Routine office visits for rashes and growths

During a routine office visit, one of our dermatologists will perform a full skin examination on the initial visit to screen for melanoma and other types of skin cancer.  The visit proceeds with the dermatologist addressing the problem for which the patient is seeking treatment.  After a detailed history of the problem, a focused skin examination is performed. Most dermatologic problems can be broadly categorized as rashes or growths. 

Rashes

Many rashes are easily recognizable by their clinical appearance and presenting symptoms.  Such rashes require no additional diagnostic tests.  Other rashes, however, will require testing to make the diagnosis.  These include scraping the skin to look for fungal or viral infections, a culture to look for other types of infection, or biopsy of the  rash (see below).  Rashes are treated by various topical medications that include creams and ointments, as well as oral medications that include antibiotics and immunosuppressive drugs.   The type of rash will determine the treatment selected.

Growths 

Growths are classified as benign, premalignant, or malignant.  Benign growths that are irritated, painful, bothersome, or of cosmetic concern may be treated by biopsy removal, or by cryotherapy (freezing) with liquid nitrogen, which destroys the growth. 

Growths that are suspected of being cancerous are biopsied and examined by a skin pathologist to determine the type of cancer, growth pattern, and depth of invasion.  Cancerous growths typically involve additional, more extensive surgery where sutures are placed, including the Mohs procedure.  Certain types of skin cancer are treated with cautery (heat destruction) and curettage. 

Premalignant growths, such as actinic keratoses, are often seen in individuals with fair skin and a history of sun exposure.  Actinic keratoses are treated by cryotherapy with liquid nitrogen, or with creams. 

Biopsy Procedure

A biopsy is often performed on the day of the routine visit.  The skin is first anesthetized with an injected numbing medication.  A superficial biopsy is performed with a scalpel held parallel to the skin surface, a Dermablade, or scissors.  Deeper biopsies are performed with a punch tool, which removes a small cylinder of skin, or a scalpel held perpendicular to the skin surface, usually requiring sutures.  The biopsy is then sent to one of our skin pathologists for examination under the microscope.  The biopsy result will dictate the plan of treatment.