Surgical dermatology is a specialized area of dermatology that focuses on the treatment of skin conditions and diseases through surgical procedures. These procedures can be performed for both medical and cosmetic reasons, addressing issues such as skin cancers, benign growths, scars, and other abnormalities.
Skin biopsy
It is recommended if you have a new or changing mole, to diagnose skin rashes such as inflammatory skin conditions,auto immune diseases,skin cancers,bistering skin diseases and others.It is performed after numbing the area.Depending on the skin condition, our doctor will recommend one of the following:
- Shave biopsy: top layers of skin is scraped by a special razor.Stitches are not needed
- Punch biopsy: Sample is taken by a round tipped tool called punch.It takes skin and top layer of fat.Stitches are used to close the wound.
Scalp Biopsy
It is similar to skin biopsy.Either a punch or excisional biopsy is performed on scalp depending on the scalp condition.It is used to diagnose hair loss and scalp disorders.Procedure takes around 20 -25 minutes. Post skin or scalp biopsy keep the area clean.Stitches are generally removed within a week and your biopsy result will be discussed with you.Based on the results, next step will be planned
Excisional Biopsy (Mole Removal)
Entire lump or area of skin is removed by a scalpel.Sample removed might include a border of healthy skin.Stitches are used to close the wound.This is usually performed when a skin cancer is suspected, or to remove a skin growth completely such as a mole,cyst or a skin lump.
Electrocautery
Electrocautery is a form of electrosurgery as it uses electric current to remove an unwanted or harmful tissue.It is also used to seal a blood vessel and stop bleeding during surgery.An electrically heated handheld device (cautery pen) is used to treat skin conditions such as actinic keratosis,molluscum,warts,skin tags,seborrheic keratosis,noncancerous skin growths.
Procedure is usually performed after numbing the treatment area with a topical cream.With the cautery pen skin lesions is burned off with precision,speed and high effectiveness.Recovery is is within few weeks.Treatment area may heal with lighter or darker color which is usually temporary.
Since electrocautery uses electric current it is not recommnended for people with pacemakers or implanted devices.
Cryotherapy
Cryotherapy is applying extreme cold substance such as liquid nitrogen to destroy abnormal tissue.Freezing kills abnormal cells and immune system helps to clear the tissue out of body.It is used to treat a variety of skin conditions such as warts,actinic keratosis,seboherric keratosis and some precancerous and early stage skin cancer including squamous and basal cell carcinoma.Besides skin it is used to treat cervical cancer,prostrate cancers and others.
Skin can turn red or blister after cryotherapy.It will usually scab and heal within one to three weeks.In certain conditions more than one treatment might be needed.
Curettage
Curettage is the surgical scraping, which may be used to remove a foreign matter, diseased tissue such as tumors or growths or to obtain a biopsy that can be used for diagnosis. A a small, spoon-shaped tool with a very sharp edge called a curette is used to perform this procedure. In our center we use curettage and electrocautery commonly to scrape away skin lesions like
- Benign lesions such as warts, spider nevi, skin tags, seborrheic keratoses, and angiomas
- Premalignant skin lesions called actinic keratoses
- Cancerous skin conditions such as basal cell carcinoma and cutaneous squamous cell carcinoma
The wound may be sore for several hours after the procedure, once the anesthetic has worn off. Patients are advised to follow the below instructions:
- Keep the dressing on for 24 hours or as advised by the dermatologist
- Avoid stretching or using the wound area
- Take pain killers, as advised
- If the wound bleeds, press on it with a towel for 20 minutes and seek medical attention if the wound is still bleeding after this time
- Keep the wound dry for 48 hours, after which it can be gently washed and dried
- Seek medical attention if the wound reddens or becomes very painful
The wound generally takes two to three weeks to heal.Topical antibiotics may be used to prevent infection.
Acne Surgery
Acne vulgaris is a common chronic inflammatory disease of the pilosebaceous unit that can lead to permanent scarring, leaving the face disfigured and negatively impacting one’s quality of life. Acne-related scarring has been associated with higher rates of mental distress making the treatment of acne scars a priority for clinicians. Treatment options for acne scarring vary based on depth and extent of involvement and can include laser resurfacing, microneedling, chemical peel, dermal fillers, subcision, and punch excision, among others. Laser treatment for acne scars helps to minimize the appearance of scars.Laser light breaks up the scar tissue and also stimulates cells to produce new collagen.Multiple sessions will be needed depending upon the severity. Consult our dermatologist to know if you are a good candidate for laser treatment.
Comedone Extraction
Acne starts with tiny blockage in the hair follicles known as comedones. These comedones are extracted by using a comedone extractor.It is done to remove whiteheads and blackheads. It may cause little discomfort, pain, scarring and infection.
Subcision
Subcision is a minimally invasive surgical procedure primarily used to treat depressed scars, such as acne scars, and certain types of wrinkles. It is designed to improve the skin's surface by breaking up the fibrous bands of tissue that pull the skin down and create a pitted or sunken appearance.
Laser
Lasers have revolutionized the practice of modern dermatology. In the last few years, we have looked beyond the traditional lasers and explored new concepts. Lasers are accepted for treating pigmented lesions, hair removal, vascular lesions, leg veins, tattoos, and for skin resurfacing.
The 308 nm excimer laser has recently been shown to clear psoriasis faster than conventional phototherapy. Scalp psoriasis may soon be treated by fiber-optic delivery of this UV laser. Excimer laser has proved to be effective in the treatment of limited vitiligo, however, the rate and speed of repigmentation is highly associated with the site and duration of disease as the face and neck (UV sensitive areas) are the highly respondent areas along with an earlier resolution of the lesions while the joints and extremities (UV resistant areas) exhibit the slightest response to therapy Also, the shorter disease course is more promising in the treatment results.
Erbium YAG or carbon dioxide CO2 are ablative lasers. They remove the entire top layer of your skin in the area of scarring. It can take a week or more for the redness from ablative lasers to subside.
The heat from these lasers stimulate collagen production and stimulate new cell growth to replace scar tissue.
Fractional lasers (Fraxel) aim to stimulate the tissue underneath your scar to remove cells that are darkly pigmented underneath the top layer of skin.
Some side effects of laser treatment are swelling,redness, pain,hyperpigmentation and infection. While these conditions are rare and often preventable, it’s important to speak to your doctor about your risk factors before you decide to go ahead with treatment.
If you notice pus, extensive swelling, or fever after laser treatment for acne scarring, you’ll need to speak to your provider right away
Skintags Removal
Skintags medically called acrochordons are soft, small wart like skin growth. They hang off from the skin and vary in size from few mm to 5 cm. They appear in skin folds like neck, underarms and others. They are generally harmless, sometimes they may bother if rubbed or scratched accidentally. They can be removed by simple procedures like excision, cryotherapy and cauterization.
Warts Removal
Warts are benign (not cancerous) skin growths caused by human papillomavirus (HPV). Virus can enter through cut or damage in skin. These are contagious and spread by contact. Some individuals are more susceptible to warts than others. Kids and adults with immune system disorders are particularly prone to it.
Warts are often skin colored and feel rough. They are common on hand and feet. They can be flat or filiform. They can develop under or around the finger and toe nails and can be uncomfortable. Warts can also be seen in genital area
With a healthy immune system wart can go away on its own. This can take long and, in the meantime, spread to other parts of body. To prevent it from spreading to other parts and to other people, you can cover your wart and wash hands after touch them. If wart is in hairy like beard/pubic area, they can spread by shaving.
Treatment of warts depend on age, location and health status of the patient. They are removed by electrosurgery and curettage, excision and cryotherapy. Resistant warts can be treated with immunotherapy. Bleomycin or lasers. Our doctor at BMWC, is experienced and highly skilled in treating warts in kids/adults and those who don't respond to simple treatments. Removing warts in kids can be painful. In our center we make sure kids have proper anesthesia and try to make the procedure as painless as possible. Discuss with our doctor the best treatments options and how to prevent recurrence of warts.
If you or a family member has viral warts, follow these precautions to prevent the spread of infection.
Don't share personal items like towels, razors etc.
Clean and cover cuts
wash hands often
prevent dry, cracked skin
Stop nail biting and cuticle chewing
Wear flip flops at public places like pools.
There is no cure for viral warts. Warts can return at the same site or appear is new spot. Old warts can shed virus cells into the skin before the warts are being removed. This allows new wart to grow around the first one. To prevent this best way is to treat new wars as soon as they appear.
Vitiligo surgery
- i) Skin graft - pigmemented skin is removed and transplated to one or more areas of vitiligo.
- ii) Cell transplant - Instead of grafting the skin, cells are taken from the skin then placed on vitiligo areas.Re pigmentation can occur form 6 - 12 months. Surgery is not recommneded when vitilogi is active which means in the last 12 months new patches have appeared or existing spots have grown.Also people with tendency for hypertrophic scars or keloids should avoid surgery.
