Services
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General Dermatology:
Skin Cancer Treatment, Screening, and Education
Acne/Rosacea
Eczema/Dermatitis
Psoriasis
Mole and Pigmented Lesion Evaluation/Surveillance
Rashes
Warts
Diseases of the skin, hair, and nails
Other Dermatologic Diseases
Phototherapy

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Skin Cancer Diagnosis and Treatment:

           

Skin cancer is the uncontrollable growth of abnormal cancerous cells in a layer of the skin. It affects one out of every five Americans, making it the most prevalent form of cancer. However, the majority of all skin cancers can be cured if detected and treated in time. Please see ‘Skin Cancer: Signs and Symptoms’ and ‘Skin Cancer Fact Sheet’ provided by the American Academy of Dermatology.

 

There are several different kinds of skin cancers, distinguished by the types of cells affected. The three most common forms of skin cancer are:

 

Basal Cell Carcinoma

Basal cell carcinomas (BCC) usually appear as shiny, pink to pearly, fragile, raised translucent lumps that can bleed easily.  Basal cell carcinomas are the most common cancer, with more than 2.5 million occurring annually in the United States.  Although basal cell carcinomas do not usually spread to other parts of the body through the blood stream, it may cause considerable damage by direct growth and invasion.

 

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is usually distinguished by raised, scaly, firm reddish lumps or growths that are sometimes tender or painful.  More than 500,000 squamous cell carcinomas occur annually in the United States.  Squamous cell carcinoma has the ability to metastasize, or spread through the bloodstream or lymphatics, to other parts of the body.  The risk of metastasis increases with tumor size, duration, and specific locations such as the ear or the lip.  Approximately 2,000 deaths occur each year from this form of cancer.

 

Malignant Melanoma

Malignant melanoma typically first appears as a pigmented light brown to black irregularly shaped blemish. These lesions frequently stand out from the rest of a person’s pigmented lesions as the ‘Ugly-Duckling’ lesion.  Improved outcomes are achieved with early diagnosis and treatment.  Melanoma is unfortunately the most deadly form of skin cancer, with it’s lethality coming as a result of melanoma’s ability to metastasize to other parts of the body through the bloodstream and the lymphatic drainage system.  High-intensity ultraviolet exposure is associated with increased risk of developing melanoma.  Recent studies have linked tanning beds to the dramatically increasing incidence of melanoma, finding that "those who tanned indoors had a 74% greater risk of developing melanoma than those who never used the machines."

 

Treating Skin Cancer

The dermatologic surgeon will select the most appropriate treatment for a particular skin cancer or precancerous condition from among the following procedures and techniques:

  • Cryosurgery
    Liquid nitrogen is applied directly to the skin to freeze cancerous tissue, in a more aggressive fashion than treating pre-cancerous growths.  This results in a crusted wound which then heals on its own.
     

  • Curettage
    Malignant tissue is scraped away with a sharp instrument. This method is most effective for small, superficial cancers that have not been treated previously.  It is often followed by destruction of the cancerous tissue with an electric needle.  The wound then heals on its own.
     

  • Surgical Excision
    Surgical excision involves excising around and under the skin cancer with a safety-zone of normal-appearing skin, fully removing the tumor for pathologic evaluation.  The wound is then reconstructed with sutures.  
     

  • Mohs Micrographic Surgery (Mohs)

    Mohs Micrographic Surgery is an outpatient procedure performed under local anesthesia with two goals:  1) to remove skin cancers with exceptional accuracy and the highest possible cure rate available from any technique, and 2) to keep the surgical defect (wound) as small as possible by minimizing the removal of normal healthy skin.  These goals are achieved by surgically excising the obviously involved area of skin but without the safety-zone of normal-appearing skin that would normally be removed with a standard surgical excision.  A bandage is then applied and the patient waits while the tissue is converted to microscopic slides.  The Mohs Surgeon then evaluates the entire surgical (peripheral and deep) margin by examining the microscopic slides.  If any cancer is present at the base or edge of the excision, its location is mapped out, and an additional layer is surgically removed from only the involved area.  The microscopic evaluation is then repeated and this process continues until 100% of the cancer has been removed. 

                Once the cancer has been entirely removed, the Mohs Surgeon is able to reconstruct the wound with whatever technique will result in the best long-term cosmetic and functional outcome.  This can involve linear, flap, or skin graft techniques, or combinations of the above.

     

    For more information please visit the websites for the American Society for Mohs Surgery and the American College of Mohs Surgery.

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Photodynamic Therapy for Precancerous Actinic Keratoses & Chronic Photodamage

 

What is an Actinic Keratosis?

Actinic Keratoses (AKs) are rough, scaly patches on the skin, caused by cumulative excessive exposure to the sun, which can sometimes progress into dangerous skin cancers. Many doctors believe that AKs and squamous cell carcinomas (skin cancer) are really the same condition at different stages of a continuum.

 

How long has Photodynamic Therapy (PDT) been around?

Photodynamic therapy has been utilized for more than 20 years.  It was approved by the Food and Drug Administration for the treatment of Actinic Keratoses in 1999.

 

What is ALA?

ALA is short for Aminolevulinic acid, which is a clear solution that is applied to the skin during the treatment.  ALA occurs naturally in the body and it is involved in the synthesis of hemoglobin.  ALA is preferentially absorbed by abnormal precancerous skin cells and therefore causes minimal to no damage to normal tissue.

 

How does PDT work?

After absorption by the abnormal precancerous cells, ALA is converted to a natural photosensitizer called Protoporphyrin IX (Pp IX).  The skin is then illuminated with a visible blue light source and this begins the Photodynamic process of singlet oxygen production.  The release of the singlet oxygen from Pp IX destroys the targeted precancerous cells.

 

What can I expect?

  • You will be given a series of two (sometimes three) treatments, about two weeks apart.
     

  • The technician will do an aggressive acetone scrub, using cotton squares, on the area to be treated. Then ALA will be applied and allowed to incubate for 60-90 minutes. After the incubation period, you will wash off the ALA and will then be exposed to visible blue light for approximately 17 minutes, which activates the photosensitizing agent to destroy the targeted precancerous cells.
     

  • Subsequent treatment sessions may need longer incubation times depending on your response and tolerance to redness and peeling.
     

  • After the treatment is completed you must remain completely out of the sun for 24-48 hours because any visible sunlight or ultraviolet exposure can further activate the process and cause an excessive reaction. Sunscreens will NOT protect from visible light, which has the ability to further activate the process and result in excessive reactions.
     

  • You may get a sunburn-like reaction and experience some mild discomfort. Red, chapped, flaking, or peeling skin may continue for 7-10 days after the treatment.
     

  • You will be given more details in the Consent Form and Aftercare Instructions at the time of your first appointment.
     

  • If you have a history of cold sores (aka: fever blisters, herpes simplex), you may be given preventative treatment with anti-viral medications to prevent an outbreak.
     

  • You should not undergo photodynamic therapy if you have a history of any photosensitizing condition.

For More Information on Photodynamic Therapy:

Please watch the informative ‘PDT Patient Education Video’.

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COSMETIC DERMATOLOGY - Botox, Fillers, Juvederm & Radiesse

BOTOX Treatments:
BOTOX Cosmetic is a purified protein injected directly into the target muscle to treat vertical lines between the eyebrows, the squint lines or “crow’s feet” at the corners of the eyes and the forehead horizontal lines.  It may also be used for eyebrow positioning. This is a non-surgical procedure that weakens and relaxes facial muscles. Since there is no way to make the undesirable facial expression, the lines gradually smooth out from disuse, and new creases are prevented from forming. Other muscles like those needed to raise the eyebrows are not affected so a natural expression is maintained.

Other Applications
Excessive sweating can be alleviated with injections directly into the underarm skin. Botox paralyzes the sweat glands of the skin which are responsible for excessive perspiration. A single treatment session can provide months of relief, and experts believe that injections can be repeated indefinitely once or twice a year to maintain dryness.

Side Effects
Side effects are minimal and typically relate to the local injection. Soreness or mild bruising, while uncommon, may occur around the injection site. Makeup may be worn after treatment, but care should be taken to avoid pressing or massaging the area for several hours. In rare instances, patients may develop temporary weakness of the neighboring muscles, a temporary droopy brow or eyelid, or a headache.

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Juvéderm™ injectable gel is a nonsurgical, physician-administered treatment. Tiffany Serell, PA-C, MS eases Juvéderm™ under the skin using a fine needle to augment, or fill, the soft tissue of the dermis—the dense inner layer of skin beneath the epidermis—to add volume and diminish wrinkles and folds. Juvéderm™ injectable gel is used most effectively for those wrinkles and folds in the lower third of your face, like your "laugh lines," "smile lines" or "parentheses" (nasolabial folds), or "marionette lines" (oral commissures).

Juvéderm™ is a "next-generation" filler. It is made from hyaluronic acid—a naturally occurring substance in your skin that helps to hydrate and add volume. Natural hyaluronic acid in your skin may diminish with age, contributing to the formation of wrinkles and folds. Juvéderm™ injectable gel works to correct this by restoring hyaluronic acid in your skin, helping to smooth wrinkles and folds.

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Cosmetic Products

At the Fort Collins Skin Clinic, we carry an extensive selection of photo-protective and cosmetic skin-care products from:

Additional Products Available:

  • Latisse

  • Topical retinoids

  • Bleaching and blending creams

  • Benzoyl peroxide cream

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Content ©2005 American Society of Dermatologic Surgery


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