Procedures

Most dermatologic procedures are performed in the dermatology provider’s office. This page explains the most common procedures that patients may have to treat a variety of conditions from acne to skin cancer. These procedures are performed with local anesthesia and have minimal recovery time.
ACNE SURGERY
Acne surgery refers to a group of minor surgical procedures that dermatologists use to treat certain types of acne, especially when other treatments (like topical or oral medications) have not been effective. These procedures are generally performed to remove or drain acne lesions, such as cysts or comedones (blackheads and whiteheads). The goal is to speed up healing and reduce the risk of scarring.
 
Common Types of Acne Surgery
 
Comedone Extraction
• This procedure involves manually removing blackheads and whiteheads. The dermatologist uses a small tool called a comedone extractor to gently press around the clogged pore and remove the contents. It is often done when comedones are persistent and do not respond to topical treatments.
 Drainage and Excision of Cysts
• For larger, painful acne cysts that don’t respond well to other treatments, drainage and excision may be performed. The cyst is cut open, drained of pus, and sometimes completely removed. This can relieve discomfort and prevent the cyst from rupturing under the skin, which could lead to scarring.
 Incision and Drainage (I&D)
• This is often used for large, painful acne lesions that have become infected or inflamed. The dermatologist makes a small incision in the lesion and drains the pus, helping to relieve pain and pressure, and promoting faster healing.
 
Benefits
 
• Immediate Relief: Acne surgery can provide quick relief for painful cysts and reduce inflammation.
• Preventing Scarring: By properly removing or draining deep acne lesions, the procedure can reduce the risk of acne scars forming.
• Effective for Resistant Acne: It’s particularly helpful for treating stubborn acne that doesn’t respond well to traditional therapies like topical creams or oral medications.
 
Risks and Side Effects
 
• Temporary Redness and Swelling: The treated area may be red or swollen for a short time after the procedure.
• Scarring: While acne surgery can reduce the risk of scarring, there is still a small chance of scar formation, particularly if the procedure is not performed properly or the skin doesn’t heal well.
• Infection: There is a small risk of infection, which is minimized by the use of sterile techniques.
 
Post-Procedure Care
 
• Avoid Picking or Squeezing: After the procedure, it is essential to avoid touching or picking at the treated area to allow it to heal properly.
• Topical Treatments: The dermatologist may recommend using topical antibiotics or other treatments to prevent infection and reduce inflammation after the procedure.
• Sun Protection: Protecting the treated skin from sun exposure is important to prevent hyperpigmentation or scarring.
 
Acne surgery is typically performed as an outpatient procedure in a dermatologist’s office. It can be an effective part of a broader acne treatment plan when combined with medications or skincare regimens



BIOPSY
A skin biopsy is a medical procedure in which a small sample of skin tissue is removed and examined under a microscope to diagnose or rule out various skin conditions or diseases, including skin cancer, infections, inflammatory conditions, and other abnormalities. A skin biopsy is a commonly performed procedure that helps provide a definitive diagnosis when visual examination of the skin is not sufficient.
 
Reasons for a Skin Biopsy
 
 A skin biopsy may be performed to:
 • Diagnose skin cancer (such as melanoma, basal cell carcinoma, or squamous cell carcinoma).
 • Identify non-cancerous skin conditions, such as psoriasis, eczema, or dermatitis.
 • Investigate infections of the skin caused by bacteria, fungi, or viruses.
 • Diagnose autoimmune or inflammatory conditions, such as lupus or vasculitis.
 • Evaluate abnormal growths or moles that have changed in size, shape, or color.
 • Determine the cause of a rash or unexplained skin lesion(s).
 
Types of Skin Biopsies
 
There are several types of skin biopsies, and the choice of procedure depends on the size, depth, and location of the skin lesion being evaluated.

Shave Biopsy
 • How it’s done: A thin, superficial layer of skin is shaved off using a scalpel or razor. This type of biopsy is used for surface-level growths or conditions, such as warts, moles, or lesions that  don’t require deep tissue sampling.
 • Best for: Diagnosing non-melanoma skin cancers, superficial lesions, or benign skin growths.
 • Healing: Usually heals well without stitches, leaving a small, flat scar.
 
 Punch Biopsy
 • How it’s done: A small, round tool (like a tiny cookie cutter) is used to remove a circular piece of skin that includes deeper layers, such as the dermis and sometimes the subcutaneous fat. This type of biopsy is used for diagnosing conditions that affect deeper layers of the skin.
 • Best for: Investigating rashes, inflammatory skin conditions, or lesions that require deeper tissue samples.
 • Healing: Usually requires stitches to close the wound, and the area will heal with a small scar.
 
 Excisional Biopsy
 • How it’s done: The entire lesion, along with some surrounding healthy skin, is removed using a scalpel. This is a more extensive procedure and is commonly performed when melanoma or other types of skin cancer are suspected.
 • Best for: Removing and diagnosing larger, suspicious lesions or skin cancers.
 • Healing: Stitches are required, and a larger scar will form as the wound heals.
 
 Incisional Biopsy
 • How it’s done: Only a portion of the lesion is removed for analysis. This is useful for larger growths where full removal is not necessary or practical.
 • Best for: Sampling a part of a large tumor or lesion to confirm a diagnosis before proceeding with further treatment.
 • Healing: Stitches may be needed, and scarring is similar to that of a punch biopsy or excisional biopsy, depending on the size of the tissue sample.
 
The Procedure
 
 Preparation
 • The area to be biopsied is cleaned and a local anesthetic is injected to numb the skin.
 • Once the area is numb, the dermatologist or healthcare provider performs the biopsy, removing the skin sample using the appropriate technique (shave, punch, excisional, or incisional).
 Tissue Handling
 • The removed skin sample is placed in a container with a special solution to preserve it.
 • The sample is sent to a laboratory for histopathological analysis by a pathologist who examines the tissue under a microscope.
 Aftercare
 • The biopsy site is typically covered with a bandage, and the patient is given instructions for caring for the wound to prevent infection and promote healing.
 • If stitches are used, they are generally removed after 7–14 days, depending on the location and size of the biopsy.
 • Healing times vary depending on the type of biopsy performed, but most biopsy sites heal within 1 to 2 weeks.
 
Risks and Complications
 
 While skin biopsies are generally safe, there are some potential risks, including:
  • Infection: Proper wound care can help minimize this risk, but any signs of infection (increased redness, swelling, or pus) should be reported to a healthcare provider.
• Scarring: Depending on the size and depth of the biopsy, scarring may occur. Excisional biopsies typically leave more noticeable scars than shave or punch biopsies.
  • Bleeding: Mild bleeding or bruising at the biopsy site can occur, but significant bleeding is rare.
  • Allergic reaction: Although uncommon, some people may have an allergic reaction to the local anesthetic used during the procedure.
 
Results
 
• Benign findings: If the biopsy reveals benign (non-cancerous) skin growths, no further treatment may be necessary, though follow-up may be required for monitoring.
• Cancerous findings: If skin cancer is detected, further treatment (such as surgery, radiation, or other therapies) may be recommended, depending on the type and stage of cancer.
• Inflammatory or infectious conditions: For conditions like psoriasis, lupus, or infections, the biopsy can help guide appropriate treatment with medications or other therapies.
 
When to See a Doctor
 
If you notice any changes in your skin, such as new growths, changes in moles, or persistent rashes or lesions, you should consult a healthcare provider. Skin biopsies are an essential tool for early diagnosis, especially in cases of skin cancer, where early detection can lead to more effective treatment and better outcomes.


CRYOTHERAPY
Cryotherapy is a medical treatment that uses extreme cold to destroy abnormal tissue. It is commonly used for a variety of conditions, including skin lesions, warts, and certain types of skin cancer. The cold is typically delivered via liquid nitrogen, which freezes and kills the targeted tissue. Here are some common applications of cryotherapy:
 
 Skin Lesions: Cryotherapy is often used to treat benign skin conditions such as warts, moles, or actinic keratoses (precancerous skin growths).
 Skin Cancer: It can be effective in treating superficial types of skin cancer, such as early-stage basal cell carcinoma or squamous cell carcinoma in situ (Bowen’s disease).
 
How Cryotherapy Works
 
  For Skin Lesions: The healthcare provider applies liquid nitrogen directly to the affected area using a spray device or cotton swab. The extreme cold freezes the tissue, causing it to blister and eventually fall off.
  For Cancerous Lesions: The extreme cold destroys cancer cells by freezing them. Over time, the frozen tissue dies and is absorbed by the body or falls off.
 
Benefits
 
  Minimally Invasive: It requires no cuts or stitches.
  Quick Procedure: It typically takes only a few minutes.
  Minimal Scarring: Cryotherapy can result in less scarring compared to other removal methods.
 
Potential Side Effects
 
  Blisters and Scabs: The treated area may blister, scab, or form a sore, which heals over time.
  Temporary Pain: The area may be painful or sore for a short period.
  Pigmentation Changes: It can cause temporary or permanent changes in skin color at the treatment site, especially in people with darker skin tones.
 
Cryotherapy is a quick and effective treatment and is usually recommended for smaller or superficial lesions.


ELECTRODESICCATION AND CURETTAGE
Electrodesiccation and curettage (ED&C) is a common procedure used to treat certain types of skin lesions, particularly superficial skin cancers like basal cell carcinoma, squamous cell carcinoma in situ, and benign skin growths. The procedure combines scraping away abnormal tissue (curettage) with the use of electrical energy to destroy any remaining cancerous cells (electrodesiccation).
 
How It Works
 
  Curettage
      The doctor uses a tool called a curette (a small, spoon-shaped instrument with a sharp edge) to scrape off the abnormal tissue. The curette is used to physically remove the bulk of the lesion.
  Electrodesiccation
      After curettage, the doctor applies an electric current to the treated area using a needle-shaped electrode. This current generates heat that destroys remaining abnormal cells and helps control bleeding. It essentially “burns” the tissue and prevents regrowth.
 
Applications
 
Electrodesiccation & Curettage (ED&C) is most often used for:
 
  Basal Cell Carcinoma: For small, superficial or non-aggressive forms of this skin cancer.
  Squamous Cell Carcinoma in Situ: Early-stage or superficial forms of this skin cancer.
  Seborrheic Keratoses: Benign, often pigmented skin growths.
  Warts and other benign lesions.
 
Benefits
 
  Quick Procedure: The procedure is relatively fast and typically done in a dermatologist’s office under local anesthesia.
  Cost-effective: ED&C is generally less expensive than more involved surgeries like Mohs surgery.
  Good for Small Lesions: ED&C is particularly effective for smaller or superficial skin cancers.
 
Drawbacks and Side Effects
 
  Scarring: ED&C often leaves a scar, which may be more noticeable compared to other skin cancer treatments like Mohs surgery.
   Limited to Superficial Cancers: ED&C is typically not recommended for deeper or more invasive skin cancers, especially in high-risk areas like the face.
  Risk of Recurrence: The risk of the cancer coming back may be higher with ED&C compared to more precise methods like Mohs surgery, particularly for certain types of skin cancer.
 
Procedure
 
The area is first numbed with local anesthesia. The doctor scrapes away the tumor using the curette and then applies electrodesiccation to the area. This scraping and burning process is often repeated two or three times to ensure all cancerous cells are removed. The treated area heals over the course of several weeks, with a scab forming and eventually falling off.
 
ED&C is generally a good option for small, superficial lesions on low-risk areas of the body. However, it may not be suitable for sensitive areas like the face, where minimal scarring is important.

MICRODERMABRASION
Microdermabrasion can reduce the appearance of fine lines, wrinkles, and acne scarring. Melasma and hyperpigmentaion will be less noticeable after microdermabrasion treatment.  Microdermabrasion is one of the three most commonly performed esthetic dermatology procedures in the United States. The low cost per treatment ($85 each or $275 for four) makes it a practical choice for patients with minor skin imperfections. Microdermabrasion sloughs off the dead and dull surface layer of the skin which stimulates an increase in collagen production. After several treatments, many patients experience a visibly dramatic improvement in the appearance of their complexion due to the effects of microdermabrasion on the tone, color, and texture of their skin. Schedule your appointment today.


MOHS SURGERY
Mohs surgery is a precise surgical technique used to treat skin cancer. During the procedure, layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. It’s most commonly used to treat basal cell carcinoma and squamous cell carcinoma, the two most common types of skin cancer.
 
The key benefits of Mohs surgery include:
 
    High cure rate: It’s known for its effectiveness, often resulting in the complete removal of cancer.
    Tissue preservation: Because only the cancerous tissue is removed, healthy tissue is spared, which minimizes scarring.
    Microscopic examination: Each layer of tissue is examined under a microscope during the procedure, ensuring that all cancerous cells are removed before the surgery is completed.
 
It’s typically performed under local anesthesia, and patients usually remain awake during the procedure. The surgery may take a few hours since it involves analyzing tissue layers in real-time. Mohs surgery is often recommended for skin cancers located in areas where preserving as much healthy tissue as possible is critical, like the face, ears, or hands.


PHOTODYNAMIC THERAPY

Photodynamic therapy is a treatment for pre-cancerous sun damage lesions called actinic keratoses. Photodynamic therapy (PDT) is performed with a combination of medication and light therapy and can be done in your dermatology provider’s office. PDT is a non-invasive procedure which makes it possible to treat many AK lesions simultaneously and eliminates the scarring caused by other types of treatment for actinic keratoses. Most insurance companies provide coverage for PDT.

SURGICAL EXCISION
Surgical excision is a medical procedure in which a doctor removes a lesion, tumor, or abnormal tissue from the body using a scalpel or other surgical instruments. This procedure is often performed to remove skin lesions, tumors, or abnormal growths, and it is frequently used to treat cancers, such as skin cancer, or to completely remove a suspicious growth for diagnostic purposes.
 
Reasons for Surgical Excision
 
Surgical excision is commonly used for:
 
   Skin cancer removal: Excision is often used to remove basal cell carcinoma, squamous cell carcinoma, or melanoma.
   Benign growth removal: Non-cancerous growths, such as moles, cysts, or lipomas, can be excised if they cause discomfort, are cosmetically undesirable, or carry a potential risk for malignancy.
  Infected or damaged tissue: Some infections, chronic wounds, or necrotic (dead) tissue may require excision to promote healing.
 
Procedure Overview
 
    Preparation
        Anesthesia
        Local anesthesia is commonly used for small or superficial excisions (such as for skin lesions), numbing the area so the patient does not feel pain during the procedure. In some cases, regional or general anesthesia may be required, especially for larger or deeper lesions.
        Marking the lesion
        The surgeon or dermatologist may mark the area of skin or tissue to be excised. The surrounding tissue is also often marked to ensure the removal of a safe margin of healthy tissue.
      Excision
        A scalpel or surgical tool is used to carefully remove the lesion along with a small margin of healthy tissue to ensure all abnormal cells are removed, especially if the lesion is cancerous.
        The excision depth depends on the size, type, and location of the lesion. In cases of skin cancer, deeper tissue layers may also be removed to ensure complete cancer removal.
        The excised tissue is usually sent to a lab for histopathological analysis to determine whether all cancerous cells have been removed and to evaluate the nature of the lesion.
      Closure
        After the lesion is removed, the wound is typically sutured (stitched) closed. For larger or more complex wounds, additional techniques like skin grafts or flaps may be required to close the defect and promote proper healing. Skin glue or Steri-Strips may be used in some cases to assist in wound closure. A bandage or dressing is applied to the area to protect it and aid in healing.
 
Healing and Recovery
 
    Wound care: After the procedure, the patient is given instructions on how to care for the wound, including keeping the area clean, dry, and protected. Patients are often advised to avoid activities that could disturb the healing wound.
    Stitches: If sutures were used, they may need to be removed after about 7 to 14 days, depending on the location and depth of the incision.
    Healing time: Healing typically takes 1 to 2 weeks for smaller excisions but may take longer for larger or deeper procedures. Scarring will form as the wound heals, and the scar’s appearance may fade over time.
 
Risks and Complications
 
As with any surgical procedure, surgical excision carries some risks, including:
 
        Infection: Any surgical wound can become infected, though this is generally rare. Signs of infection include increased redness, swelling, warmth, or discharge.
      Scarring: Scarring is a common outcome of surgical excision, but the severity of the scar depends on the size and location of the excision, the patient’s skin type, and how well the wound is cared for after surgery.
      Bleeding: Mild bleeding may occur after surgery, but significant bleeding is uncommon.
      Nerve damage: In rare cases, excision of deeper lesions may cause damage to underlying nerves, resulting in numbness or loss of sensation around the surgical site.
      Recurrence: In some cases, particularly with cancerous lesions, there may be a recurrence of abnormal cells or the cancer itself if the entire lesion or tumor was not successfully removed.
 
Advantages of Surgical Excision
 
    Complete removal: Surgical excision offers a high chance of completely removing abnormal tissue, particularly when a margin of healthy tissue is also removed. This is especially important in the treatment of skin cancer.
    Diagnostic clarity: Removing the entire lesion for analysis provides a definitive diagnosis, particularly when used for biopsies.
    Curative potential: In cases of localized skin cancer, surgical excision can serve as a curative treatment.
 
Aftercare and Follow-up
 
    Wound care instructions: Patients are advised to follow the healthcare provider’s instructions for cleaning and dressing the wound, including avoiding certain activities that could disrupt healing.
    Sun protection: In cases of skin excisions, patients are advised to protect the surgical site from sun exposure to reduce the risk of scarring and prevent further skin damage.
    Follow-up appointments: A follow-up appointment may be necessary to check the wound healing progress, remove stitches, or review biopsy results.
    Ongoing monitoring: If the lesion removed was cancerous, ongoing monitoring of the area and surrounding skin may be recommended to detect any recurrence or the development of new  lesions.
 
Alternatives to Surgical Excision
 
In some cases, these other treatment methods may be considered instead of surgical excision:
 
    Cryotherapy: Freezing the lesion with liquid nitrogen may be an option for smaller, superficial lesions.
    Electrosurgery: Using heat from electrical currents to burn off abnormal tissue.
    Laser therapy: Lasers can be used to remove certain types of skin lesions.
    Mohs surgery: A precise surgical technique for skin cancer, where thin layers of skin are removed and examined one at a time until no cancerous cells remain. It’s often used for delicate areas like the face.
 
Surgical excision is an effective and commonly used procedure for the treatment and diagnosis of many skin conditions, particularly when complete removal of a lesion or tumor is necessary. It’s essential to follow proper aftercare and attend follow-up appointments to ensure optimal healing and to monitor for any signs of recurrence or complications.


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