DeKalb Clinic Specialties

Skin Cancer
Skin cancers are comprised of 3 types including basal cell cancers, squamous cell cancers and melanomas. Basal cell cancers typically have very small areas of invasion and are easily treated by simple local excision in the office. Squamous cell cancers are slightly more malignant and require a wider resection but often times can also be performed in the office. Melanomas have a very significant malignancy and these tend to occur in more sun exposed areas and they can also have an increased risk in people with multiple nevi and first-degree family members with melanomas as well.

There are clinical characteristics from melanomas called the ABCD of melanomas; this includes the asymmetry of the mole, such as the contour and color. The borders of melanomas typically are irregular with finger-like projections. They often have distinct colors such as red, white or blue and the diameter often times is greater than 6 mm (or the size of a pencil eraser). Currently there is not a good chemotherapeutic agent for the treatment of melanoma so the main treatment is surgical excision. The extent of the excision and the possibility of removal of lymph nodes often times depends on the location and the staging of the tumor.

Cysts & Fatty Tumors
There are a full host of other cystic lesions that can occur in the skin and soft tissues of the body. The most common of these are lipomas and sebaceous cysts. Lipomas typically occur in the subcutaneous tissues of the skin and they are slow growing, mobile, soft lesions with a fairly regular border. Deeper lesions or extremely large lipomas may require further imaging studies to ascertain that they are not an undiagnosed low-grade cancer. Treatment for these is elective and is indicated when they are increasing in size or in such an area that is causing irritation and pain. Smaller superficial lipomas are can be removed in the office.

Sebaceous cysts are plugged skin glands that fill up with the oils that are normally secreted to lubricate the skin. These can be present with an infection and initially will require lancing and antibiotics to let the infection resolve. A non-infected sebaceous cyst is often times removed in the office with a minor surgical procedure and this is generally recommended if it is not infected, if it is increasing in size or causing a cosmetic problem. Again, these typically are elected procedures as well.

Pilonidal Cysts/Abcesses
Pilonidal sinuses are relatively common occurring in up to 1% of young adults. These are sinuses or infections that occur in the midline crease between the buttocks. This is called the sacrococcygeal pilonidal sinus. These are believed to be acquired by hair follicles that get pulled into the skin due to the constant motion thus leading to infections and abscesses. These will often present as a painful abscess, lancing and debriding any hair that remains within the cavity often times will cure the disease in up to 60-70% of patient's. This can often, unfortunately, progress to a chronic pilonidal cyst, which presents with recurrent abscesses and infections. This means that the deeper abscess cavity containing the hairs is not being adequately débrided and a more formal surgical resection is usually indicated. Very large pilonidal tracts will often not heal on their own either. Recurrence rates despite surgical removal can be up to 8-10%.