DERMATOLOGY

With an extensive history of skin cancer, this patient finds the doctor he trusts the most.

"I have had so much skin cancer, reports Fred Holloway. "I'm loaded up with it.

Thanks to a combination of fair skin and some severe childhood sunburns, Fred has spent much of his adult life receiving treatment for recurrent cancerous lesions.

"I've been treating this stuff for a good thirty years, he says. "When I moved down to Florida, my insurance at the time only covered me for a dermatologist who was about a forty-five minute drive from where I live, and I went there to be treated.

Fred became disenchanted with both the doctor and the long drive, and started to look for other options.

"I wasn't at all happy with the individual I was consulting, he confides. "So eventually, when I reached the age where I was eligible for Medicare, I started in Port St. Lucie with different doctors who were recommended to me. I have seen as many as five different ones here in the Port St. Lucie area.

With so much experience, Fred has strong feelings about who he sees for his skin cancer examinations and treatments. He now consults board-certified dermatologist Tim Ioannides, MD, of Treasure Coast Dermatology exclusively.

"I must say, in no uncertain terms, that Dr. Ioannides is without question the most professional doctor I have seen, and I've been to six different ones since I have lived in Florida, says Fred.

The Mohs procedure

Because skin cancer surgery must be performed in such a way as to leave the patient with the most cosmetically pleasing result possible, the surgeons at Treasure Coast Dermatology are trained in Mohs micrographic surgery , a special technique for select skin cancer patients.
"Mohs surgery is a highly specialized technique for precise, minimally invasive surgical treatment of skin cancer, explains Dr. Ioannides.

"Mohs surgery has the highest surgical cure rate for both basal cell carcinoma and squamous cell carcinoma, reports Jonathan Sanders, MD, JD. "For basal cell carcinoma, the technique produces approximately a ninety-nine percent cure rate, with just a slightly lower cure rate for squamous cell carcinoma.

The Mohs procedure is named for Dr. Frederick Mohs, who developed the surgery in the 1930s at the University of Wisconsin. It involves removing successive layers of tissue and immediately examining them with a microscope, so that all roots and extensions of the cancerous lesion can be eliminated.

Dermatologists who perform Mohs surgery must have specialized skills in dermatology and dermatologic surgery. Training for the Mohs procedure is available through select residency programs, specialized fellowships, and intensive training courses. Drs. Ioannides and Sanders are both members of the American Society for Mohs Surgery.

The entire procedure can take several hours to complete, but actual surgical time may be measured in just minutes. Most of the time is spent in careful preparation and scrutiny of the excised tissue.

"If cancer cells are still evident in a layer of tissue, another thin layer is excised during the same procedure, describes Dr. Ioannides. "The process is repeated until all the cancer cells are removed. In addition to removing the cancerous cells in the affected area, this process preserves as much healthy tissue as possible around the site of the lesion.

"That is the key issue, adds Dr. Sanders. "This is the most 'tissue-sparing' procedure for treatment of skin cancer. We know we are not taking out more tissue than we should, so it sets us up for the best cosmetic outcome possible, given the size of the lesion.

"It's also important to note that this is an outpatient procedure performed right here in our office under a local anesthetic, says Dr. Ioannides.

"Mohs surgery has a number of indications, he adds. "The size of the lesion and whether it's recurrent may lead a dermatologist to perform the Mohs procedure.

Professionalism and compassion

After so many years of skin cancer treatments, Fred appreciates the ease and effectiveness of the Mohs surgery.

"Years ago, when I first started skin cancer treatment, no one locally performed the Mohs procedure, he remembers. "I would go to my dermatologist, they would just cut off an area, cauterized it, maybe scraped it a little bit, cauterized it again, put a bandage on it, and that was it. In fact, no one ever suggested Mohs surgery to me over all those years I have had this stuff taken off, until the last two or three dermatologists I've seen.

"A lot of those [lesions] that were treated years ago have since come back. The edges weren't all clear when they cut it out, because they had no way of telling. But now, with the Mohs operation, the edges have to be clear or they keep cutting away until they get the edges clear.

Because he has new lesions appear so frequently, Fred is glad he consults Dr. Ioannides for them.

"Dr. Ioannides has been treating me for a good three years. During this time, I've had several skin cancers. I know Dr. Ioannides is a believer in the Mohs procedure, and I think it's the preferred treatment, too.

Fred has nothing but good to say about Dr. Ioannides and his staff.

"Of all the places I've been - and he has a fairly large staff there of nurses and office staff - they are all really the most professional and the most pleasant. Dr. Ioannides is excellent, and the girls are all very pleasant and very, very professional. I'm totally happy with him.

Spotlight on Sunscreen

The sun is necessary for life, but too much sun exposure may lead to poor health. More than one million people in the United States are diagnosed with skin cancer each year. Skin cancer, though, is largely preventable if people protect themselves from the sun, so whether it's a cool day in February or a sunny day in July, the board-certified physicians of Treasure Coast Dermatology are here to help you play it safe outdoors.

Properly used, sunscreens offer protection from the sun's damaging ultraviolet (UV) radiation. According to recent surveys, many people are confused about the correct use and effectiveness of sunscreens. Sharing information to help clear up some cloudy issues, Drs. Ioannides and Sanders hope to enable readers to protect themselves against sun damage confidently.

Since ninety percent of all skin cancers can be attributed to the sun, sunscreen is an important part of any skin protection program.

"With the rate of skin cancer soaring, particularly in Florida, protecting the health of our skin has never been more important, notes Dr. Sanders.

"Regular sunscreen use can inhibit squamous cell carcinoma, a form of skin cancer that kills between two thousand and five thousand Americans each year, adds Dr. Ioannides.

"In fact, he explains, "instead of just wearing sunscreen, people should also wear broad-brimmed hats and sun-protective clothing.

"Proper sun protection, including sunscreen, provides an intense, long-term benefit against squamous cell carcinoma, adds Dr. Sanders. "Remember: we're here to help people play it safe, this season and every season.

The ABCs of Self-Exams

When you check your skin, be sure to look for

A - Asymmetry - moles or pigmented spots that are unevenly matched in size, shape, color or thickness.

B - Border Irregularity - If the edges of your moles or spots are ragged, scalloped or poorly defined, you need to have them checked by a professional, like the ones at Treasure Coast Dermatology.

C - Color - Moles or spots that are uneven in color or appear even slightly mottled are a sign that you need to pick up the phone and make an appointment with a board-certified dermatologist.

D - Diameter and Difference - Think of the size of a pencil eraser from those days when you were learning your ABCs. If your mole is larger than the size of a pencil eraser, or if it looks different from all the others you've acquired, you should see a dermatologist. If your mole bleeds or itches, or just bothers you - even if it's smaller than a pencil eraser - pick up the phone and put your mind at ease.

E - Evolution or change in the lesion. Any change in a previously unchanging mole or pigmented spot should be reported to your dermatologist.