News
May is Skin Cancer Awareness Month
Our very own Dr. John Geisse was interviewed for this article published in the Daily Republic about Skin Cancer for Skin Cancer Awareness Month.
Jill Biden has Mohs Surgery
On January 11, 2023 Jill Biden (the First Lady) had Mohs Micrographic Surgery for Basal Cell Carcinoma.
This procedure is safe and a fairly common treatment option for certain Basal Cell Carcinomas.
Solano Dermatology Supports 10,000 Degrees
More information about 10,000 degrees can be found at 10000degrees.org
Drug Shortages
Did you know that drug shortages are a common occurrence in the United States. At any time of the year the FDA reports multiple medications that are out of stock. This becomes troubling for people with specific diagnoses who require treatment that doesn’t have alternatives.
However, we are now in a crisis where the supply of an entire class of medications has been disrupted and millions of patients have/will be affected. Local Anesthetics.
Dermatology practices like ours have been struggling to get local anesthetics like lidocaine. These anesthetics are used for hundreds of procedures that are done in our offices each week. We use lidocaine to biopsy lesions suspicious of cancer and to perform surgical procedures to remove malignant and nonmalignant, but sometimes critical, lesions.
This is frustrating for both our patients and our providers. We are dependent on the suppliers of these medications to have them readily available for our use. It’s surprising that our government hasn’t done much to prevent these drug shortages since the first FDA drug shortage report to congress in 2013.
Please consider sending your representative a letter regarding your concern.
[Date]
Dear [Congressional Member]:
I am writing to you as your constituent to discuss an issue of great concern—the national drug shortage. It is troubling that commonplace medications that are used in physicians’ offices every day are not available in the United States, and that their unavailability places America’s patients, including your constituents, at risk.
The issue of drug shortages in the United States is an escalating problem that began nearly a decade ago when limited production capacity and lack of competition in the pharmaceutical industry led to a shortage of generic injectable medications, including lidocaine and lidocaine with epinephrine. Since then, medical organizations, like the American Academy of Dermatology Association, have actively lobbied Congress and federal agencies, including the Federal Drug Administration, to address the concern. I fear that those efforts have not fixed the problem. Therefore, I am writing to you as a patient and your constituent to let you know how this shortage affects us.
Lidocaine is a local anesthetic frequently used for common dermatologic procedures, and lidocaine with epinephrine is essential to control bleeding during these surgical procedures. However, lidocaine with epinephrine is only available in limited quantities and in some cases has been on back order for months. The impact on this shortage is most acutely felt among solo and small practitioners where the predominant outpatient care is provided.
This is what the national shortage of lidocaine means to me and millions of other patients across the United States:
- A patient (especially one taking a blood thinner) may not be able to have a biopsy of a suspicious skin lesion simply because the risk of bleeding is too high.
- A patient’s skin cancer surgery may be delayed indefinitely simply because the physician cannot control the pain and bleeding inherent in the surgical procedure, which could lead to intraoperative complications.
- A physician may have to find unconventional alternatives to anesthetizing me, thus increasing the risks associated with my procedure.
Please put an end to our nation’s drug shortage by working with the pharmaceutical industry, federal agencies and our national medical organizations to rapidly identify feasible solutions to this national crisis.
Yours most sincerely:
[Patient Name and Contact Information]
Virtually all hospitalized Covid patients have one thing in common: They’re unvaccinated
Solano Dermatology encourages everyone who is eligible to get vaccinated for COVID-19.
Read the full story about how important this vaccine is at NBC news article June 2021.
Botox
Botox® Cosmetic is the most common nonsurgical anti-aging treatment. It is a safe and effective way to reduce or eliminate lines on the face caused by use of the facial muscles. With a few injections the areas treated can smooth out and give you a younger, relaxed look, with results lasting a few months and follow-up treatments often lasting longer, if you would like to learn about other cosmetic procedures then consider looking into microneedling.
According to Healthcare Business Today, Botox® Cosmetic is a natural purified protein that is injected into the targeted muscles of the face and blocks nerve impulses that cause contractions. The absence of muscle contractions prevents the skin from being bunched and creating lines. The protein does not travel elsewhere in the body, so there are no unwanted effects from a treatment. There is a potential of bruising from the injection, and one of our expert providers can discuss with you possible outcomes and rare side effects.
Within the first few days the treatment starts to take effect and the majority of patients see significant improvement at 7 – 10 days, and further improvement for up to a month. Results can last up to four months, however individual outcomes may vary.
Our practice has an excellent relationship with the makers and suppliers of Botox Cosmetic® and participate in the Brilliant distinctions® program, allowing patients to earn points for their treatments which can be used for special perks.
As with all cosmetic procedures it is best to consult with one of our providers on your specific concerns so that you receive the best treatment, or combination of treatments, for you. The cost of Botox® depends on a number of factors, including how much is used and will be discussed with you during your consult.
Call our office at (707) 643-5785 to get started.
Treatment of Melanoma
Malignant Melanoma is also epidemic worldwide and is the third most common form of skin cancer. There is a great deal of information already published about malignant melanoma on the internet. We will limit our discussion primarily to melanoma cancer treatment, which is primarily done by a dermatologist. Early detection of melanoma is critical and saves people’s lives because the prognosis or risk of spreading varies directly with its depth of invasion. Most melanomas start out early and are not very deep; if they are caught at that stage and removed completely they are not likely to spread.
The lowest risk form of melanoma is called in situ (MIS) which is on the surface of the skin similar to squamous cell carcinoma in situ. Those cancers should not spread at all although our statistics tell us that actual cure rates for MIS are not 100% as one might think. That is probably because some patients who have been diagnosed with MIS might have had areas of invasion that were missed under the microscope, since standard pathology misses a great deal of what is actually cut out by the dermatologic surgeon due to how the tissue is processed. This is not wrong; it is just how things are done in standard pathology which when compared to MOhs micrographic surgical pathology is much less thorough. The pathology partly dictates our treatment and the margin of normal skin around the melanoma. If the melanoma is in situ the standard recommendation is 5 mm margins, although research shows that that may not be adequate in many cases. Frequently melanomas are very ill-defined. We use a special light, a Wood’s light, to help delineate the size of a melanoma. This is a black light or UV light which illuminates brown spots and helps us determine the size of the melanoma which sometimes can be quite subtle and difficult to see with the naked eye. In situ melanoma on the central face in critical areas such as the eyelids, nose, ears, and lips can be treated with Mohs micrographic surgery, but the pathology is difficult requiring a special stain called an immunoperoxidase stain which labels melanoma cells to increase our sensitivity and our success rates. Despite that, this form of melanoma has a higher recurrence or persistence rate after Mohs or any form of treatment. When we do Mohs micrographic surgery on this type of melanoma on the face, we often have patients use Aldara or imiquimod cream to help clean up single cells that we may have left behind. Aldara or imiquimod cream has been use for in situ or superficial melanoma, although the research is quite limited and failure raters are substantia; thus we rarely if ever recommend it as what is called primary treatment. We sometimes do recommend it as mentioned above for what is called adjuvant treatment after surgery to possibly help improve our cure rates.
Patients’ Choice Award
Dr. Geisse was awarded the Patients’ Choice Award!
The Patients’ Choice award is bestowed upon physicians based on your patients’ appreciation and praise for the quality of care and service you provide.
Every month, more than 200,000 patients across the U.S. provide online feedback about their doctor experiences. They rate various components of the care they receive, such as bedside manner, doctor-patient face time, follow-up care, ease of appointment setting and courtesy of office staff. They also share their overall opinions.
Over the course of 2013, hundreds of thousands of patient reviews were written and shared. While physicians generally receive positive feedback from their patients, only physicians like you – with near perfect scores – have been voted by their patients for this honor.
In fact, of the nation’s 870,000 active physicians, only 5 percent were accorded this honor by their patients in 2013.
Congratulations Dr. Geisse!