needs to be removed, only direct visualization and gradual removal of the affected cells, nothing more and, certainly, nothing less.

Mohs comes with a number of very exciting benefits. Learning them will help you determine if this is the right treatment for you.

  • Mohs holds the highest rate for successful skin cancer treatment to date – approximately 99%.
  • Ability to remove cancerous cells of the affected area completely, leading to a very low risk of recurrence.
  • Ability to achieve results even when other treatment has proven ineffective.
  • Highly effective at saving healthy tissue around the affected area.
  • Same-day surgical procedure, requiring no hospitalization.

Undergoing treatment for skin cancer should not stop you from engaging in life. With Mohs surgery, the surgical procedure is completed on an outpatient basis, requiring only local anesthetic to maintain comfort. Avoiding a procedure in which general anesthesia is required means that patients are back at home quickly, feeling good. Mohs also carries a far lower risk of complications, and leads to a faster recovery period, due to the fact that there is no need for anesthesia.

Physicians now know that patients who have developed one area of skin cancer are more likely to experience another area of concern. Because early detection makes a world of difference in prognosis, we recommend regular skin assessments with your experienced dermatologist.

Contact us for further details on skin cancer, Mohs, or to discuss your skin concerns personally.

Mohs Procedure

Understanding the Mohs surgery procedure in Englewood/South Denver and Lone Tree

Skin cancer is a serious, potentially life threatening problem, which is unfortunately common. However, with today’s advanced medicine, we have several options for treating skin cancer. The success of treatment varies, depending on several factors, including the type of cancer and how advanced it is. For the most challenging cases, Mohs surgery is recommended. Why? Mohs is a precision technique, utilizing a unique procedure to achieve the highest cure rate of any cancer treatment available.

A different approach

Traditional cancer removal procedures utilize various techniques, such as cutting, freezing, scraping, and cauterizing, but they all operate on the same basic principle. The physician examines the tumor, determines how extensive it is, and then removes it. Unfortunately, that approach is dependent upon the physician accurately estimating the extent of the cancer. The Mohs technique takes the guesswork out of cancer surgery.

Rather than attempting to remove the entire cancer at once, the Mohs surgeon removes only a thin layer of tissue. That layer is then tested, and the precise location of cancer cells is mapped. Another thin layer of tissue is removed, from only the area that showed cancer cells. It is tested, and the process is repeated until the final sample shows no more cancer. You might expect the process to take weeks, but it is completed in a single visit, because the surgeon also acts as the pathologist, using advanced technology to test the sample right in the office.

Benefits of Mohs Surgery

Mohs is usually recommended over other methods in two situations:

  • Aggressive cancers – Specific types of cancer spread much more quickly, making it difficult for a doctor to guess how deep it is. Additionally, large cancers and those that have returned after treatment are especially challenging. In these situations, the precision and verification of Mohs are invaluable.
  • Cosmetically sensitive cancers – In some situations, a doctor may be able to guess the size of the cancerous area with reasonable accuracy, but it is not precise. Therefore, a certain amount of presumed-healthy tissue is removed around the cancer as a safety measure. If it is located on your face, hands, or other highly visible area, you will want the smallest possible scar, which is achieved with Mohs.

Due to the complexity of the procedure, it requires exceptional skill and training to perform it properly. Dr. Joel Cohen is an experienced Mohs Surgeon, and he is among the select few who have been fellowship-trained through the respected Mohs College. You can schedule a consultation with him at our Englewood/South Denver or Lone Tree location by calling 303.756.(7546).