1. Your physician explains the procedure and obtains your consent to do the procedure.
2. The area may be photographed.
3. The area is cleaned and numbed with an anesthetic medication. You will feel a prick and some stinging as the medication is injected into your skin.
4. A small piece of skin is obtained either by a scalpel, a special biopsy blade, or by a cookie cutter like device.
5. Depending on how much and how the skin is taken, stitches may be placed. If stitches aren’t placed, bleeding may be stopped by application of certain chemicals or via a cautery device.
6. The area is bandaged.
7. Wound care is reviewed.
8. The tissue is sent to a pathologist to help render a diagnosis.
Step 4 alludes to the different types of skin biopsies. A shave biopsy is usually done with a blade and do not require stitches. A punch biopsy uses a special cookie cutter device to obtain skin. Stitches frequently are placed when a punch biopsy is taken.
A lot of people have rough small bumps of their arms, thighs and buttocks. These bumps can be skin colored or reddish and have unfortunately been likened to “chicken skin” and can feel like sandpaper. They represent a condition called keratosis pilaris. This is a benign condition which is inherited from mom
or dad, but it can prove to be a cosmetic nuisance and can occasionally itch too. There are several things that you can do to get smoother skin over these affected areas. Using a loofah sponge can help flatten and make these bumps less rough. Moisturizers, lactic acid containing lotions (such as AmLactin or LacHydrin), or lotions and creams containing urea, salicylic acid, alpha-hydroxy acids, tretinoin or tazarotene can help as well. This condition is chronic though (there’s no cure) so you do have to keep up with these maintenance measures if you want to keep the keratosis pilaris in check. However, because it’s a benign condition, there’s no medical necessity for treatment.
This weekend, I covered the dermatology on-call pager for the hospital and clinic. I frequently get calls from patients who have had a procedure such as a biopsy or surgical excision performed and want to know whether the wound is infected. Some signs that your wound may be infected are:
– presence of pus (whitish yellowish slightly thick fluid)
– redness around the wound, especially if it spreads
– warmth around the wound
– increasing pain, pain out of proportion to findings
– fevers or chills
These are just guidelines for things to look out for. If you had a recent procedure and are worried about potential infection, call the provider who did the procedure or seek medical attention to have the wound evaluated. If the wound is infected, a culture (swab) from the wound may be taken, and you may be placed on an antibiotic. The wound may need to be opened and drained as well if there’s evidence of an abscess (infected fluid collection).
Now, if you were to get a puncture wound from a sea urchin spine, you might want to go to a clinic and get it checked out. These wounds can get infected, and if they’re near a joint, you can develop arthritis.
Hopefully this hasn’t happened to you during your summer vacation, but if it does, you’ll know what it is! I recently saw someone who came in with itchy pink bumps of the torso and buttocks in a one-piece swimsuit distribution. Turns out it was “Seabather’s eruption” — aka “sea lice” which is actually caused by larvae! The culprits are either tiny little thimble jellyfish larvae in the waters off of Florida, Mexico and the Caribbean, or sea anemone larvae in the waters off of Long Island, NY. After you emerge from the water, these little critters get trapped under your swimsuit. Your body then develops a sensitivity reaction to these larvae. Thus the itchy rash in the swimsuit areas.
The seabather’s eruption typically occurs between May and August so we’re right at the tail end of the season for this rash. Now, if you get an itchy rash after a dip in the ocean, you might know what you have! (And no, this does not mean that you should necessarily go for a dip in the nude. But if you do, remember your sunscreen. If it’s during the day.)
If you are a former sun worshipper, you may be no stranger to the actinic keratosis (abbreviated as AK). AKs are usually gritty skin colored, pink or red growths of the skin showing up on sun-exposed areas like the face, scalp, back of hands, etc. They’re more than just a cosmetic concern though. AKs are pre-cancers, meaning that a fraction of them evolve into squamous cell carcinomas (cancers) of the skin. Fortunately, there are many options for treating AKs. Most commonly, dermatologists use cryotherapy (the liquid nitrogen cold spray which is -196 degrees celsius!) to get rid of these spots. Creams such as 5-fluorouracil (brand names of Efudex, Carac or Fluoroplex), imiquimod (aka Aldara or Zyclara) or diclofenac can also be used. Other treatments include curettage, photodynamic therapy, chemical peels, or laser therapy. Your doctor will choose a treatment based on what your AK looks like, where it is, or how many you have. Now, if you have AKs, that’s probably a pretty good sign that you’ve gotten some sun in the past and you should be getting regular skin checks.
The FDA recently approved Xeomin for use in temporary improvement against glabellar wrinkles (glabella = the area between your eyebrows and above your nose; wrinkles in this area are your frown lines). Similar to Botox and Dysport, Xeomin contains the botulinum toxin. Unlike Botox and Dysport, the toxin itself is naked and not associated with proteins. What this practically means in terms of aesthetic outcome is still unclear. So, the jury’s still out on how Xeomin will fare in comparison to Botox and Dysport. Xeomin will likely widely be available in the spring of 2012. It will be interesting to try it out and see what the key differences are between to botulinum toxins — or maybe they are more similar than dissimilar! Xeomin is manufactured by Merz Aesthetics while Botox is manufactured by Allergan and Dysport by Medicis.
Seborrheic keratoses (SKs) account for many referrals to the dermatologist. What are seborrheic keratoses? If you’ve seen a dermatologist before, they may have been referred to as barnacles, wisdom spots, SKs, seb kers, or some other creative terms. Bottom line is, they are benign spots. Chances are mom or dad had them too and passed on some of the genes that dictate their growth to you. There are many flavors (or perhaps more appropriately, looks) to seborrheic keratoses. They typically look like stuck-on warty pigmented growths on the skin but they can also be smooth, barely raised, pink or non-pigmented. In general, they don’t cause problems so if your SK doesn’t bother you, don’t bother it! Unfortunately, sometimes they do get in the way — e.g. of your necklace, bra strap, waistband, eyeglasses, brush/comb, etc. Or maybe you’re just bothered by the way they look. (You can’t tell your SK where to grow and it might just crop up in a very visible area like the face.) In this case, talk to your dermatologist. There are various options for removal. Cryotherapy (the liquid nitrogen cold spray), curettage, and shaving are just some methods for removal. There are benefits and drawbacks to each so let a doctor take care of removal. You don’t want to exchange an SK for a scar. And you probably want a method that can keep your SK away for as long as possible. Some people also use a loofah sponge when showering or bathing to help even out the wartiness/roughness of the SK.
Just keep in mind, since seborrheic keratoses often are pigmented, it can be hard for the non-trained eye to distinguish a potential skin cancer from a seborrheic keratosis. So when in doubt, see a dermatologist for evaluation!