Dr. Kamell, Dr. Bodnar, Dr. Mitchell, and Dr. Rietkerk’s are trained and experienced in evaluation and treatment of general dermatologic conditions in patients of all ages, from newborns to the elderly. This includes the diagnosis, treatment and prevention of problems of the skin, hair and nails. We offer full body skin exam for evaluation of moles and other cutaneous growths for early detection of skin cancers. We manage sun damaged skin including actinic keratoses, lentigines, and seborrheic keratoses. We treat mild to severe acne and rosacea (including Isotretinoin for severe refractory or cystic acne). We diagnose and treat rashes of all kinds including eczema, psoriasis, allergic contact dermatitis, other allergic processes, autoimmune skin conditions, cutaneous manifestations of systemic diseases, and genetic skin conditions. We also manage skin infections such as warts, mollluscum, impetigo, herpes, and shingles.
A few of these are highlighted below:
Full Body Skin Exams
Full-body skin exams are an important tool in screening patients for benign or cancerous lesions that they may not have been able to see or recognize on their own. From head to toe and back to front, we inspect the skin for any irregular moles and other suspicious growths. This quick and painless preventive measure is an invaluable tool in the early detection of skin cancer as well as many other dermatological conditions. For those at low to average risk, an annual Full Body Skin Exam is advised. For those with personal or family history of melanoma or many irregular moles, a full body skin exam should be performed at least every six months.
Moles are generally brown spots that represent proliferation of melanocytes or pigment cells in the skin. Most moles are harmless. These respect boundaries and are symmetrical or uniform in color and shape. They have sharp borders and do not grow or change. Often harmless moles which we have had for several decades gradually become raised but maintain their uniform appearance. When a mole starts to become irregular, or dysplastic, this may signify increased risk of melanoma and the mole should be evaluated. Skin biopsies to evaluate moles involve numbing the area with local anesthetic then shaving to remove the lesion, which is sent for pathology. Occasionally moles are removed with a punch biopsy which involves use of a tiny “cookie-cutter”-like instrument to remove the mole; this is repaired with sutures.
Seborrheic keratoses are noncancerous (benign) skin growths that develop in those who are genetically predisposed. They begin as brown “stuck on” flat spots which can grow rapidly and become crusty or itchy. They often appear on the back or chest, but can occur on any part of the body. Seborrheic keratoses grow slowly, in groups or singly. Most people will develop at least one seborrheic keratosis during their lifetime. Treatmetnt is not necessary, but they can be removed with cryosurgery using liquid nitrogen if they are itchy, bothersome, painful, or cosmetically disturbing.
Actinic keratoses (AKs) are lesions on the surface layer of the skin (epidermis) caused by chronic exposure to sunlight, particularly ultraviolet light. AKs occur when the cells that comprise 90 percent of the epidermis, the keratinocytes, change their size, shape and/or organization in a process called cutaneous dysplasia. This alters the texture of the skin surface and may extend deeper, into the dermis.
Actinic keratoses can signal increased risk of skin cancer and AKs can progress to squamous cell carcinoma, the second-most common form of epidermal skin cancer.
Cryotherapy with liquid nitrogen is commonly used to treat these lesions. The area scabs or crusts for 5-7 days after treatment, then the lesion should resolve.
Field treatment of areas with many actinic keratoses is also available. Field treatment options include prescriptions of various topical creams that kill precancerous cells, resulting in crusting/ redness over varying time periods. Your doctor can discuss these options with you in greater detail.
Blue U Treatment: Another modality of treatment for widespread or diffuse precancerous cells (actinic keratoses) is Photodynamic Therapy (“Blue-U Treatment”). We use a photosensitizing agent called Levulan which is activated with the correct wavelength of light to treat the lesions. The medicine then kills the precancerous cells. Your doctor can discuss these options in greater detail with you to help you determine which is best suited for your needs.
Basal Cell Carcinoma
Basal cell carcinoma is the most common kind of skin cancer. It may present as a pink scaly patch, a shiny scar-like patch, a pink pearly bump, or a sore that does not heal. Basal cell carcinomas can grow locally and can become disfiguring and destructive. Treatment is generally surgical.
Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common kind of skin cancer. It may present as a pink scaly patch, a crusty nodule, or a sore that does not heal. Squamous cell carcinomas can grow locally and become disfiguring or destructive. When allowed to become exceptionally large or in settings where the immune system is compromised, squamous cell carcinoma of the skin can become metastatic and fatal. Treatment is generally surgical.
Brown, pink, black, grey, or multicolored spots that do not respect boundaries are concerning for melanoma. Signs to watch for are the ABCDE’s: Asymmetry, Border Irregularity, Color variation, Diameter greater than 6mm, and Evolution. Early detection and surgery to remove this kind of skin cancer is life-saving.
Acne can range from plugged pores (comedones) to deeper cysts and papules. It affects 17 million Americans and is the most common skin condition for which people see dermatologists. It can be disfiguring and can negatively impact self esteem at any age. Treatment options include many topical creams as well as oral medications including various antibiotics and Spironolactone. For severe refractory cystic acne, Isotretinoin (“Accutane”) may be considered. Your doctor can discuss this with you in detail if it is appropriate for your skin.
These are viral growths that can spread from one part of the body to another or between family members or other close contacts. There are multiple destructive treatment modalities available but these often require multiple treatments for cure. These destructive treatment modalities are considered by many insurance companies to be part of the surgical deductible. If you have questions please contact our billing department.
Eczema affects patients of all ages and fundamentally results from inadequate function of the skin barrier. Allergens and bacteria contribute to increased inflammation in the skin which manifests as itch and rash. Loss of moisture through the ineffective skin barrier also contributes to itching. Itching/ scratching further damages the skin barrier and the cycle continues. Your doctor can discuss the best way to treat and manage this chronic condition so that it has minimal impact on your lifestyle.
Psoriasis is a chronic skin condition that can affect patients of all ages. Management strategies may include topical or systemic therapies. Treatment options for severe psoriasis are expanding rapidly and your doctor is happy to discuss these with you as appropriate.