When people think about skin surgery, they usually think of dermatologists or plastic surgeons. However, as general surgeons, we evaluate and treat diseases of the skin and soft tissue almost every day. Our areas of expertise include evaluation and diagnosis of pigmented lesions, soft tissue masses, traumatic tissue injury, infections, and pressure ulcers.

We obtain a thorough history and physical exam during an office consultation and make a decision on further management. Pigmented lesions that are new, enlarging or bleeding can be worrisome. On the exam, we are more suspicious if the lesion has black color, irregular boarders, ulceration, and size greater than 6 mm.

Obviously benign lesions may be observed or excised based on patient preference. For suspicious or indeterminate lesions, we have a variety of biopsy techniques available in our office under local anesthesia, including shave biopsy, full thickness punch biopsy and full thickness excisional biopsy.

If a patient has a postitive biopsy for malignant melanoma, we stage the disease based on the thickness of invasion. If it is less than 1 mm thick, it is considered stage I which has a very low chance of metastasizing to lymph nodes. The treatment is a wide local excision with a one centimeter margin. This is an outpatient surgery at the hospital under twilight anesthesia. If the primary lesion has a depth of invasion 1 to 4 millimeters, it is considered intermediate thickness and does have a chance for lymph node metastasis. Thus, we recommend a sentinel lymph node biopsy. This technique allows analysis of one or two lymph nodes in the Axilla or groin. If negative, the patient is spared the morbidity of a complete lymph node dissection.

These "lumps or bumps" are usually fatty tumors (lipomas) or sebaceous cysts, which come from plugged up sweat glands. However, soft tissue tumors may represent lymph nodes, congenital cysts or benign or malignant neoplasms such as sarcoma or metastatic disease. We question patients regarding how long they have had the lesion, if it is growing, if it is painful or has ever been infected. We ask about personal or family history of malignancy. The examination focuses on skin changes, size of the lesion, weather it is fixed to the muscle and the consistency.

The initial options include imaging by ultrasound or MRI, needle biopsy or excisional biopsy. The decision is based on suspicion of malignancy. If a patient has a small superficial tumor that is stable, it can be watched. Deeper masses are usually imaged with MRI as a first step. It is not usual to perform a needle biopsy unless the lesion is thought to be a lymph node. Therefore, If it has reached a large size, is rapidly growing, is hard or fixed to the muscle, it should be removed for diagnosis and treatment. All specimens are sent for pathologic analysis. If a malignancy is diagnosed, it is sometimes necessary to perform another more radical surgery, with or without the addition of chemotherapy or radiation, depending on the diagnosis.

Our full thickness excision method involves two layer skin closure using absorbable suture. This plastic surgical technique leads to minimal scarring and increased patient satisfaction.

Treatment of skin infections, ulcers and varicose veins rounds out our expertise. We provide urgent service to patients with skin and soft tissue infections. If a patient calls our office with a boil or severe infection we will work them in the same day for evaluation and incision and drainage when necessary. Many times, the wound is left open to heal from the bottom up. We see all our patients through the wound care process. If someone needs inpatient care, we are readily available to provide this.