Surgical dermatology refers to the subspecialty of dermatology that manages skin conditions through surgical procedures. These procedures may involve the superficial layers of the skin or extend through to the underlying layers below depending on the condition being treated. All of our providers routinely perform dermatologic surgery but Dr. Crotty has received advanced training in Mohs micrographic surgery, a technique used to minimize scarring and the recurrence of cancer cells.
Acne surgery: This involves the opening of closed and open blackheads and whiteheads. It may also include injection of very small amounts of cortisone into large, inflamed acne nodules and cysts. Acne surgery is done to speed up the process of acne resolution.
Cryosurgery: Cryosurgery (freezing) is used for a variety of different skin lesions. It is commonly used for freezing precancers brought on by sunlight. Cryotherapy is also used to treat warts and is sometimes used as a treatment for prurigo and prurigo nodularis. The freezing itself can be slightly uncomfortable but is a simple and effective technique for many conditions.
Curettage: Curettage (scraping) is a very effective tool used for the removal of very superficial skin cancers on the chest, back, and legs. This is a type of scraping technique used with a special device where the provider scrapes the skin cancer off the skin including a portion of normal skin at the periphery. Curettage is one treatment option for precancers and removal of seborrheic keratoses and other benign skin growths.
Electrocautery: Electrocautery uses a heat device to burn small, benign growths including skin tags and seborrheic keratoses. It is sometimes used to stop bleeding and can be used in combination with curettage to remove benign skin lesions.
Excisional surgery: This is commonly used to remove skin cancers which may be deeper or to remove dark moles which cannot be removed by a simple shave technique. It involves using a scalpel and requires cutting into the fatty tissue, often in an oval fashion to completely remove the lesion. After excision surgery sutures are required to close the layers of skin.
Excimer Laser: The 308 nm excimer laser is a technology used to treat a variety of skin conditions. It is particularly beneficial in psoriasis and vitiligo. In these diseases, the excimer laser provides a localized form of light therapy which treats only diseased portions of the skin and spares the rest of the body. In treating psoriasis, the excimer laser usually requires 8-10 treatments to clear localized patches. The treatment of vitiligo can be more prolonged, taking 40-50 treatments until repigmentation occurs. It is especially beneficial for loss of color on the face. Other diseases where the excimer laser has been helpful include loss of color following laser procedures, scalp psoriasis, white stretch marks, and white scars on the face.
Mohs micrographic surgery: Mohs micrographic surgery is the most advanced technique for removal of skin cancers offering the highest cure rate for basal and squamous cell carcinomas. Developed by Dr. Fred Mohs, Mohs surgery involves the systematic removal and analysis of thin layers of skin at the location of the skin cancer until the last traces of cancerous tissue have been eliminated. The immediate and complete microscopic examination and evaluation of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Only cancerous tissue is removed, minimizing both post-operative wound size and the chance of regrowth. This allows for the best cosmetic surgical reconstruction with minimal scarring or change in your appearance. High precision makes Mohs surgery ideal for the elimination of cancers in cosmetically important areas such as the face (nose, eyelids, lips, hairline), hands, feet and genitals. A Mohs surgeon performs the function of a surgeon, a dermatopathologist, and reconstructive surgeon on an outpatient basis under local anesthesia. Dr. Crotty is a specialist in Mohs micrographic surgery and trained under Dr. Fred Mohs while a resident at the Mayo Clinic.
Punch grafting: This is a technique for removal of pinpoint scars related to acne scarring on the face. A very small punch tool is used to core out the scar in its entirety. Usually a small skin graft is taken from behind the ear and placed in the defect. After the punch grafts have healed, the area is very gently sanded to smooth out the contour.
Shave excision: This is a simple method using a scalpel blade or a razor blade to remove a benign mole or benign skin lesions. The technique is relatively superficial and does not involve deep excision so no sutures are required.
Subcision: Subcision is used for the treatment of acne scarring. A special needle is used to undermine scars which have adhered to the deep tissue. Using the needle in a back and forth motion under local anesthesia, the needle breaks up the underlying scar tissue and allows the tissue to “float to the surface.” Subcision is often used in conjunction with other techniques at the same time including laser resurfacing or dermasanding.