Approaches to Dermatologic Surgery

Vishal A. Patel, MD, and Jordan C. Carqueville, MD, discussed dermatologic surgery cases that may have multiple potential treatment options in their session, “The Cosmetic Approach to Dermatologic Surgery.”

Dr Patel is the director of cutaneous oncology and dermatologic surgery and an associate professor of dermatology and medicine/oncology at the George Washington University School of Medicine & Health Sciences in Washington, DC. Dr Carqueville is the founder and medical director of the Derm Institute of Chicago.

Dr Patel began by noting the intersection of cosmetic dermatology, dermatologic surgery, and dermatologic oncology and posed a series of questions to Dr Carqueville about her preferred treatment approaches.

1. What is your preferred treatment for a 27-year-old who has a hypertrophic scar on the neck from a car accident?

Dr Carqueville: “It depends on the scar, but I often use laser-assisted drug delivery when surgery is not the ideal option, which helps achieve enhanced absorption.”

2. What strategies do you utilize to maximize the scarring outcome for a 37-year-old woman with basal cell carcinoma (BCC) on the forehead?

Dr Carqueville: “I often utilize neuromodulators at the time of surgery or suture removal to enhance cosmetic outcomes on the glabella or forehead.” 

3. A 44-year-old woman has a superficial BCC on the right anterior lower leg.  What is your preferred nonsurgical treatment for this lesion and area?

Dr Carqueville: “I prefer surgery; however, there are various laser options that may be considered, including pulsed dye laser.”

4. A 53-year-old woman has significant actinic damage on the chest and face. What is your preferred field cancerization?

Dr Carqueville: “I love laser for treatment of actinic damage. The utilization of peels can help improve actinic damage and help with field cancerization, and they are easy to carry in the office and cost-effective for the patient.”

5. What is your preferred skin cancer prevention and rejuvenation treatment for a 30-year-old who spent summers as a lifeguard?

Dr Carqueville: “I use nonablative or ablative resurfacing lasers to rejuvenate the skin and aid in skin cancer prevention.”

“We are not just saying that we will make the cosmetic appearance better, but there is this scientifically shown and mechanistically meaningful way of reducing skin cancer development,” Dr Patel remarked. Dr Carqueville concluded, “This is a nice coming together of cutaneous oncology with cosmetic dermatology because I do think it goes hand in hand and we are all working toward the same goal: good health, no skin cancer, and great appearances too.”

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Reference

Patel VA, Carqueville JC. The cosmetic approach to dermatologic surgery. Presented at: Dermatology Week; May 3–6; Virtual.