Cosmetic Surgery Blog

Understanding the ABCDEs of Melanoma

Detail of facial melanoma on middle aged man

Cosmetic and skin cancer surgeon Dr. Ralph Massey specializes in the diagnosis and surgical treatment of melanoma in Santa Monica, CA. Dr. Massey is a tireless educator and advocate of the vital importance of detecting skin cancer early, especially if melanoma is suspected. Join us for the following insights from Dr. Massey on the ABCDEs of melanoma, a critical tool for helping in the early recognition of this most serious form of skin cancer.

The ABCDEs of Melanoma Explained

Melanoma is a formidable adversary, but knowledge is our greatest weapon in the fight against this condition. The ABCDEs of melanoma represent key characteristics of moles or growths that could signify the presence of cancer. Dr. Massey stresses the importance of familiarizing oneself with these signs:

Asymmetry – One-half of the mole or birthmark does not match the other. Healthy moles are typically symmetrical, so any asymmetry warrants closer examination.

Border – Irregular, scalloped, or poorly defined borders in a mole can be a warning sign. Unlike benign moles that have smoother, more even borders, malignant ones often display uneven edges.

Color – The presence of varied colors within a single growth – including shades of brown, black, pink, red, white, or blue – can indicate melanoma. Uniform coloration is more common in non-cancerous moles.

Diameter – Melanomas usually are larger in diameter than a pencil eraser (6mm). However, they can be smaller when first detected, making it crucial not to overlook smaller suspicious moles.

Evolving: Any change in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching, or crusting, points to evolution. A mole that changes over time is a red flag.

Skin Cancer: The Importance of Early Detection

Early detection of melanoma can significantly enhance treatment success. Regular self-examinations using the ABCDE guide and annual skin checks by a dermatologist are vital strategies in identifying melanomas at their most treatable stage. 

Preventing Skin Cancer: Sunscreen, Lifestyle and Diet can Minimize Risk

The importance of using a proper sunscreen to protect your skin from exposure to Ultra-Violet (U.V.) Light exposure can not be overstated. Whether from the sun or tanning beds, U.V. Light is a known carcinogen that causes the majority of skin cancers. Applying broad-spectrum sunscreen of SPF 30 or higher every two to three hours and wearing protective clothing can significantly minimize the risk for developing melanoma. 

While avoiding sun exposure during peak hours and the diligent use protective clothing and sunscreen are the first lines of defense against developing skin cancer, following are some additional preventative measures to consider: 

Oral vitamin D supplements – For individuals seeking the therapeutic benefits of the sun or tanning booths, vitamin d supplements have been shown to provide similar benefits in place of sun exposure and the use of tanning beds.therapeutic benefits in place of sun exposure or the use of tanning beds.

Nicotinamide (Vitamin B3) –  High-risk individuals can reduce their risk of basal cell and squamous cell skin cancers by over 20% through the twice-daily oral intake of 500 mg nicotinamide (vitamin B3). This readily available supplement is considered safe.

Low Fat Diet – Evidence suggests that maintaining a low-fat diet (less than 20% of calories from fat) over the long term may lower the risk of skin cancer.

Tea Consumption – Incorporating black or green tea into daily consumption habits may slightly reduce the long-term risk of skin cancer.

Skin Resurfacing – Procedures such as CO2 laser or medium-depth chemical peels offer dual benefits: they improve skin appearance while also reducing the risk of further skin cancers in treated areas by addressing sun damage.

DNA Repair Enzymes – To mitigate UV-induced damage and reduce the risk of skin cancer, topical DNA repair enzymes can be utilized. Eryfotona Actinic sunscreen contains these enzymes.

Aspirin and Melanoma – Studies suggest that daily aspirin intake may decrease the risk of melanoma in women, although this effect has not been observed in men. Further research is necessary to fully understand this relationship.

Antihistamines – While preliminary evidence suggests that daily use of the oral antihistamine desloratadine (Clarinex) may slightly lower the risk of melanoma, further research is needed for confirmation.

Expertise in Treatment

Dr. Massey is fellowship-trained in a procedure called Mohs micrographic surgery. This precise surgical technique first involves the removal of unhealthy tissue structures that rise above the skin’s surface. The next stage of the surgery continues with the removal and evaluation of microscopic layers of skin tissue lying underneath and in tissue margins around the removed growth. This meticulous process continues until examination of a removed layer confirms that no cancerous or precancerous cells remain. 

Mohs surgery is highly effective in removing unhealthy cells while preserving as much healthy tissue as possible to aid in cosmetic reconstruction. As a leader in both cosmetic and cancer surgery, Dr. Massey leverages his extensive skill set to not only treat skin cancer effectively but also to restore and enhance his patients’ appearance post-surgery.

Contact Our Office 

Contact us to schedule a skin cancer consultation with Dr. Massey in Santa Monica, our practice provides patients with the comfort and convenience of an on-site surgical suite and diagnostic lab. The doctor’s commitment to patient education, along with his comprehensive approach to skin cancer treatment, makes him a trusted ally in the fight against skin cancer. 

Beyond Beauty: The Unexpected Health Benefits of Cosmetic Surgery

A Relaxed woman breathing fresh air in a green forest

Cosmetic surgery has always been synonymous with enhancing beauty and aesthetics. Patients often choose cosmetic surgery primarily to enhance their physical appearance. However, its benefits extend far beyond aesthetics.

There are actually a number of health benefits provided by cosmetic surgery. Here at Ralph A. Massey Cosmetic & Skin Cancer Surgery, our priority is to provide not only aesthetic results but also consider the health benefits of cosmetic procedures in Santa Monica.

Physical Health Improvements

While cosmetic surgery mainly focuses on aesthetics, there are many cosmetic procedures that also address physical health concerns.

Take breast reduction, for example. This procedure addresses the chronic pain suffered by patients due to massive breast size weighing heavily on their shoulders and chest area. It also reduces rashes beneath the breasts, posture issues, and painful bra-strap indentations.

Another example is blepharoplasty surgery. By reducing the sagging of the upper eyelids, this procedure can effectively address obscured peripheral vision. This issue most frequently affects older patients.

Rhinoplasty is also performed for functional purposes. When a patient experiences breathing difficulties due to their nasal structure, functional rhinoplasty can be performed to clear the nasal passages.

Benefits of Cosmetic Surgery in Skin Cancer

Cosmetic surgery, especially when performed by an expert skin cancer surgeon like Ralph A. Massey, MD, can play a vital role in the recovery process for skin cancer patients.

Skin cancer removal can effectively get rid of cancer cells and prevent this issue from getting worse. However, this may result in a defect in the skin. To address this, Dr. Massey can provide reconstructive cosmetic procedures such as skin grafts, flap surgery, and scar revision.

These procedures help restore the natural appearance of the area and improve functional aspects such as mobility and comfort. Beyond aesthetics, these surgeries contribute to emotional healing, helping patients regain their sense of self.

Enhanced Confidence and Mental Wellbeing

Cosmetic procedures such as rhinoplasty, breast augmentation, and the buttocks lift are designed to specifically improve the physical appearance of a patient, and these changes can sometimes lead to increased confidence. Physical appearance may not be the sole basis for one’s self-esteem, but in some cases, it can play a major role in the level of confidence a person can experience. This newfound self-assuredness can lead to a more positive outlook on life and an improvement in mental wellbeing.

Enhanced Quality of Life

Cosmetic surgery can allow patients to feel more comfortable at social gatherings, in the workplace, and during intimate moments. This will allow them to lead fuller, more satisfying lives by reducing self-consciousness during interactions.

Improved Social and Professional Opportunities

A more attractive appearance can create opportunities in both social and professional settings. Individuals who feel good about their appearance tend to be more self-assured during job interviews and social gatherings. This can lead to more fulfilling social relationships and better career opportunities. Individuals with increased confidence can perform better at work and be more successful at networking.

Take the First Step Towards Transformation

Cosmetic surgery can extend beyond beauty, impacting physical health and wellbeing. If you’re considering cosmetic procedures in Santa Monica, there’s no better partner on this journey than Ralph A. Massey MD Cosmetic & Skin Cancer Surgery.

We understand the profound impact that the right cosmetic procedures can have on your life. With his expertise in both cosmetic and skin cancer surgery, Dr. Massey is the ideal choice for your next procedure. Contact us today to schedule an appointment and begin your transformation!

Protect your Children from Sunburns

The association between sun exposure and skin cancer has become more widely understood over the years as studies and research continue to be done.

In a recent cohort study, the long-term risk of developing skin cancer as a result of sunburns has been confirmed. The study used information gathered between 1991 to 2007 through a baseline questionnaire that included questions about the number of sunburns experienced. Follow-up questionnaires were answered every five to seven years. The data for this study was gathered by the Norwegian Women and Cancer Study which was established in 1991.

The analysis of the data from the study showed that those who experienced a high frequency of sunburns throughout their lives had a notably increased risk of developing cutaneous squamous cell carcinoma and melanoma. The data also showed that those who frequently experienced sunburns during childhood had an even higher risk of developing these skin cancers. The research indicates that properly protecting yourself from the sun and avoiding sunburns, especially during childhood, is incredibly important when it comes to reducing the risk of skin cancer.

Article Citation:

Lifetime Sunburn Trajectories and Associated Risks of Cutaneous Melanoma and Squamous Cell Carcinoma Among a Cohort of Norwegian Women Simon Lergenmuller, PhD1,2; Corina S. Rueegg, PhD3; Flavie Perrier, PhD1; et alTrude E. Robsahm, PhD4; Adele C. Green, PhD5,6; Eiliv Lund, PhD4,7; Reza Ghiasvand, PhD3,4; Marit B. Veierød, PhD1

JAMA Dermatol. Published online October 5, 2022. doi:10.1001/jamadermatol.2022.4053

How Alcohol Consumption May Increase Your Risk of Melanoma

The link between alcohol consumption and an increased risk of melanoma can be attributed to multiple factors according to recent studies. While other studies have indicated that alcohol consumption increases the risk of sunburn due to ineffective sunscreen application and prolonged sun exposure, Dermatologist Dr. Niyati Sharma has noted that a German study has also found that alcohol consumption has also been linked to increased severity of sunburns.

One study has shown a 7% increase in the risk of basal cell carcinoma and an 11% increase in the risk of squamous cell carcinoma for every standard-sized beer, small glass of wine, or 10g of distilled spirit consumed daily. Another study also found that there was a 20% increase in the risk of melanoma in those who consumed liquor compared to those who abstained or consumed alcohol infrequently. That number rose to 55% in those who consumed 50g of alcohol per day.

The exact cause of this increased risk is not known yet, but Dr. Sharma has noted that a lower level of carotenoids in those who consume alcohol is likely the cause of increased sensitivity to developing more severe sunburns at an accelerated rate.

Mohs proves itself better again, even in Desmoplastic Melanoma!

Mohs surgery is a procedure used to treat skin cancer. This surgery removes a narrow margin of normal looking skin beyond the obvious tumor. This tissue is processed in such a way that all of the outer margin and underside can be examined under the microscope. If residual cancer is seen reaching the outer edges a further thin margin is removed in that area only. The process is repeated until all the margins are proved to be clear.

Desmoplastic melanoma is a dangerous form of melanoma with a particularly high rate of local recurrence after standard surgical excision. While there have been previous studies showing Mohs surgery to be equal or better than regular wide excision for early regular melanomas, this is the first study indicating Mohs surgery also gives an advantage over wide surgical excision for desmoplastic melanoma as well.

In this retrospective single-institution study of 109 desmoplastic melanoma cases, 63 were treated with wide local excision (WLE) and 46 were treated with Mohs micrographic surgery (MMS). The local recurrence rate for WLE was 8%, and 11% of the patients required repeat surgery for local recurrence or positive/equivocal margins after WLE. No local recurrence was reported among patients treated with MMS; however, 1 patient required repeat surgery due to positive margins observed on permanent frozen sections.

Melanoma, Skin Cancer Screenings, and Early Detection

Skin cancer is the most common type of cancer by a wide margin. There is a variety of different types of skin cancers that someone may develop at some point in their life. One of the most concerning types of skin cancer is melanoma.

Like other forms of cancer, melanoma forms when the cells in the body grow into a mass of cancerous cells. In the case of melanoma, the cells that are affected are the melanocytes, the pigment-producing cells responsible for producing melanin, which gives the skin a tan or darker color.

Melanomas can form on any area of the body, though they most commonly form in areas like the face, back, legs, arms, and other places that are frequently exposed to sunlight. They can also form on areas that do not receive large amount of sunlight, like the soles of the feet and the palms of the hands.

Symptoms and Signs of Melanoma

Some of the most common early signs of melanoma are a new dark spot on the skin or a noticeable change in an existing mole. These changes can pertain to the shape, size, or color of the dark spot or mole. Another indication could be a mole or dark spot that has a noticeably different appearance compared to others on the skin.

Other signs to look out for include an irregular border around the mole or dark spot, changing colors within the same mole, changes in shape and color over time, and asymmetry between different halves of a singular mole or dark spot.

The Importance of Regular Screenings for Melanoma

When it comes to treating melanoma, early detection is essential. If melanoma is caught early, the chance of successfully curing it is significantly higher. Some people also have a higher risk of developing melanoma, which makes early detection and regular screening for melanoma very important.

Just how important are regular screenings for melanoma? A study recently published in The British Journal of Dermatology studied 43,762 residents of Queensland, Australia, who were within the age range where the chance of developing melanoma was high. The study identified those who had undergone a skin cancer screening prior to the baseline set at the start of the study. Participants were also asked to fill out a comprehensive melanoma risk factors survey.

During the study, researchers calculated the incidence of confirmed melanoma cases among the patients being studied between the second and seventh years of the study. Researchers then measured the rate of biopsies performed amongst these patients between the second and sixth years of the study.

Once concluded, the study found that there was a clear higher rate of early detection in patients who underwent skin cancer screenings and a higher rate of biopsy in those patients. It should be noted that some of the melanomas discovered and treated through these screenings may have been indolent with a low chance of leading to death.

Taking the Steps to Protect Yourself

Whether you have a high risk of developing a melanoma or you just want to make sure that your skin and body are as healthy as possible, regular skin cancer screenings performed by a skin cancer expert are important for early detection. Dr. Massey is a renowned cosmetic and skin cancer surgeon who is dedicated to helping keep all of our patients safe and healthy. Contact our office today to schedule your skin cancer screening.

Protected: Delays in Surgical Treatment of Melanoma and Mortality

This content is password protected. To view it please enter your password below:

The Perils of Biotin Supplementation

This is an important note to all of my patients because of the frequency of biotin use by the public. Many doctors have recommended biotin as a supplement for years as it is inexpensive and easy to use. It is a water-soluble vitamin, which while it does little harm, the therapeutic benefit is negligible and it can contaminate lab test results (see the list below). In addition, there are no easy fixes for many of the nail and hair problems that Biotin may be recommended to help.

The lab test interference goes beyond troponin and thyroid tests. This list is likely to grow. In light of this it is now generally recommended to stop biotin 2 days before getting any blood work done.

Lab tests affected by biotin supplementation

  • Thyroid
  • Troponin (58.6%)
  • 25-Hydroxy vitamin D
  • Beta-human chorionic gonadotropin
  • Hepatitis
  • Human immunodeficiency virus serology
Article Citation:

Journal of the American Academy of Dermatology
Biotin Beware: Perils of Biotin Supplementation
J Am Acad Dermatol 2022 Feb 24;[EPub Ahead of Print], JM Falotico, SR Lipner

Melanoma still on the rise

Despite the many new treatment options for melanoma that have and will save many lives, the incidence of melanoma continues to rise. This is a worldwide problem, especially among fairer complected individuals.
In a recent article published in the Journal of the American Medical Association (JAMA), it was estimated that by the year 2040 the global burden from melanoma will increase to 510 000 new cases and 96 000 deaths.

The take-home message is that melanoma remains a significant problem and the incidence is likely going to rise significantly over the next 20 years. That’s important for us and our children!

The main preventative strategy available is to limit ultraviolet light exposure and avoid any sunburns.

For early detection, monitor your own moles and see your dermatologist if any of them are changing or start to itch or bleed. Remember when caught early melanoma is a very curable disease!

Article Citation:

Melanoma in 2020 and Projections to 2040
Melina Arnold, PhD1; Deependra Singh, PhD1; Mathieu Laversanne, MSc1; et alJerome Vignat, MSc1; Salvatore Vaccarella, PhD1; Filip Meheus, PhD1; Anne E. Cust, PhD, MPH(Hons)2,3; Esther de Vries, PhD4; David C. Whiteman, MBBS(Hons), PhD5; Freddie Bray, PhD1
JAMA Dermatol. Published online March 30, 2022.

When it comes to early melanoma, Mohs is better!

The complete removal of melanoma is a primary goal of excision, and local recurrence is one measure to evaluate the efficacy of surgical technique.

Through the comparison of published local recurrence rates for melanoma treated with Mohs micrographic surgery (MMS) or staged excision versus wide local excision (WLE) we can determine which method is more effective.
A search of 6 databases identified comparative and non-comparative studies that reported local recurrence rates after either technique. The pooled studies of over 16,000 patients showed a higher recurrence rate after Wide Local Excision (7%) compared with Staged Excision (3%) and compared with Mohs Surgery alone (<1%). The take home message is that Mohs Surgery and staged excision show lower local recurrence rates when used to treat melanoma when compared to wide local excision and it’s important in understanding which method your provider will use when you are seeking treatment

Article Citation:

Local Recurrence of Melanoma Is Higher After Wide Local Excision Versus Mohs Micrographic Surgery or Staged Excision: A Systematic Review and Meta-analysis
RLD Pride, CJ Miller, MH Murad, PJ Erwin, JD Brewer

Dermatol Surg 2021 Nov 30;[EPub Ahead of Print]

Contact Dr. Massey