Skin and Cancer Associates - Hallandale Beach

December 12, 2018

Wikipedia is frequently used as a starting point for health-focused research.

With the proliferation of online medical information, educators and students alike struggle to discern the legitimacy of “e-health” sources.¹ Wikipedia, a crowdsourced online encyclopedia, is frequently utilized as a “starting [point] for locating information” despite its perceived lower quality and reliability compared with peer-reviewed sources.² In fact, 94% of medical students surveyed in 2012 reported using Wikipedia, describing its articles as “easy to access…and understand.”³

Addressing concerns from health professors less familiar with digital resources, Jennifer Meka, PhD, of the Penn State College of Medicine in Hershey, Pennsylvania, developed a framework for incorporating online content into medical education.⁴

Marc Prensky coined the terms “digital natives” and “digital immigrants” to describe individuals who were born into the “digital era” and individuals who were not, respectively.⁵ To properly educate, Mr Prensky asserts, educators must “learn to communicate [with] their students” who are digital natives.⁵ That is, educators must accommodate and regulate students’ use of online materials.

Wikipedia, as a crowdsourced website, is vulnerable to serious errors and thus should be navigated with care. Several studies have investigated the accuracy of Wikipedia. A 2005 study published in Nature compared the accuracy of scientific articles in Wikipedia with those in Encyclopedia Birtannica.⁶ However, an additional review conducted in 2011 found “mixed results.”⁶ 

Even so, medical entries on Wikipedia remain a leading resource, amassing 4.88 billion crowdsourced pageviews in 2013 alone.⁷ In addition, 1 study even suggested that Wikipedia “[complements]…the traditional journal system,” in that scientific articles referenced by Wikipedia receive more citations.⁸ It is clear that despite reservations about scientific accuracy, Wikipedia is frequently utilized by medical students and may even influence the medical research community itself.

As such, researchers developed the Technological Pedagogical Content Knowledge (TPACK) framework to guide educators in “[teaching] effectively with technology.”⁹ TPACK expands on the teachings of Lee Shulman, who emphasized the necessity of “contextual understanding”¹⁰ for educators; in this case, medical professors must be aware that medical learning now occurs in the digital era.

Per TPACK, educators must demonstrate 3 primary forms of knowledge: content knowledge, pedagogical knowledge, and technological knowledge. Through effective utilization of the TPACK framework, educators provide an “optimal learning experience” for digital natives by teaching students to be discerning about online resources. Under TPACK, content knowledge and pedagogical knowledge each reflect standard tenets of teaching; content knowledge comprises understanding of “concepts, theories, ideas” and understanding of their acquisition.¹¹ In a  similar fashion, pedagogical knowledge refers to the understanding of the “materials, programs, and resources” that comprise the curriculum.¹¹ As an addendum, the investigators have added technological knowledge, an understanding of how to productively utilize information technology.⁹ Educators must understand their students’ preferences and needs, specifically the widespread use of Wikipedia and similar sources. By becoming educated on the same online resources utilized by students, educators can effectively provide guidelines and assistance.

Educators must teach students to effectively weigh evidence and make educated decisions, be they in the clinic or performing a resource scan on Wikipedia. Open communication regarding the reliability of these sources is paramount to a proper medical education in the digital era.

Follow @DermAdvisor

References

1. Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2):e20.
2. Judd T, Kennedy G. Expediency-based practice? Medical students’ reliance on Google and Wikipedia for biomedical inquiries. Br J Educ Technol. 2011;42(2):351-360.
3. Allahwala UK, Nadkarni A, Sebaratnam DF. Wikipedia use amongst medical students—new insights into the digital revolution. Med Teach. 2012:35(4):337.
4. Meka J, Vigliotti A. Should crowdsourced, unvetted content on Wikipedia be used in health sciences teaching and learning? AMA J Ethics. 2018;20(11):E1033-1040
5. Prensky M. Digital natives, digital immigrants. On Horiz. 2001;9(5):1-6.
6. Giles J. Internet encyclopaedias go head to head. Nature. 2005;438(7070):900-901.
7. Heilman JM, West AG. Wikipedia and medicine: quantifying readership, editors, and the significance of natural language. J Med Internet Res. 2015;17(3):e62.
8. Thompson N, Douglas H. Science is shaped by Wikipedia: evidence from a randomized control trial. MIT Sloan School of Management research paper 5238-17. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3039505. Published September 20, 2017. Updated February 19, 2018. Accessed December 3, 2018.
9. Koehler M. TPACK explained [What is TPACK? tab on TPACK website]. http://tpack.org/. Published September 24, 2012. Accessed December 3, 2018.
10. Shulman LS. Knowledge and teaching: foundations of the new reform. Harv Educ Rev. 1987;57(1):1-21.
11. Koehler MJ, Mishra P. What is technological pedagogical content knowledge? Contemp Issues Technol Teach Educ. 2009;9(1):60-70.

December 04, 2018

Nearly 50% of dermatology residents and dermatologists indicate that they have received inadequate training on skin conditions in people of color.

According to the United States Census Bureau, people of color will comprise an estimated 50% of the US population by the year 2050.¹ This ever-increasing diversity underscores the need for healthcare providers to be educated about differences in clinical presentation and outcomes of conditions in people of color compared with white patients. In a US survey published in 2011, 47% of dermatologists and dermatology residents indicated that they had received inadequate training on skin conditions in people of color.²

“Skin of color, also known as ethnic skin, traditionally refers to that of persons of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. These skin types are usually categorized as Fitzpatrick types III to VI, and are more richly pigmented,” as stated in a 2013 paper published in American Family Physician.¹ “There are notable differences in skin disease incidence, presentation, and treatment based on skin type…. due to structural and functional differences in the skin and hair, as well as the influence of cultural practices.”

Andrew F. Alexis, MD, MPH, chair of the department of dermatology and director of the Skin of Color Center at Mount Sinai St Luke’s and Mount Sinai West in New York and associate professor at the Icahn School of Medicine at Mount Sinai, highlighted 5 conditions that affect people of color with greater frequency compared with other populations.

Central Centrifugal Cicatricial Alopecia (CCCA)

CCCA is a common cause of permanent, scarring hair loss that predominantly affects black women. It is diagnosed by in-office examination and biopsy of the scalp.³Clinically, there is a centrally located patch of diminished hair growth with a reduction of follicular ostia. Bogginess may be appreciated on palpation.

CCCA is treated with anti-inflammatory medications including oral doxycycline, intralesional triamcinolone, and topical corticosteroids; growth stimulating agents such as minoxidil 5% foam; and haircare modifications including avoidance of traction-associated styles and minimization of scalp exposure to heat and chemical relaxers. The goal of treatment is to reduce inflammation and further hair loss.

Dr Alexis and colleagues at Mount Sinai West are currently enrolling participants for an open-label pilot study investigating the efficacy of apremilast in the treatment of CCCA.

Melasma

Women comprise approximately 90% of those with melasma, which most commonly affects people of color.⁴ In a recent study, the most frequently reported triggers were pregnancy (40%), sun exposure (37%), and hormonal oral contraception use (22%).⁵Melasma is typically characterized by symmetric tan brown patches that may involve the cheeks, forehead, and upper lip. Wood’s light can be helpful in distinguishing predominantly epidermal vs dermal melasma.

The condition is treated with combination therapy, including a hydroquinone- and nonhydroquinone-based topical bleaching agent; in-office procedures such as chemical peels and low-density nonablative fractional lasers; and vigilant photoprotection.

Pseudofolliculitis Barbae

The highest prevalence of this disorder is found among men of African descent, with a reported prevalence of 45% to 85%, followed by Hispanic men.⁶ Characteristic clinical features include perifollicular inflamed papules or pustules in areas of shaving — for example, the male beard or the underside of the female chin, and evidence of coarse hair shafts reentering the skin may also be seen on close examination. Associated hyperpigmentation is common.

Treatment consists of the use of topical retinoids and clindamycin lotion. In-office procedures such as chemical peels and laser hair removal are also useful — the latter being associated with long-term remission.

Atopic Dermatitis

This condition is more common in African Americans and Asian Americans/Pacific Islanders (with 2-fold and 6-fold greater number of related doctor’s visits) compared with whites and is often more severe at the time of diagnosis in people of color.^2,7

Erythema may be more challenging to detect in darker skin types. Lesions are typically “hyperchromic” rather than red and may appear to be red-brown, dark brown, or grayish in color depending on the skin type and severity of the condition.

Early and efficacious treatment is important given the higher risk for long-term sequelae such as postinflammatory hyperpigmentation and hypopigmentation, as well as permanent depigmentation in areas of longstanding severe disease that have been excoriated for many years.

Multisystem Disorders

Certain multisystem disorders are more prevalent in skin of color, including sarcoidosis, discoid lupus erythematosus, and scleroderma.

According to conservative estimates, there is a 3-fold incidence of sarcoidosis in individuals of African vs European descent.⁸ The disease can present in myriad ways. One common presentation in African Americans is dermal flesh-colored papules on the face — especially periorificially. This variant usually responds to oral minocycline.

Studies suggest that the prevalence of systemic lupus erythematosus is 2-fold to 3-fold higher in people of color of various ethnicities compared with people of European origin.⁸ People with discoid lupus erythematosus frequently have oval-shaped patches or plaques on the scalp or face. Hyperpigmentation or hypopigmentation can be seen within lesions. Treatment consists of topical or intralesional corticosteroids with or without hydroxychloroquine, depending on the severity of disease.

The highest prevalence of scleroderma is observed in Choctaw Indians, and rates are 1.5 to 3.5 times greater among people of African vs European descent.⁸ The disease may present with “salt-and-pepper”-like dyspigmentation, especially on the upper trunk. These involved areas are indurated and, when found, warrant examination of the digits and screening for systemic signs and symptoms.

Follow @DermAdvisor

References

1. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part I. Special considerations for common skin disorders. Am Fam Physician. 2013;87(12):850-856.

2. Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30(1):53-59.

3. Heath CR, Robinson CN, Kundu RV. Central centrifugal cicatricial alopecia (CCCA). http://skinofcolorsociety.org/dermatology-education/central-centrifugal-cicatricial-alopecia-ccca/. Accessed November 16, 2018.

4. Pandya AG. Melasma. http://skinofcolorsociety.org/dermatology-education/1406-2/. Accessed November 16, 2018.

5. D’Elia MPB, Brandão MC, de Andrade Ramos BR, et al. African ancestry is associated with facial melasma in women: a cross-sectional study. BMC Med Genet. 2017;18(1):17.

6. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color. Am Fam Physician. 2013;87(12):859-865.

7. Janumpally SR, Feldman SR, Gupta AK, Fleischer AB Jr. In the United States, blacks and Asian/Pacific Islanders are more likely than whites to seek medical care for atopic dermatitis. Arch Dermatol. 2002;138(5):634-637.

8. Petit A, Dadzie OE. Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease. Br J Dermatol. 2013;169(Suppl 3):1-10.

Skin cancer is quite common today. Melanoma the most serious form of skin cancer, is a cancer of the skin pigment cells, which are called melanocytes. Melanomas can occur anywhere on the skin, but they are most likely to develop on the chest and back in men and on the legs in women. Other common sites for melanomas include the neck and face. Melanomas can occur anywhere on the skin, but they are most likely to develop on the chest and back in men and on the legs in women. Melanoma only accounts for around 1 percent of all skin cancers, yet it is responsible for most skin cancer-related deaths.

Early detection of melanoma, is critical to effectively treat this potentially fatal disease. Dermatologists universally recommend regular skin exams followed by closely monitoring your skin in between exams. It is important to catch skin cancer earlier as the cure rate is around 90% if caught early. Remember to schedule your skin exams regularly!

Learn more about skin cancer detection, prevention and treatments.

During our daily routine, the skin is submitted to a lot of conditions and situations that have an impact on how healthy it is and how it looks. Some examples are sun exposure, air pollution, unhealthy diet, the stress of a busy routine or even just normal ageing. Because of this, cosmetic procedures such as facials are becoming more popular each day.

Microdermabrasion is one of these procedures that are “in” lately and you probably heard of it at some point, but it is also very likely that you don’t know much about it. There is a reason for the “hype” and the reason is that this procedure can be very useful for several conditions described below.

What is microdermabrasion and why does it work?

Starting with a short definition of microdermabrasion, it is a procedure that consists of using an abrasive yet gentle instrument to remove the outer and uneven layer of the skin. This procedure is non-chemical and non-invasive, which makes it even more attractive. In fact, microdermabrasion uses microcrystals to do the whole exfoliation process.

The microdermabrasion works in two ways:

1. Removes the dead skin cells, revealing the younger looking and healthier cells underneath it.
2. It stimulates the production of collagen and elastin, which also improves the skin elasticity and appearance.

Although the skin might feel a bit red after the procedure, the microdermabrasion is not painful.

Indications

Microdermabrasion is non-invasive and a very versatile technique that can be used for several skin conditions, from the ones that affect mostly teenagers (such as acne), to conditions that are more related to ageing (such as wrinkles and age spots). Here are some examples of conditions that can be treated or at least improved by microdermabrasion:

• Acne
• Wrinkles
• Age Spots
• Uneven skin tone or texture
• Melasma
• Sun damage
• Clogged Pores

Counter-indications

To avoid damages to the skin, the patient should not do many “potentially aggressive” procedures in a short amount of time. So, this is not indicated for patients that had recent skin procedures such as chemical peel or collagen injections or even waxing. Microdermabrasion is also not indicated for people with deep scars and/or active keloids.

Contact our office today to learn more about Microdermabrasion!

Aging is a natural part of our life which may take a toll on our skin especially on our face. Our skin loses firmness and elasticity as we age causing one of the most common skin problem – wrinkles. Facial aging is the result of both genetics and outside factors such as exposure to sun, stress and smoking. Fortunately, there are several treatments available to slow the aging process. Restylane is a clinically proven treatment that provides a fast and minimally invasive solution to smooth fine lines and wrinkles.

Restylane products use hyaluronic acid, a naturally occurring compound that is found in our body, to help provide elasticity in our skin. This compound decreases gradually as we age causing our skin to sag and develop wrinkles. Restylane treatment restores the hyaluronic acid in our skin to help reduce wrinkles by up to 80%.

The Restylane line of products includes Restylane Silk for subtle lip enhancement, Restylane  Lyft to provide volume in the cheek area, and Restylane Refyne & Restylane Defyne to smooth laugh lines around the lips, brow and eyes. The treatments will provide you with a natural looking skin and facial features while giving you the flexibility to maintain your natural facial expressions.

One thing that sets Restylane apart is the ability reduce and eliminate deep wrinkles without requiring the need for surgery. Another advantage of this procedure is that it can be accomplished in 30 minutes or less which means you can easily defy the signs of aging and achieve the natural looking results that you want. Effects will also be full evident within one week from treatment and you can perform immediately your daily normal routine. The long-lasting results of these treatments can be enjoyed for 6 months or more. Contact our office today to learn more about Restylane family of cosmetic products. Learn more about Restylane!

Light is something that is part of everyone’s lives, but not many people know the many benefits that it has besides helping us see things in the dark. In fact, light can have several benefits in the field of dermatology and cosmetics. An example of it is the Photodynamic Therapy.

The Photodynamic Therapy, also known as PTD or Blue Light Therapy, is a non-invasive therapy that uses photosensitizing molecules in combination with a light source that activates them. The combination of the light and the molecules destroy abnormal cells, leaving the healthy cells intact. This type of therapy is used to treat several conditions such as sun damage, acne, scars, rosacea and even pre-skin cancer lesions. But this treatment is not indicated to everyone. Although it can be used to treat pre-cancer lesions, PTD does not offer a cure for invasive skin cancer. In this case, more severe treatments are needed, such as radiotherapy or even surgery. The PTD is also not indicated to deep areas in the skin since it is more effective in lesions right below the surface of the skin.

A PTD session is a quite simple process. First, a solution of a photosensitizing agent is applied to the area that will be treated. After 30 to 60 minutes, which is called “incubation period”, the same area is submitted to intense light. The whole process takes about one hour. Usually, the patient will need more than one session to complete the treatment. At the end of the treatment, you should expect a smoother and healthier looking skin.

This therapy is a safe procedure, but all procedures have possible side effects. In the case of PTD, some possible side effects are burning, skin discoloration, pain, allergic reactions, prolonged sun sensitivity and others. Although some skin irritation can occur, PTD doesn’t normally leave scars.

The PTD recovery is quite straightforward and usually doesn’t present many complications. Physicians advise cleaning the area carefully to avoid infections, and they might even recommend antibiotic ointments and moisturizers. In case of swelling in the first days, ice can be used to relieve it. One of the most important measures to be taken is to protect the area with sunscreen.

So if you have any of the following skin conditions such as sun damage, acne, scars, rosacea and even pre-skin cancer lesions, PTD may be able to reduce or eliminate them. Contact our office today to learn more!

Melanoma is the most aggressive type of skin cancer and can be deadly if not caught early.  Early detection and treatment reduces the chances skin cancer developing into Melanoma. Here are some helpful guidelines set by the American Cancer Society that can help in the early detection of skin cancer. These are called the “ABCDE’s of Melanoma” and each letter stands for an aspect of a mole, sore or spot that should be observed:

A = Asymmetry. Does it have an irregular shape?

B = Borders. Melanomas usually have irregular borders that are not so easy to define.

C = Color. Melanoma lesions usually have more than one color, in an uneven distribution.

D = Diameter. Cancerous lesions are mostly larger than 6mm in diameter.

E = Evolution. This is the most important feature to pay attention to: is the mole changing in size, shape or color?

Although the early detection is very important, the prevention is even more. In the case of melanoma, the sunlight exposure is one of the strongest risk factors. It’s important to protect from UV rays every day, and not only on sunny days. It’s important to know that even when it’s cloudy, the UV rays are able to reach the skin and cause damage. Although sun exposure is essential for the health, the timing of exposure is also important. You should avoid the sun during the hours when the UV rays exposure is higher which are from 10 am to 4 pm (and midday is usually the highest point).

Some important daily measures to reduce the exposure to UV light are:

• Stay in shade
• Wear clothes that cover arms and legs, and also a hat.
• Wear sunglasses that protect from UVA and UVB rays
• Avoid indoor tanning booths
• Use a sunscreen that protects from both UVA and UVB rays, with at least SPF 15 every time you expose yourself to the sunlight.

Although these measures should be taken by anyone, they are essential for people who are more likely to get develop skin cancer such as people with light skin, history of cancer in the family and/or history of sunburns.

We recommend annual skin exams to help keep your skin looking its best, contact our office today to schedule yours!

Then there are several types of vein treatments available to help! Veins are the blood vessels that carry blood back to the heart. Because most of them carry the blood against the gravity, they have valves that help to move the blood always forward and not allowing it to return. When the valves are not working properly, and together with other factors the blood may go back and accumulate in the vein, increasing the pressure in it and causing the walls to bulge, and this creates the spider veins. Examples of factors that can help in developing spider veins are hormones, genetics, lack of exercise, sunlight, weight changes, injuries…

In mild cases, the spider veins are not much of a health issue because they don’t cause any diseases or discomfort. However, depending on the number of spider veins and what is causing them, they can become a serious issue. Spider veins can cause pain, increase the chances of creating blood clots and, in some cases, open sores can also appear as a consequence.

Whether spider veins are bothering you for a cosmetic reason or for a health reason, rest assured that there are ways of getting rid of them. Depending on the amount and how serious is your case, the dermatologist can suggest different types of treatment, and there are two that are the most frequent:

1. Sclerotherapy

In this treatment, the doctor injects in the spider veins a solution that will make the close so that the blood will be forced to go through a healthy vein. The spider veins in question will then fade in a few weeks.

2. Laser Treatment

In this case, the doctor directs bursts of a strong light to make the veins fade.

In both treatments, there is no need for anesthesia or incisions. It is very likely that you will need at least 3 sessions and larger veins are more difficult to get rid of. The recovery process is also very straightforward: the patient can be back to its normal activities after the sessions, but it’s important to protect the area from the sunlight.

Contact our office today to learn which vein treatment may be right for you!

Skin cancer is one of the most common types of cancer, and occurs in both men and women. The skin is formed by several types of cells, which means that there are different types of cancer depending on the type of cells that they are affecting.

Basal Cell Carcinoma

Basal cells are in the lower part of the epidermis (one of the skin layers) and are the responsible for the skin renewal. These cells are always dividing to replace the squamous cells that are being removed from the surface. As they move to the skin surface, they start to get flatter until they turn into squamous cells.

Basal cells carcinoma is the most common type of skin cancer (8 out of 10 skin cancers). This type of cancer grows slowly and can develop on sun-exposed areas. Because it grows slowly it is considered a non-aggressive type of cancer and it’s not likely to spread easily. But, if left untreated it can start spreading to other places.

Squamous Cell Carcinoma

Squamous cells are the flat cells that are in the outer part of the epidermis. These are the cells that are constantly shedding when new cells are formed.

Squamous cell carcinoma occurs in these cells that are in the outer layer. It’s more likely to occur in sun-exposed areas, but it can also occur in non-exposed areas as well.

Treatment

For both types of skin cancer, the range of treatments is the same. They can include medications, surgery, radiation or even light therapy. Here are some examples of treatment:

• Medications

In the case of skin cancer, the medication can be topical (a cream that will be rubbed in the lesion area) or taken orally. Oral medication is usually used for more advanced cases.

• Radiation

This uses X-Rays to destroy a tumor, and the main advantage is that there is no need for anesthesia or cutting.  The cure rates using this technique are around 90%

• Cryosurgery

In this technique, the tumor is destroyed by freezing it with liquid nitrogen. The cure rates of this technique are not as high as other surgical ones, only 85-90% and this is why it is not as used anymore.

• Photodynamic Therapy (PTD)

This technique uses a topical acid which is light-sensitizing, and then the medicated area is activated by a strong blue light.  Technically this will only destroy the cancerous cells, with almost no damage to the surrounding areas. The cure rates are 70-90%.

• Excisional Surgery

This is the classical surgery, that uses a scalpel to remove the lesion along with a border of healthy tissue around it (for safety).

• Curettage and Electrodesiccation

This is used only for small lesions. The cell growth is scraped off with a curette and then the site is burned with an electrocautery needle. The procedure is painful, and it requires anesthesia. The cure rates are usually up to 95%.

• Mohs Micrographic Surgery

This technique uses both surgery and microscopy techniques at the same time. The physician removes a thin layer of tissue containing the tumor, and then the layer is analyzed under the microscope. This analysis allows the physician to map where the cancerous cells are, and repeat the procedure only where the cancer is. This way the healthy tissue is preserved and the cure rate is also high, around 99%.

• Laser Surgery

This uses a beam of light of a specific wavelength to destroy the cancerous cells.

In some cases, more than one technique may be used for a better cure rate. Talk to your doctor about your options.