SOUTHERN DERMATOLOGY &
SKIN CANCER CENTER
For more information about skin conditions and their treatment, contact:
SOUTHERN DERMATOLOGY and SKIN CANCER CENTER
An Affiliate of Anne Arundel Dermatology
Gregory J. Wilmoth, MD
Eric D. Challgren, MD
Margaret B. Boyse, MD
Laura D. Briley, MD
Tracey Cloninger, PA-C
Stephanie S. Pascale, MSN, FNP-C
4201 Lake Boone Trail, Suite 200
Raleigh, NC 27607
Telephone: (919) 782-2152
THE SKIN RENEWAL CENTER AT SOUTHERN DERMATOLOGY
4201 Lake Boone Trail, Suite 207
Raleigh, NC 27607
Telephone: (919) 863-0073
“Not only is the skin our largest organ but, for the careful observer, it often reveals vital information about an array of diseases that, in early stages, are free of symptoms,” observes Dr. Gregory Wilmoth of Southern Dermatology and Skin Cancer Center in Raleigh.
“For example,” he explains, “rashes appearing as pimples, lumps, bumps, and blisters can be visible clues to such underlying conditions as kidney, liver, thyroid or even Hodgkin’s disease, as well as diabetes, inflammatory bowel disease, or connective tissue disorders such as lupus.”
Dr. Wilmoth acknowledges that many common skin problems are just that—skin problems. The challenge, he says, “is to recognize the symptoms that suggest more complex health issues.
And while other doctors may misinterpret a rash as a benign problem, dermatologists are trained to understand those subtle differences. One good example of this is severe acne in teenagers, which sometimes signals the existence of polycystic ovary disease, often as the result of an imbalance in androgen hormones.”
Skin Issues That Are More Than They Seem
“Dermatology is a highly visual specialty,” notes Dr. Wilmoth. “And the art of seeing clearly what others may miss is an essential skill in the life of a dermatologist. In fact, the skin is a mirror reflecting whatever is going on in the body—including chemical imbalances and stress, as well as disease. And symptoms that show up in the skin are important clues to what is going on underneath.”
Certain skin problems, explains Dr. Wilmoth, deserve special attention because they signal more complex, serious underlying issues. These include xanthoma, lupus, and dermatomyositis.
“Xanthoma, for example, is a common skin condition that can forewarn elevated cholesterol, which is often a precursor of heart disease,” he explains. “This disease—which we commonly see in older patients—is basically a concentration of fat beneath the surface of the skin. As a result of that concentration, the skin takes on a yellowish hue, and patches on the skin have a slightly bumpy texture, usually appearing on the eyelids, knees, and elbows.
“It’s a good example of a silent disease,” he notes. “It does not itch, nor is it painful. What’s important is that it may be a symptom of underlying metabolic disorders that are associated with an increase in blood lipids—such as diabetes and some types of cancer. We can surgically remove these bumps, but the key is to identify and control the underlying disorders.”
Among other diseases that can also be detected by way of our skin, are connective tissue diseases, such as lupus. “Lupus,” explains Dr. Wilmoth, “is a chronic autoimmune disease, ranging from mild to severe, in which the immune system becomes hyperactive and attacks normal tissue. Sometimes lupus may first show up as a rash on the face, often in a design similar to a wolf’s face—across the cheeks and nose. It’s not uncommon for an early-stage lupus rash to be misdiagnosed as rosacea by a practitioner who is unaccustomed to seeing the variety of rashes and skin conditions that make up the professional life of a dermatologist. Again, the lupus rash is most often a silent indicator of an underlying problem, which, although free of pain or itching, is a serious health issue.”
Symptoms of lupus—which remains incurable but can be effectively managed—vary greatly from one patient to another. Patients with severe problems are best treated by a team approach where effective care can be rendered by dermatologists, rheumatologists, nephrologists, immunologists, and family practice physicians.
“Dermatomyositis is another connective tissue disease we see that may signal more serious problems,” says Dr. Wilmoth. “The classic version of dermatomyositis involves a skin rash with a muscle weakness. However, often it’s not fully developed at the time that you encounter the patient, and some patients won’t have any muscle involvement.
“But, while the symptoms may not be extreme, the reason this disease is of concern is that—for a good proportion of patients—dermatomyositis is a manifestation of underlying carcinoma. They may have cancer of the colon or lung or pancreas, or in some other location. So, in my assessment of these patients, particularly later age adults, I advise additional cancer screening—such as mammography, colonoscopy, and blood work—to rule out the possibility of an underlying cancer.”
Melanoma: A Silent Killer Demanding Vigilance
Melanoma is one of the most well-known serious diseases affecting the skin. “And, because it is a cancer,” notes Dr. Wilmoth, “it is a true silent killer. It doesn’t itch. It doesn’t hurt. There’s not a bump. It’s asymptomatic. Just a brown patch of skin. And sometimes, unfortunately, by the time a person finds out they have melanoma, it can be very advanced, even lethal.”
“With early detection, there are rarely complications in the treatment of basal and squamous cell skin cancers,” notes Dr. Wilmoth, “both of which are the result of over-exposure to the sun. There is a better than 90 percent cure rate for these types of cancer. But it is melanoma—where cells are wildly out of balance and dividing rapidly—that gets our very focused, undivided attention.
“Dermatologists, of course,” says Dr. Wilmoth, “are trained to see the difference between a cancerous and benign skin growth, but in my experience, eight out of ten people come here with a melanoma somewhere on their body because they intuitively know there’s a problem. They come here because ‘It looks funny,’ or because ‘My wife has been bugging me about this mole; she thinks it looks funny.’
“What we look for are moles that are changing or increasing in size, changing their character or their color or causing some kind of symptom, such as bleeding or hurting. But the simple cue is that a mole is changing in some way.
“I want to emphasize,” adds Dr. Wilmoth, “that the vast number of moles that appear on our skin—and most adults commonly have 40 or more moles at any one time—are perfectly harmless. But I want to find the ones that aren’t harmless; that are, in fact, potentially lethal.”
The main diagnosis is still done by clinical examination, says Dr. Wilmoth, “but monitoring one’s own skin health is easy and helps ensure that cancers will be detected early, when they are most treatable. So, we encourage our patients to be vigilant, and to keep an eye on freckles and spots on their body. Get a friend or spouse to check your back or take a close look in the mirror. And make a point of monitoring changes in moles themselves using ABCDE guidelines—looking for changes in asymmetry, border, color, diameter, and evolution (the ABCDEs). A monthly exam is fine, but it may not need to be that often. Ideally, everyone will have a skin check with a dermatologist regularly, and certainly every year beyond the age of 50.”