Biopsies & Botox

Dermatologists and plastic surgeons are increasingly regarded in the public eye as the go-to people for cosmetic fixes. But some eager aesthetic candidates, who might not otherwise have come into a medical setting but for their sometimes media-inspired cosmetic wish list, are having skin cancers and other serious conditions diagnosed as a result. For Mary Lupo, M.D., a dermatologist in New Orleans who specializes in cosmetic dermatology, spotting conditions that require dermatological treatment on those who come in for cosmetic reasons is a daily occurrence.

"I've diagnosed more basal cell carcinomas on patients who came to me for cosmetic reasons than you can imagine," notes Dr. Lupo. "I diagnose medical problems in new cosmetic patients every day." She says that conditions range from common basal cell carcinomas to Graves' disease to more serious forms of skin cancer. "These patients were completely unaware that they even had a medical problem...They came to see me for acne, laser hair removal, discoloration of their skin, general photoaging and issues like that." When she spots a problem on the initial physical exam of the face, neck and hands, Dr. Lupo suggests a total body exam, which then takes priority over any cosmetic procedures.

"When I have a patient who comes in with a medical and cosmetic problem, I always do the medical problem that day and we reschedule the cosmetic. If I have time to do the biopsy for the basal cell and the Botox, I'll perform both. But if not, I'll just do the biopsy."

"I think one of the biggest problems is when practitioners represent themselves as dermatologists or having dermatology training when they don't. If someone is a general practitioner and they have no dermatology training, that can be a big issue when they're performing a cosmetic procedure." The consequence can be that patients who have cosmetic procedures done by nondermatologists may wrongly assume they've had a skin cancer screening when, in fact, no screening was conducted. The problem was underscored in a recent survey conducted by the American Society of Dermatologic Surgery, in which more than 90 percent of respondents indicated that they had seen patients whose skin cancer had been either misdiagnosed or overlooked by a nonphysician.

Even if it is a physician conducting a cosmetic procedure, patients should be made aware if dermatology or skin cancer treatment is outside of his or her training or specialty, says Lloyd Krieger, M.D., medical director for Rodeo Drive Plastic Surgery in Beverly Hills, Calif.

"It is incumbent on the physician to explain to the patient what they are evaluating and able to treat and what they are not, because I don't think patients necessarily know that," he explains. "The patient may say 'I went into the room and I got undressed and I was seen by the doctor and I'm good.' But that's not really true if the physician only evaluated them for something like liposuction."

SCREENING STANDARD Dr. Krieger's practice is taking a proactive approach to address the problem of overlooked skin cancers with an awareness and prevention program in which all patients receive skin cancer screenings.

"I've found a number of skin lesions on my cosmetic patients which turned out to be malignant and we just decided to check all patients for suspicious skin lesions," Dr. Krieger says. "The Skin Cancer Awareness Program is just a way of formalizing that," he explains. "If someone's coming in for a blepharoplasty, for instance, it would be unusual to get them undressed for a total body screening for skin cancer, but that's what we're doing now."

Skin cancers aren't the only conditions that cosmetic patients can turn up with. Another condition Dr. Lupo says she regularly uncovers is hepatitis. "I can't tell you how many hepatitis cases I've diagnosed among people coming to me with telangiectasias to have laser," she says.