Malignant Melanoma: Total Body Skin Exams Save Lives and Suffering

Dermatology Times reported a study which I am not sure has been published in which Dr. Jonathan Kantor noted that 17 of the last 25 cases of malignant melanoma he has treated were found on a routine total body exam and only 8 of the cases presented to him at the concern of the patient. Malignant melanoma is the deadliest form of skin cancer and accounts for up to 2% of cancer deaths in the United States. The chance of any of us developing the cancer is 1 in 70, not insignificant odds. The only cure at this time is early detection and as a pancreatic cancer survivor I can tell you that any unnecessary delay in detection is foolish and heart-breaking.
Unfortunately, we have evolved a paradox in this country with few doctors well versed in detecting melanoma. Certainly dermatologists are far and away the most competent diagnosticians of this horrible disease, yet dermatologists see the fewest numbers of patients. In addition most dermatologists are busy and don't want to do full body exams and most patients don't want their dermatologist to examine their whole body. To that we add a generalized paranoia on the part of physicians and patients. Patient paranoia is based on fear of missing the significance of a changing mole. Physician paranoia is based on the fear of being sued. Together they have created an environment in which tens of thousands of normal moles are removed each year and still the patients don't undergo full body exams. Since fully 50% of melanomas may not arise from a pre-existing mole and since needless removal of moles causes disfiguring scarring we have created a self-righteous monster in which patients and doctors are smug about poor medical care.
A case in point: A mother brought her 16 year-old son to see me to check his moles. I found 5 scars on his body. The mother told me the scars were from removing moles that looked suspicious. Oh, I said, "and how many of these moles were cancer?" "None", she replied. "Well". I said, "that proves your doctor is 100% accurate. Every time she thinks a mole is suspicious it is not cancer. How many more moles will you remove from your son before you consult a second opinion?" The moral to the story is competent dermatologists know when to biopsy and when to watch. Needless disfigurement does not reduce the incidence of malignant melanoma. A second opinion never hurts.

The Non-Surgical Rhinoplasty

I am going to share this space with my associate Dr. John Rachel, MD. Dr. Rachel is the associate medical director of MetropolitanMD. He is a double board certified facial-plastic surgeon with extensive experience in nose reconstruction. Recently, he has been performing minimally invasive augmentation techniques as a substitute for surgical rhinoplasty and has achieved excellent cosmetic results and many appreciative patients. Some of these patients had previous rhinoplasty and as a result of the previous surgical defects of their nose they were poor candidates for more surgery. Coming into the office for a few filler injections sure beats a surgical experience and weeks to months of recovery.

Dr. Rachel:
As minimally invasive procedures in cosmetic surgery become more advanced and popular, the idea of improving the appearance of the most prominent structure of the face is very appealing. There are several reasons that patients present to our office for an improvement in the way the nose looks. Some patients were born with a nose that needs adjustments and others have had previous trauma or surgery with a resultant defect that needs some tweaking. The advent of modern soft tissue fillers, including Restylane and Radiesse has resulted in an alternative for surgical correction of some of these defects. The advancement in the technology for fillers has led to the ability to correct nasal deformities without invasive surgical procedures. In the past, the only available procedures for changing the appearance of the nose was to undergo rhinoplasty (surgical nose reshaping) which required surgery with incisions and a recovery period. The alternative to surgery is using soft tissue fillers. Fillers can be used for correction of many of the problems previously addressed by surgery. The changes that our patients commonly want to correct are a small hump, a crooked nose or a nose that droops. The non-surgical rhinoplasty consists of simple injections that are performed in our office. The injections may be repeated weekly for several treatments until the resulting nose sculpture is optimal. The results can last 9-12 months with no recovery and no surgery and patients can return to work the same day. If you have a nose that you wanted to change without needing a surgical “nose-job” come in for a complementary consultation to see if you are a candidate for this non-surgical procedure.

How To Choose A Cosmetic Surgeon

I have written about this subject before, but in the wake of the tragic death of Kanye West's mother following cosmetic surgery it bears repeating.
Basically there are 6 specialties of surgery which are eligible for board certification by The American Board of Cosmetic Surgery. They are: Dermatologic Surgery, Facial Plastic Surgery, General Surgery, Plastic Surgery, Oral Maxillo-facial Surgery, and Oculoplastic Surgery. All of these must demonstrate advanced training before they qualify to sit for these board exams.
I will concentrate this blog on how a patient can choose a surgeon.

1. Interview the surgeon. What is his training in the field and what is his experience in the performing the surgery in question. How many procedures has he performed.
2. Investigate the surgeon's credentials. Is he board certified and is he recognized in the community. Use professional societies such as the physician's appropriate Board, state medical societies, the AMA, hospitals on which the physician has privileges.
3. Ask where the surgery will be performed. Outpatient surgery centers which are certified by national accrediting agencies are 3X safer than hospital centers. Only certified centers, however, have the same oversight for safety as hospitals.
4. Ask to see before and after photographs. If you don't like the photos you won't like your results either. And it is OK to ask the physician for the name of a patient who had the procedure in question. However, the patient should have somewhat the same age and body type as you because otherwise the comments won't apply to you.
5. Referrals from friends are a good introduction to a physician. However, they are only one person's experience. Interview the doctor. You will live with him for the next year.
6. When any doubt exists or just for good measure, interview 3 surgeons. If there are questions about the surgery it is unlikely that all 3 will recommend a bad choice.

As a group physicians are reliable, moral, dedicated people. Your health and appearance are important to us and we respect your need to make careful evaluations between physicians. I can be reached at 847-832-6700 or e-mail me at drlack@metropolitanmds.com.

Reassessing The Need For Cosmetic Surgery

The untimely and tragic death of Kanye West's mother following cosmetic surgery forces the medical community to reassess the need for cosmetic surgery and the rewards vs. the risks.
In my judgement there are at least 3 reasons for the massive increase in and the need for cosmetic surgery worldwide.
First, as longevity increases there is a need for the human being to maintain functionality. Growing old gracefully is euphemism for "I don't want to do it so you shouldn't either". My mother lies in a nursing home bed unable to walk and barely able to communicate. Hundreds of thousands of people sit in nursing homes as virtual or actual invalids because of their inability to function in society. Millions of people see their faculties waste away as they can no longer find jobs, no longer enjoy relationships, no longer function in their familial societies. We are talking about quality of life! Just as functional organs are necessary for quality of life, so is appearance and the ability to relate to each other.
Second is the need for self-esteem in mental health. Vanity is a synonym for self-esteem. It is not narcissism. It is one of the main reasons getting up in the morning is fun. Now cosmetic surgery can function to enhance appearance and self esteem and this is ideally the goal of the cosmetic patient. And cosmetic surgery can function as a neurotic wish to repair self-abuse. It is the job of the cosmetic surgeon to differentiated between the two. Cosmetic surgeons are trained physicians who make diagnoses, evaluate the cause, evaluate options for repair, educate the patient, and facilitate the patient getting well. We are not cosmetologists. It is our job to differentiate the cause of the problem and to refer patients for appropriate help when cosmetic surgery will not meet their needs.
Third, we have a plethora of non-invasive treatments which have minimal risk to patients and maximize the self esteem resulting from appearance. It is no accident that I named this blog "health and appearance" and not just the latter.
In an age of instant communication, sober thought is needed to prevent castigating an entire medical sub-set with pejorative labels.

American Academy of Cosmetic Surgery Hospital Opens in Dubai

I have just returned from a trip to Dubai at which the World Congress on Liposuction was held and the new American Academy of Cosmetic Surgery Hospital was opened in Dubai. The Congress was an overwhelming success with approximately 175 American surgeons and more than 225 non-American surgeons in attendance. We are expanding our influence and extending our mission of educating the public and physicians in the best practices of cosmetic surgery to the middle east.
Hopefully, with missions such as Dubai Health Care City, operated by Harvard Medical Management Corporation, we can influence the geopolitical climate in this very unstable and dangerous part of the world. Dr. Jeehan Qadir, owner of the hospital, repeatedly referred to the opportunity to render compassionate care to this war torn region of the world. Needless to say, the wealthy of the region will similarly benefit from American expertise in this area of medicine and the potential here is for a win-win situation for the western world and for the middle east.
Time will tell.