MEDICAL

DERMATOLOGY

MEDICAL SERVICES

Your Source for Medical Skin Care in Brentwood, TN

Board-certified dermatologist, Dr. John Q. Binhlam, and his dedicated staff are proud to offer comprehensive skin care to patients, managing conditions from mild to severe.

CONDITIONS WE COMMONLY TREAT

Acne
Acne is the term used to describe blackheads, whiteheads, pimples, minor lumps or any plugged pores that occur on the face or upper torso. While most major acne problems occur during adolescence, this condition can occur before and after the teenage years. While acne can affect males and females, males tend to have more severe, longer lasting types of the condition and many females will have frequent flare-ups of acne during hormonal shifts (such as their menstrual cycle). Minor acne often results in low self-esteem because it can mar the natural beauty of the facial features. In general, minor acne will come and go on its own, recurring more frequently between the ages of adolescence and tapering off in regularity thereafter. More extreme acne can lead to serious permanent scarring, which is the result of tissue injury. In some cases, acne can continually afflict a person later in life.
Many people are concerned with acne prevention. Medications are available to lessen the severity of outbreaks, and your doctor can recommend changes in habit that may reduce outbreaks. If you do have acne, there are ways to prevent acne scarring. Treating acne inflammation at the onset of the condition will help lessen the severity of the injury to your tissue, which will prevent or decrease scarring. If over-the-counter medication is not working for you, your doctor can prescribe stronger, more intensive medication.
BirthMarks
A birthmark is a congenital, benign irregularity on the skin which is present at birth or appears shortly after birth, usually in the first month. They can occur anywhere on the skin. Birthmarks are caused by overgrowth of blood vessels, melanocytes, smooth muscle, fat, fibroblasts, or keratinocytes.

 

Treatment. While you can leave most birthmarks alone, it’s important to see a dermatologist soon after you notice a birthmark. Some birthmarks can cause a problem later on. Treatment can prevent that.

 

The safest and most effective treatment varies with the birthmark and child. Here’s what your dermatologist may recommend:
• Watch the birthmark
• Laser therapy
• Propranolol (pro-pran-oh-lol)
• Timolol
• Corticosteroid
• Interferon
• Surgery to remove the birthmark
• Makeup

 

(Source: www.WebMD.com and American Academy of Dermatology)
Contact Dermatitis
When your skin comes in contact with an irritant and becomes inflamed, this is known as contact dermatitis. The inflammation causes a red, itchy rash that is not contagious. There are many substances that can cause the irritation, including soaps, make-up, certain metals used in jewelry, or plants like grass, weeds, poison ivy or poison oak. Once you determine what is causing your rash, avoid coming in contact with it. The rash should clear up in 2-4 weeks. Meanwhile, you can use anti-itch creams to relieve your skin.
Eczema
Eczema is sometimes called dermatitis. It is actually a group of skin conditions that can affect you at any age. It is not contagious but can be uncomfortable because it makes the skin hot and itchy. In severe cases, it can even cause bleeding. There are several types of eczema and each type requires different treatment methods. Eczema can occur because of irritation, allergic reaction or hereditary conditions. The most common variety is atopic eczema, which can be treated with steroids to reduce inflammation and creams to relieve the itchiness and dryness. In some cases, light treatments and dietary changes have been shown to help. While there is no cure for eczema, many people grow out of it. In addition, using the proper medications and staying clear of substances that cause eczema to flare up can greatly reduce your discomfort and can lessen the severity of the condition. Only your doctor can correctly diagnose and analyze your condition. It is important to consult with your physician to make sure that you receive the most effective and efficient treatment possible.

 

Hair Loss
Most everyone loses up to 100 hairs a day, but due to the amount of hair we have on our head, this amount of hair loss shouldn’t cause alarm. However, severe hair loss, also known as alopecia, may eventually lead to complete baldness for some men. Hair loss can happen as a result of heredity, medications or an underlying medical condition.
 
The most common type of hair loss is pattern baldness, which is usually permanent and affects approximately one-third of all men. This may occur suddenly or over a period of time. Other types of hair loss may only be temporary and can affect other parts of your body as well. You should contact your physician if you notice extreme, sudden hair loss.
 
To this day, there is no cure for permanent hair loss, but certain medications, such as Rogaine or Propecia, have proven effective in reducing the pace of hair loss. Surgeries including hair transplants and scalp reduction are treatment options for hiding hair loss. We will work with each patient individually to determine the best treatment option for your individual needs and desires.
Lupus
Lupus is a chronic autoimmune inflammatory disease. It takes place when your immune system tries to fight off a virus, bacterium or germ and cannot distinguish between the foreign body and healthy tissue. Instead of only attacking the foreign body, the immune system also attacks the healthy tissue. Lupus causes inflammation that can affect the skin, joints, organs and blood cells.
Nail Diseases
While nails are attached to the skin, the diseases that can affect nails are different than skin diseases. Many times nails can become infected, inflamed or deformed, which is known as onychosis. Onychosis is inflammation of the tissue that surrounds the nail, especially in the creases where the nail attaches to the skin. The inflammation is usually the result of an infection. To name a few, some other diseases include onychocryptosis or “ingrown nails” where the nail digs into the surrounding tissue and causes an infection, onychodystrophy where the nail is deformed and discolored, and onychogryphosis where the nail thickens, develops deep ridges and turns brown.
Psoriasis
Psoriasis is a chronic disorder that creates itchy, red marks on the body. These areas form multi-layered “scales” that vary in severity. Psoriasis can occur at any age in both males and females. It is not contagious, though there does seem to be a hereditary connection. It is not a life-threatening condition, and in most cases, people who have mild symptoms may not even know that they have psoriasis. Cuts, scratches, infections and dry skin seem to cause flare-ups. In addition, lack of sun exposure and certain medications may cause psoriasis to flare up. Often, psoriasis affects the same area repeatedly. Elbows, arms, knees and legs are commonly afflicted areas.
Generally, your doctor can diagnose you merely by examining your skin, but he or she may also perform a biopsy if needed. Steroids, oils, sprays, medications, vitamins, light therapy and many other treatments are available. Based on the severity of your condition, your doctor will consult with you to find the treatment that’s best for you. It is important to treat this condition, both to alleviate pain and to help significantly improve your quality of life.
Rashes
Rashes are when the skin has mild redness, small red bumps, and in severe cases, redness, swelling and blisters. Many rashes are caused by skin irritants and can also be classified as contact dermatitis. In other cases, the rash appears in conjunction with a viral infection, fungal infections, bacterial infections, exposure to certain bugs, or exposure to extreme heat.
Rosacea
A chronic skin and eye condition, rosacea’s symptoms include redness and pimples in the early stages and thickened skin and sometimes an enlarged nose in the advanced stages. People with this condition experience frequent facial flushing, accompanied by swelling or burning. Although doctors are still exploring the cause for this condition, it is clear that the blood vessels in afflicted people dilate far more easily than normal, which stimulates many of the symptoms. When rosacea affects the eyes, people experience dryness, itching, burning sensations and swelling in and around their eyes. Some also complain of light sensitivity and blurred vision. In most cases, outbreaks of rosacea occur around the facial areas. Many doctors believe that heat exposure, strenuous exercise, stress, alcohol consumption and spicy foods may all contribute to increased redness.
Rosacea has no cure, but a variety of treatments are available. Treatments are intended to control outbreaks and they are also intended to improve physical appearance. Antibiotics are generally used to regulate the condition. Laser surgery or electro-surgery options are available for more severe cases.
Skin Infections
Types of skin infection include bacterial, fungal and viral skin infections.
Bacterial Skin Infections. Some of the most common types of bacterial skin infections include staph infections, cellulitis, impetigo and boils.
Fungal Skin Infections. Fungal skin infections of the skin are very common and include athlete’s foot, jock itch, ringworm, and yeast infections.
Viral Skin Infections. Viral skin infections include molluscum contagiosum, shingles and chickenpox.

 

Treatment. If you have an infection, your doctor may prescribe medicine. What he gives you depends on the type of infection:
• Bacterial: Antibiotics
• Viral: Antivirals
• Fungal: Antifungal creams, ointments, or powders
Any break in the skin can lead to a tetanus infection if your tetanus shot isn’t up to date. Check with your doctor to see if you need a booster one.
Warts
Warts are the result of a virus that causes many cells to grow on the external layer of skin. They are not dangerous to your health or cancerous and usually fade away on their own over time. Typically found on your hands and feet, common warts can make patients feel self-conscious and want them removed. Removing the warts will keep them from spreading, but they might come back as they can be a recurring problem.
SURGICAL SERVICES

Comprehensive Surgical Skin Treatments

At Advanced Skin & Laser Center, we are proud to harness the latest advances in cutting-edge dermatological technology, helping us to ensure our treatments are always as safe, effective, and convenient as possible. While we offer many non-surgical and cosmetic treatments, for certain cases and conditions, surgery is the best way to ensure healthy skin. We’re proud to offer a variety of surgical skin treatment options.

SERVICES WE PROVIDE

Cysts
Epidermoid cysts, or skin cysts, are bumps and/or lumps that form underneath the skin. They are “pockets” of tissue that can be filled with pus, fluid or other materials. They form from the cells that make up the external layer of the skin. If your skin cysts make you self-conscious, we can surgically remove them. We also surgically remove them if they burst and become infected.
Excision of Melanoma and Non-Melanoma Skin Cancers
Melanoma is cancer of the cells in the skin that produce melanin, the pigment in your skin. This is considered the most severe type of skin cancer, but as long as it hasn’t spread, to areas such as the eyes or internal organs, it can be removed with surgery. If the melanoma is small and thin, all of it may be excised, or cut out, during the biopsy. Otherwise, our doctors will surgically remove the cancer and a border of surrounding skin as well as a layer of tissue under the skin – just to ensure all of the cancer is gone.
This same excision technique applies to non-melanoma skin cancers, such as basal cell or squamous cell skin cancers, as well. These cancers arise from excessive sun exposure. Once detected, they can be surgically removed.

Mohs Micrographic Surgery for Skin Cancer

Mohs surgery, also known as microscopically controlled surgery, was developed by Dr. F. Mohs in the 1940’s. It is a common procedure used to treat certain skin cancers and to prevent the recurrence of that cancer. This precise method of treating skin cancers allows us to surgically remove the skin cancer and immediately examine the tissue to identify any remaining cancerous tissue.
Mohs surgery is often used when:
  • certain areas of the body affected by skin cancer doesn’t respond to other treatment options
  • the skin cancer is affecting an area of the body that the patient wishes to keep as much of the normal tissue as possible
  • the size of the skin cancer cannot be easily determined by a visual examination
  • cancer returns to a previously treated area
Mohs surgery is performed on an outpatient basis and requires a local anesthetic. In addition to having a higher success rate, Mohs is also recognized for its precision, making it the most aesthetic choice for skin cancer treatment.
Recovery time depends on the size of the skin cancer. While some wounds can heal by themselves, others may require sutures, a small skin graft or in some cases, reconstructive surgery. If any discomfort should occur following this treatment, it is usually very mild and can be treated with Tylenol. While minimal bleeding is common, you should seek immediate medical attention if you experience persistent, excessive bleeding.
Mole Removal
We offer many different mole removal services. We can excise, or cut, your mole off without the need for stitches. On smaller, not-as-deeply-rooted moles, we can use a laser to remove them. If your mole is non-cancerous, there is no need to remove it other than for aesthetic purposes. If your mole has un-even edges or you notice it is growing in size, please come in to have it biopsied. We will determine if it is cancerous and needs to be removed.
Nail Removal
If one of your nails has recurring fungal infections, this can cause a portion or the entire nail to die. If this happens, we can surgically remove the nail fairly quickly in the comfort of our office. You will receive an injection in the finger or toe so you won’t feel anything. The nail is then loosened from the surrounding skin, and the doctor will place a tool between the nail and skin in order to remove the nail. And if you wish to keep the nail from growing back, thereby avoiding future infections, we can place a chemical on the wound that destroys the nail’s matrix. After the procedure, an antibiotic will be applied and the wound will be bandaged.
Scar Revision
The goal of scar revision surgery is to lessen the scar so that it blends in more evenly with your surrounding skin. We will attempt to make the scar tissue match your surrounding skin’s texture and tone. We use laser therapy, chemical peels, microdermabrasion and sometimes incisions to reduce scars. Incisions are only used to cut out deep scar tissue that can’t be treated with the other options.
SKIN CANCER TREATMENT

Expert Skin Cancer Treatment

Exposure to the sun’s harmful ultraviolet (UV) rays cause 90% of all skin cancers. The effect is cumulative. Each unprotected exposure increases one’s lifetime risk of developing skin cancer.

 

As your first choice for skin cancer treatment, we are grateful that most skin cancers are visible and can be diagnosed and successfully treated before they spread (metastasize) to other parts of the body. In fact, Advanced Skin & Laser Center detects and treats many lesions at a precancerous stage – the point at which their cells may be close to turning cancerous but have not yet done so. Naturally, preventing these precancerous lesions (precancers) in the first place is even better. Education by a dermatology expert of the risks may be the first step in preventing skin cancer.

NON-MELANOMA SKIN CANCER

BASAL CELL CARCINOMA
The two most common skin cancers are basal cell carcinoma and squamous cell carcinoma affecting more than 1.3 million people in the United States each year. Both are caused by long-term exposure to the sun and typically appear in the same locations as precancerous actinic keratoses (AKs). The rim of the ear and the lower lip are especially susceptible to SCC.
Outdoor workers have a high incidence of BCC and SCC, but in the general population, increasing numbers of individuals only in their 20’s and 30’s are being diagnosed with these cancers.
Some BCCs resemble non cancerous skin conditions such as psoriasis or eczema.
There are five typical characteristics of BCC:
  • A shiny bump that is pearly or translucent and is often pink, red, or white. The bump can also be tan, black, or brown in dark haired people and can be confused as a mole.
  • An open sore that bleeds, oozes, or crusts and remains open for three or more weeks. A persistent non-healing sore is a very common sign of an early basal cell carcinoma.
  • A scar-like area that is white, yellow, or waxy, and often has poorly defined borders. The skin itself appears shiny and taut.
  • A pink growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.
  • A reddish patch or irritated area frequently occurring on the chest, shoulders, arms, or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.
While BCCs seldom spread to vital organs, they can cause major damage – even the loss of an eye, ear, or nose. Certain rare forms can become lethal if not treated promptly.
SQUAMOUS CELL CARCINOMA
Many SCCs develop from an existing precancerous actinic keratosis (AK) or actinic cheilitis. SCCs usually appear as thick, rough, scaly patches that may bleed if bumped. They often look like warts and sometimes appear as open sores with a raised border and crusted surface over an elevated pebbly base. The skin around SCCs typically shows signs of sun damage such as wrinkling, pigment changes, and loss of elasticity. These lesions persist for weeks and occasionally bleed. They may also rapidly increase in size.
In general, SCCs are more threatening than BCCs and have a greater chance of spreading and becoming life threatening if untreated.
Skin Cancer Treatment Options for Basal and Squamous Cell Carcinoma:
  • Curettage and Electrodesiccation – As with AKs, the growth is scraped off with a curette, but when treating BCCs or SCCs, the procedure is typically repeated a few times to help assure that all cancer cells are eliminated. Local anesthesia is required, and bleeding is controlled with an electrocautery needle.
  • Excisional Surgery – Along with the above procedure, this is one of the most common treatments for BCCs and SCCs. Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The incision is closed, and the growth is sent to the laboratory to verify that all cancerous cells have been removed.
  • Mohs Micrographic Surgery – The physician removes the tumor with a curette or scalpel and then removes very thin layers of the remaining surrounding skin one layer at a time. Each layer is checked under a microscope, and the procedure is repeated until the last layer viewed is cancer-free. This technique saves the greatest amount of healthy tissue and may reduce the rate of local recurrence. It is often used for tumors that have recurred or are in hard-to-treat places such as the head, neck, hands, and feet.
  • Cryosurgery, laser surgery, and photodynamic therapy – the same treatments used to eliminate AKs can also be used to treat BCCs and SCCs.
  • BCCs and SCCs are easily treated when they are detected at an early stage. However, the larger a tumor grows, the more dangerous and potentially disfiguring it may become and the more extensive the treatment must be.

MELANOMA

Identifying Melanoma
Melanoma is the deadliest form of skin cancer. It is most often caused by intense, intermittent exposures to the sun especially exposures that occur before age 18. In the past two decades, as outdoor recreational activities have increased and fashions have left more skin exposed, melanoma incidence rates have more than tripled.
Fair-skinned people with light hair and eye color, and those who have had sunburns or tend to burn easily, are at an increased risk of developing melanoma. So are those who have a family history of the disease or have ever had a melanoma or other skin cancer. People with large, unusually colored, and irregularly shaped moles (dysplastic nevi, also called atypical moles) are also at higher risk.
In its earliest stages, melanoma is readily treatable. Left untreated, it will spread to vital organs, frequently becoming life-threatening.
How to Spot a Melanoma
Most people have some brownish spots or growths. Almost all of these are normal, but growths that change noticeably in size or have irregularities in shape and color could be melanomas. It is important to check the skin from head to toe every month, staying alert for lesions that have the “ABCD” signs of melanoma: Asymmetry, Border irregularity, Color variability, and Diameter larger than a pencil eraser.
  • Asymmetry – Most melanomas are asymmetrical: A line through the middle would not create matching halves. Common moles are round and symmetrical.
  • Border Irregularity – The borders of early melanomas are often uneven and may have scalloped or notched edges. Common moles have smoother, more even borders.
  • Color Variability – Varied shades of brown, tan, or black are often the first sign of melanoma. As melanomas progress, the colors red, white, and blue may appear. Common moles usually are a single shade of brown.
  • Diameter – Early melanomas tend to grow larger than common moles; generally to at least the size of a pencil eraser (about 6mm, or ¼ inch, in diameter).
Treatment Options
  • Excisional Surgery – When melanomas are discovered at an early stage, thin and have not spread beyond the original tumor site, standard excisional surgery is frequently the sole treatment required.
  • Regional Lymph Node Dissection – If stray cancer cells spread beyond the tumor’s original borders, they may reach nearby lymph nodes. This is a major concern because lymph nodes empty fluid into the bloodstream, and cancerous cells could be carried throughout the body. To keep this from happening, surgeons may remove the entire group of lymph nodes closest to the tumor. Sometimes remaining nodes are spared if no cancerous cells are found in the sentinel nodes.
  • Other Treatments – When cancer cells spread beyond the lymph nodes, the melanoma is considered advanced, and a variety of treatment options are used. These additional treatments include radiation, chemotherapy, and immunotherapy (synthetic versions of natural disease-fighting drugs such as interferon and interleukin). These techniques do not cure the majority of advanced cancers. However, they often delay the cancer’s advance and increase the lifespan of patients.

SKIN CANCER DETECTION & PREVENTION

Pre-Cancerous Actinic Keratosis
Actinic keratosis is the most common type of precancerous skin lesion. The more time individuals spend in the sun over the years, the greater their odds of developing one or more AKs. These lesions are more common in older people and outdoor workers, but anyone can develop these precancerous growths, just as anyone can develop skin cancer.
An AK is evidence that sun damage has occurred and that the individual is at greater risk of skin cancer. These lesions most often appear on skin surfaces that have been exposed to the sun or to artificial sources of UV light such as tanning beds.
The more AKs that are present, the greater the chance that one or more may turn into skin cancer. Patients may have invisible lesions on the surface. Untreated, a significant number of AKs may develop into squamous cell carcinoma (SCC), a common form of skin cancer. Actinic cheilitis, a particularly aggressive type of AK that develops on the lips, sometimes transforms into a type of SCC that can spread rapidly to other parts of the body.
Once an AK becomes a cancer and invades more deeply into the skin, it may bleed, ulcerate, become infected, and even spread to internal organs.
Check your skin regularly for any lesions that look suspicious. If you notice changes in shape, size, or color, see your physician promptly.
Treatment Options for AKs Treated early, almost all AKs can be eliminated before becoming skin cancers. Various treatments can be used effectively with little or no scarring.
  • Cryosurgery – This is the most widely used treatment for AKs. It is useful when a limited number of lesions are present. It is applied with a spraying device that freezes them without requiring any cutting or anesthesia. They shrink or become crusted and fall off.
  • Curettage and Desiccation – When the AK is suspected to be early cancer, the physician may take tissue for a biopsy by shaving off the top of the AK or scraping it off with a curette. The curette is used to remove the base of the lesion and bleeding is stopped with an electrocautery needle. A local anesthetic is necessary.
  • Topical Medications – When there are numerous lesions, topical creams and solutions are used. They treat both visible and invisible AKs with a minimal risk of scarring compared with other therapies.
  • Laser Surgery – The skin’s outer layer and variable amounts of deeper skin are removed using a carbon dioxide laser. The risks of scarring and pigment loss are slightly greater than with other techniques, and local anesthesia may be required.
  • Photodynamic Therapy (PDT) – PDT can be especially useful for lesions on the face and scalp. A topical is applied to the lesion(s) at the physician’s office. The next day the patient returns and those medicated areas are activated by a strong light. This treatment selectively destroys AKs while causing minimal damage to surrounding normal tissue. Redness and swelling are common side effects of this therapy.
Preventing Skin Cancer
While AKs and skin cancers are almost always curable when detected and treated early, the surest line of defense is to prevent them in the first place. Here are some dermatologist-recommended sun-safety habits that should be part of everyone’s daily healthcare:
  • Avoid unnecessary sun exposure, especially during the sun’s peak hours (10am to 4pm).
  • Seek the shade
  • Cover up with clothing, including a broad-brimmed hat, long pants, a long-sleeved shirt, and UV-blocking sunglasses.
  • Wear a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher.
  • Avoid tanning parlors and artificial tanning devices.
  • Examine your skin from head to toe every month.
  • Have a professional skin examination annually.
Join Our Patient Rewards Programs & Save

 

Advanced Skin & Laser Center is proud to offer several rewards programs that are free to join and help you save on cosmetic treatment costs. Each time you receive a cosmetic service, you earn points. Points can be converted into coupons that may be applied toward the cost of future services. The more points you have, the more money you save. Enroll today and start saving.

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