As both a board certified dermatologist and dermatopathologist, Dr. Goldenberg has a special interest and expertise in skin cancer diagnosis and treatment. Early detection and treatment of skin cancer has been one of the most significant advances in dermatologic surgery in the past decade. An average skin cancer patient has a “spot” that is changing. Sometimes it is “a bump that won’t heal”, “a mole that changed color” or “a sore that is bleeding”. Other times it is a mole that is growing, bleeding, or itching. Dr. Goldenberg is an expert in early diagnosis and treatment of skin cancer. As a Board Certified Dermatopathologist, Dr. Goldenberg is able to visualize what lesions would look like under the microscope for a deep understanding of each lesion he examines.
Common skin cancers include basal cell carcinoma, squamous cell carcinoma and melanoma. Of all types of skin cancer, basal cell carcinoma is the most common. Fortunately, they tend to grow slowly and remain localized. They frequently appear on sun-exposed parts of the body. Common appearances of a basal cell include a fleshy bump with a pearly surface, a scar-like lesion or a bump that bleeds. A more severe but less frequent type of skin cancer is known as squamous cell carcinoma. It frequently appears as a scaly, red patch or nodule that grows. Common locations include the nose, ears, hands and scalp (especially in men that have lost their hair). Early diagnosis and treatment is a key to preventing any skin cancer from growing into melanoma, which is a potentially fatal disease.
Malignant melanoma is the most serious type of common skin cancer. Typically, it appears as a mole that changes size, bleeds or begins to itch. Most melanomas are asymmetric due to cells growing at different rates. Many have an irregular border, are more than one color and have a diameter of more than 5 mm. Early detection and prompt intervention by a dermatologist are the best treatment for melanoma.
Basal Cell Carcinoma
Basal cell carcinoma is the most common cancer in humans. Fortunately, they tend to grow slowly and remain localized. Chronic exposure to sun and UV rays are a major contributing factor for all basal cell carcinomas. It is not a coincidence that they tend to occur most frequently on the face, ears, neck, scalp, shoulders and back. Basal cell carcinoma can masquerade as acne bumps, eczema lesions or scars. Some telling signs that a spot on your skin might be a basal cell carcinoma include: an open sore, a reddish patch, a shiny bump or nodule, a pink growth, and a scar-like area. These lesions tend to bleed and may be itchy. Basal cell carcinoma usually doubles in size every year but is usually curable, especially if detected and treated early. As with other forms of skin cancer, the age of onset is decreasing and the rate of incidence in women is rising. Basal cell carcinoma skin cancers have increased over the past few decades, and the average age of onset of the disease has steadily decreased.
Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common skin cancer. It arises from the middle layers of the epidermis and occurs on all areas of the body, including the lips and nails. It is most frequently seen in areas that have been exposed to the sun such as the face, neck, scalp, hands, shoulders, arms and back. Squamous cell carcinomas vary in their behavior, and the aggressive subtypes can metastasize with fatal outcomes. These lesions usually present as scaly bumps that tend to bleed.
Burns, immune suppression (for example, the use of steroids or drugs for organ transplantation) scars, long-standing sores, radiation and certain chemicals (such as arsenic and petroleum by-products) increase the incidence of squamous cell carcinoma. Squamous cell carcinomas typically appear as scaly bumps that grow or bleed. They usually arise among a field of precancerous growths known as actinic keratoses.
Sometimes, they grow rapidly and are painful (the keratoacanthoma subtype), and sometimes they smolder.
Melanoma is the most deadly form of skin cancer. However, if diagnosed and removed while in its early stages it is almost 100 percent curable. Unfortunately, once it spreads it is difficult to treat and is frequently deadly. The cells that give rise to melanoma are known as melanocytes. These cells produce melanin, the pigment responsible for tanning and producing the color of the skin, hair and eyes. Typically, melanocytes occupy one out of every ten cells of the basement membrane of the skin epidermis. When they proliferate, they may produce freckles or moles. If they become malignant, they produce melanomas.
Melanomas may have a myriad of possible appearances ranging from an irregularly colored lesion to an unremarkable beige spot. In general, a pigmented spot that is changing should be considered a potential melanoma and be evaluated by a dermatopathologist. A dermatopathologist is a physician who after completing training in either dermatology or pathology pursued additional training in accredited programs for the interpretation of skin biopsies. Dermatopathologists integrate the clinical information with microscopic observations of the skin biopsy taken from the patient to provide diagnostic information to the dermatologist or surgeon who will be administering treatment. Dr. Goldenberg is one of a select group of dermatologists who are also dermatopathologists.
The best strategy for beating skin cancer is early detection and treatment. During a self exam, you should monitor your entire body for changes in the size, shape and color of any spots. During a skin cancer screening, Dr. Goldenberg will ask about any spots or marks that concern you to determine whether a biopsy may be indicated.
Dr. Goldenberg specializes in performing total body checks, an exam in which Dr. Goldenberg will look at every inch of your skin to determine if there are any atypical lesions that need to be monitored or removed. People with a history of sun burns, sun tans, atypical/dysplastic moles and prior history of skin cancer need regular total body examinations.
Dr. Goldenberg specializes in using the MelaFind device, that can help determine if a mole has a high or low risk of being a malignant melanoma skin cancer.
If the lesion is suspicious, a biopsy should be performed. During a skin biopsy, a small piece of skin (typically smaller than a pencil eraser) is removed. The procedure uses local anesthetic and takes a few minutes. The information obtained from the biopsy allows Dr. Goldenberg to decide whether skin cancer surgery is indicated. As a dermatopathologist and dermatologist, Dr. Goldenberg personally evaluates all of his patients’ biopsies.
Excisional surgery refers to excising (cutting out with a scalpel) a lesion, and then suturing the area to close it. A dermatopathologist evaluates the edges of the tissue removed to determine whether the margins of the specimen are free of cancer. Dr. Goldenberg performs excisional surgery in his New York city office using local anesthesia. A typical procedure takes about 15-30 minutes. Common cancers treated with excisions may include: basal cell carcinoma, squamous cell carcinoma and melanoma.