What is a Mohs Surgeon?

We loved this article from EverydayHealth.com. Having an annual checkup and a spot or two removed is definitely less scary than battling skin cancer. If you are seeking treatment for skin cancer or need guidance with an irregular mole visit Dr. Germain, certified Mohs surgeon, for the best care in Charleston.

5 Reasons Why Skin Cancer Surgery Isn’t So Scary
•By Christina Heiser

Get the inside scoop on Mohs surgery, the most popular treatment option for basal and squamous cell carcinomas.

Wear a wide-brimmed hat to minimize your sun exposure.
Veva Vesper has dealt with more than her fair share of skin cancer in the last 25 years. The 69-year-old Ohio resident has had more than 500 squamous cell carcinomas removed since the late 1980s, when the immunosuppressant medication she was taking for a kidney transplant caused her to develop them all over her body — everywhere from the corner of her eye to her legs.

While Vesper’s story is unusual, skin cancer is the most common cancer in the United States. In fact, it’s currently estimated that one in five Americans will get skin cancer in his or her lifetime.
Mike Davis, a 65-year-old retired cop, and like Vesper, a patient at The Skin Cancer Center in Cincinnati, Ohio, has a more familiar story. Earlier this year, he had a basal cell carcinoma removed from his left ear — the side of his face most exposed to UV damage when driving on patrol.
The buildup of sun exposure over your lifetime puts you at greater risk for developing basal and squamous cell skin carcinomas as you age. Both Vesper and Davis had Mohs surgery, the most effective and precise way to remove the two most common types of skin cancer.

“The benefits of Mohs surgery are twofold: One, you’re going to remove just the cells you need to without having to take a lot of unnecessary tissue, and two, Mohs surgery can tout cure rates of 99 percent,” says Dendy Engelman, MD, a dermatologist and Mohs surgeon in New York City and the director of dermatologic surgery at New York Medical College.

We asked top experts to answer the most common questions about Mohs surgery.

1. What exactly is it? 
Mohs surgery is named after Frederic Mohs, a professor of surgery at the University of Wisconsin, who developed the treatment in the 1930s. “It’s a very tissue-sparing technique, where we go layer by layer, examining 100 percent of the margin in order to trace out the cancer using a microscope,” says Engelman.

You’ll be awake for the procedure, which is done under local anesthesia. The surgeon starts by cutting out a small piece of the tumor with a scalpel. A lab technician then freezes and stains the tissues for the surgeon to look at under a microscope. “Cancer grows like roots of a tree,” explains Brett Coldiron, MD, the founder of The Skin Cancer Center in Cincinnati and an assistant clinical professor at the University of Cincinnati. “What we do [during Mohs surgery] is cut out a disc of skin and check for roots poking through. It’s very obvious under the microscope.”

“Mohs surgery can tout cure rates of 99 percent.”Dendy Engelman, MD, dermatologist and Mohs surgeon. If a root is visible, the surgeon will go back and remove another layer of the tumor, repeating the same process until the entire cancer is gone.  “Very rarely do we go past three passes,” says Coldiron.

2. Who should get it?
“Moh’s surgery is very useful around the eyes, nose, mouth, and ears,” says Coldiron. “It’s also useful around the cheek if it’s a larger tumor.” Additionally, Mohs surgery can be performed on the hands, feet, and neck — areas where you’d want to preserve as much tissue as possible, says Engelman.
While Mohs surgery is generally used on basal and squamous cell cancers, in some cases it can be used to treat melanoma, especially if the cancer is thin or confined to the outer layer of skin. “Patients should ask their Mohs surgeon if this a procedure they offer, as not all Mohs specialists treat melanoma with Mohs,” says Engelman.

3. How long does it take?
Expect to be at the doctor’s office for approximately one to three hours. After your surgeon removes the first layer of tissue, which takes about 10 minutes, you’ll be sent to the waiting room for about a half hour while the surgeon examines the tumor.  Then, you’ll be brought back to the exam room to either get stitched up, which takes another 20 minutes, or have another piece of the tumor removed.

4. Will it hurt? 
No more than a biopsy, says Engelman. The area is numbed with enough lidocaine, a local anesthetic that reduces pain, to last for about two and a half to three hours. “The discomfort is minimal — there’s just that initial stick [of the needle],” says Engelman. “You may feel a little bit of pressure [during the procedure], but you don’t feel pain.”

Afterwards, most patients only experience minimal pain. “Certain areas like the scalp, legs, or areas under tension (like skin over joints) may be more sensitive and may require prescription strength pain medication for one to three days post-surgery, but the vast majority of surgeries do not require prescription analgesics,” says Engelman.

5. Will there be a scar?
Yes — but it’ll become less noticeable over time. “It may take six months for the redness to fade and for the scar to settle down, but six months down the road, most patients are happy with the final result,” says Coldiron.

To ensure the wound heals nicely, follow the post-operative care instructions given to you by your doctor, says Engelman. “Moist wounds have been found in studies to heal faster than those left exposed to air,” she says. “The scar formed tends to have a better aesthetic appearance when kept moist and covered with a bandage.”

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“5 Signs of a Good Dermatologist”

We loved this article from EverydayHealth.com:
“5 Signs of a Good Dermatologist” by Grace Gold

Whether you want to get rid of adult acne or you’re curious about the latest in anti-aging technology, choosing a dermatologist can sometimes be as daunting as the skin problems that plague you. Simplify the search by paying attention to these five guidelines when shopping around.

Not all dermatologists are created equal. Finding the one who will work with you to resolve your particular problems and concerns requires some research. When you’re looking for your ideal dermatologist, use these five guidelines to differentiate the best from the rest.

The best credentials. Report cards matter. Any doctor with a medical degree can start a dermatology practice, but certified physicians boast additional years of supervised study and have passed rigorous exams. Do a free online search to ensure that a prospective dermatologist is board certified by the American Board of Dermatology, which is the gold standard for the industry, says Wendy Lewis, the author of America’s Cosmetic Doctors and a cosmetic surgery consultant. She warns, “Many doctors call themselves dermatologists but may be internists, general practitioners, or something else.” Even if a doctor claims to be a “board certified physician,” the certification isn’t necessarily in dermatology. If you’re specifically interested in anti-aging options — such as laser resurfacing, wrinkle fillers, peels, and skin tightening — you can check the American Society for Dermatologic Surgery for additional certification. Says Lewis, “Members include top experts in cosmetic procedures.”

Unrushed appointments. Exceptional dermatologists don’t look at the clock; they look at your chart and are completely focused on your personal story and your questions. “Your dermatologist should take the time to explain things, address your concerns, and explain treatment plans, as well as any tests you may have to undergo,” says David Bank, MD, president of the New York State Society for Dermatology and Dermatologic Surgery. If a dermatologist dismisses your thoughts, is difficult to follow up with, or rushes you through an appointment, it’s time to find someone who values you more as a patient.

No sales pitching. It’s a doctor’s office — not a home shopping television show. The dermatologist and the office staff should never aggressively push products, treatments, or other remedies that don’t specifically address your personal concerns. “If you feel that a dermatologist is selling you, he or she may be more interested in your money than in helping you,” says Dr. Bank.

A generous sampling policy. An office chock-full of mini tubes of various products shows that a dermatologist genuinely wants patients to find the best — and not just any — solution to a given skin problem, and that he or she is conscious of budgets and prescription copay amounts. “If your dermatologist wants you to try a product to make sure it’s right for you before you commit to buying a prescription, it’s a great sign,” says Bank. And don’t be shy; speak up and ask if samples are available, as doctors often have to trash loads of expired samples.

After-hours care. You should never feel left in the dark. Whether you’re experiencing an allergic reaction following a treatment or you have a pressing question about it, there should be a way for you to reach the dermatologist during evenings and on weekends. “A good dermatologist will have on-call service for emergencies after hours,” says Bank. Some may have answering services that relay messages, while others may leave an urgent contact number on the office’s answering machine. Rather than finding yourself out of luck after weekdays at 5 pm, find a dermatologist who will be there for you.

Looking for a new dermatologist? Come see us at Germain Dermatology. Dr. Germain and our staff will treat you with the most advance practices and products and make you feel like family. 

Pregnancy Glow- Not a Myth.

Are you one of those amazingly beautiful pregnant women, who love every second of being pregnant? Or are you more realistically one of those women, who really want to enjoy being pregnant, but are uncomfortable, sick and frankly exhausted?
 It’s not a case of bad luck or bad genes, there is actually a scientific reason behind that ‘pregnancy glow’ some are blessed with (and we are willing to bet that you are glowing outside, whether you feel it inside!).
Your actual glow?
“During pregnancy, blood volume expands, giving the skin a flushed look, similar to what you get after exercise,” explains Jennifer MacGregor, MD, a dermatologist at Union Square Laser Dermatology, in New York City. “Your sweat gland activity also increases, leaving more secretions on the skin, which gives it a little bit of a sheen.”
The Clear Skin?
“Your hormones seem to balance out in such a way that it can take care of skin problems,” says Judith Hellman, MD, a dermatologist in New York City. “It’s why women often go on birth control pills to clear up acne — the pills actually mimic the hormonal state of pregnancy.”
Adding to the ‘glow’ your hair and nails flourish due to extended growing periods and pre-natal vitamins. Whether you feel like a house or loving every minute of your pregnancy- know that you are still glowing to everyone around you.
It’s a scientific fact. 
*Thank you to Everyday Health for some great facts.