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Dermatologist

Dermatologists are physicians who specialize in diagnosing and treating diseases related to the skin, nail and hair. Pediatric dermatologists are trained to cure any skin disorders in infants, children and young adults. Cosmetic dermatologists are trained specialists in beautifying the skin by removing scars and external marks on the skin either through medications or surgical procedures. Dermatologists have to complete medical school and then an internship period of one year followed by three years residency program in dermatology. After completion of the residency program, they take up training in sub-specialties of dermatology such as cosmetic dermatology, pediatric dermatology etc.


Task of a dermatologist

Dermatologists have the prime responsibility of providing care to the most exposed organ of the body, their task includes:


  • Skin reflects the conditions of the internal organs and any kind of disorder in any of these organs reflect on the skin, thus dermatologists have to have expertise in other medical specialties too.
  • They treat conditions such as ,skin cancer.
  • Overall conditions of the skin are improved by removing any superfluous growth, discolorations, damage caused due to exposure to sunlight etc.
  • They prescribe medications or ointments to treat problems of the skin.
  • Phototherapy along with application of ointment on the skin is suggested in extreme cases.

Latest techniques employed in the field of dermatology

With the newer techniques available for treatment in the field of dermatology it has become easier to treat skin related with ease.


  • Laser techniques are profoundly used to cure skin related problems.
  • Variety of creams and lotions provide solutions to many skin problems.
  • Modern surgical techniques help in correcting the disorders of the skin.

Conscious Sedation

Conscious sedation is used in procedures for which general anesthesia is not required and wherein the patient needs to respond to questions. The American dental association started using this phrase extensively; they used this procedure to keep their patients comfortable during a dental procedure. Conscious sedation is a type of sedation wherein the patient can respond to verbal directions even while under the influence of sedation. This type of sedation is classified under moderate sedation. Conscious sedation is achieved using intravenous agents.

Conscious sedation procedure is used in biopsy, dental procedures, plastic and reconstructive surgeries, dermatology, Endoscopy procedures and minor surgeries. Generally carried out as a day care procedure, a patient needs to be reviewed completely before administering conscious sedation. It is generally considered a safe procedure and is low cost when compared to general anesthesia.

A certified medical professional carries out this procedure. The patient is given medication that relaxes and then the pain killer is administered to eliminate pain during the procedure. In a few cases, medications are administered for the patient to forget the procedure (amnesic). Throughout the procedure, the patient's heartbeat, breathing, pulse rate, etc are continuously monitored. Once the procedure the patient is kept under observation until he/she completely recovers. Recovery is much faster when compared to general anesthesia. The patient takes 24-48 hours to experience complete recovery from the procedure.

Common side effects from conscious sedation include nausea, headache, muscle pain and sore throat. No solid foods must be eaten for a few hours prior to the procedure. Do inform the physician if you are diabetic, lactating mother or allergic to medications.


Melanoma

Melanoma is a type of skin cancer that develops from abnormal moles, or the pigment skin present in the skin. Because of its nature to spread to other parts of the skin, melanoma is more serious that other forms of skin cancer. It can cause serious illness and death. Derived from Greek origin 'melas' which means 'dark', melanocytes are cells that produce dark pigment called melanin which is responsible for the color of the skin. Melanoma is a most common form of cancer and the risk can increase with age. However, melanoma affects people of all ages, races, and genders and ethnicity.


Signs and symptoms

As melanoma occurs in the skin and it can be seen, patients themselves are the first to detect many melanomas. If caught early, melanomas can be cured by relatively minor surgery. However, early diagnosis and detection are crucial as it may otherwise invade healthy tissues and spread to other parts of the body making it out of control. The ABCD of melanoma can be described as:

Asymmetry: that is the shape of one half does not match with the other half.
Border: the edges are blurred, irregular.
Color is uneven and includes shades of black, brown and tan.
Diameter: there is a change in size as it increases.


Causes of Melanoma

Researchers opine that a gene known as BRAF plays a lead role in causing melanoma. As BRAF is a switch gene, it allows other cells to divide and grow. Mutations in this gene can cause explosive growth and the resultant melanoma skin cancer.

  • Sunburns, especially slow daily sun exposure, even without burning.
  • White ancestry (Caucasian)
  • Fair skin, light hair and light colored eyes
  • Intense exposure to sun especially during childhood
  • Many moles in the body, to the tune of more than hundred
  • Large irregular funny looking moles
  • History of close relatives especially parents, siblings or children with melanoma- presence of close family melanoma is a high risk factor; although only 10% of cases run in families.

Melanoma can occur on any skin surface – it is common on the area between a man's shoulders and hips. For women, melanoma generally develops on the lower legs. People with darker skin develop melanoma on their palms and soles as well as under toe and fingernails.


Diagnosis of melanoma

Get the dermatologist to examine your body fully and find out whether the moles are odd. The medical term for such moles is 'atypical'. The dermatologist will perform a skin biopsy to evaluate if the mole is cancerous or not. The doctor will remove all or part of the skin under local anesthesia and send the specimen to a pathologist for analysis. The biopsy report will reveal:

  • A totally benign condition that requires no further treatment, as in the case of a regular mole.
  • An atypical mole which depends on the judgment of the pathologist to treat – either conservative removal by taking off a bit of the normal skin all around to make sure that the spot is completely out or
  • A melanoma requiring surgery
  • Some doctors may perform epiluminescence or dermatoscopy.

Melanoma treatment

Once melanoma is diagnosed as cancer and staged, then the doctor will discuss the treatment options with the patient. Treatment is based on the stage of cancer and other related factors. In case of normal moles, which are small brown spots or growths of skin that appear in the first few decades of life in almost everyone, no treatment is necessary.

People with classic atypical mole syndrome have more than 100 moles, with many moles over 8 mm diameter and one or more moles are atypical. Treatment options include Surgery, chemotherapy, and immunotherapy and radiation therapy. Sometime a combination of treatment is used. In general melanoma is treated by surgery alone. But surgery need not be extensive, as was some years ago. During early stages of melanoma, surgeons will remove only a centimeter or even less of normal tissue around the melanoma. Whereas, deeper and more advanced cancers would require extensive surgery. The removal of nearby lymph glands depend upon factors that include tumor thickness, body location, age etc. If the stage is pretty advanced, immunotherapy treatments are adopted.


Prevent melanoma

Reduce sun exposure. Perhaps avoidance of sun exposure is the best means to prevent melanoma. Wear hats and tightly woven clothing and apply sunscreens liberally when going out. Although there is a controversy among dermatologists about sunscreen protecting against melanoma, it is certainly preferred to unprotected sun exposure.

Early detection is the key to prevention. Get your skin checked at least once every few years. In the US, the American Academy of Dermatology sponsors free skin cancer screening clinics every year all over the country. Special pigmented lesion clinics have also been established in many medical centers to allow close clinical and photographic follow ups of patient with high risk. But a reference from a concerned dermatologist is essential to undergo the screening.

Any person with high risk and having a close relative who has/had melanoma should be screened by a doctor for cancer of the skin. As with any other cancer, early diagnosis and proper evaluation and treatment is the essence.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019