December 2008

Double Play "Oswald L. Mikell, MD"

Author: Paul deVere | Photographer: rob kaufman

He can save your life and he can make you feel (and look) better. Dr. Oswald Mikell, named the 2008 Dermatologist of the Year by the South Carolina Dermatology Association, is certified by the American Board of Dermatology and the American Board of Cosmetic Surgery. For his patients, that means he can, among a host of other procedures, treat skin cancer and do a “nip and tuck” here and there.

“Because of the population of baby boomers, I think we’re seeing more anti-aging interest in general, and that would include cosmetic surgery,” Mikell said, then added with a smile, “They can’t trade the cars in, so they want to paint them.” He happily admits that’s just fine with him. Mikell is head of a group practice, Dermatology Associates of the Lowcountry, with offices on Hilton Head Island, and in Okatie, Beaufort, and Walterboro. Many of the services offered include cosmetic surgery and treatments, such as treating acne scarring, skin resurfacing, and facial rejuvenation.

“We’re full service. Our procedures focus on diseases of the skin, hair and nails,” Dr. Mikell said. “For instance, if you have psoriasis, there is no treatment we don’t do.” Mikell explained that the majority of the staff, which includes a physician assistant and family nurse practitioners, do more general dermatology, like treating skin diseases, performing biopsies and some minor surgery. They remove moles and warts. Dr. Forte Rabb, also associated with the group, and Dr. Mikell are the physicians who do surgery on the face. Mikell does the larger surgery and the cosmetic surgery.

But, he estimates, 50 percent of his practice involves skin cancer surgery. There are basically two types of procedures: the standard incision and Mohs Micrographic Surgery. Mikell described both.

In explaining the standard method, Mikell said, “Let’s say you have a skin cancer on your arm where you have a lot of loose skin. The typical standard incision would be an ellipse of skin. You would be taking skin beyond what you see with regard to where the margins of the skin cancer are. When you send that to the lab, they would divide the piece into what they call blocks. So each one of these blocks would be processed and then they would take slices off the end of each block and put that on a glass slide and examine it. So when you’re looking at the end of it, you’ll hope to see skin cancer (in the center) and normal tissue on three sides. Then they will tell you it’s clear. With this extra skin, you’ll get a 98 percent cure rate with that,” Mikell said.

But if the cancer is in a sensitive area, like an eyelid or the tip of a patient’s nose, standard pathology is definitely not the best recourse. That is where Mohs micrographic surgery comes in. Dr. Mikell is a member of the American Society for Mohs Surgery.

“The concept is generally to achieve cancer free margins by taking the least amount of normal skin. It’s something that isn’t for every patient and for every location on the body. Let’s say the cancer is close to your lower eyelid; you wouldn’t want to take a big hunk out of that and have a sagging or pulled down eyelid if you could avoid it. But you want to make sure the cancer is gone before you go in and do a procedure to give you the kind of closure that would give you the best result,” explained Mikell.

In Mohs surgery, the physician may go one millimeter or so beyond the edge of the cancer. Mikell said there are pluses and minuses to the Mohs method. Using standard pathology, the surgeon cuts the cancerous tissue out plus some additional healthy tissue surrounding it, sews up the wound and sends the patient home. But it takes a week or more to get results back from the lab. The Mohs surgery is done in Mikell’s office.

“When we do the Mohs surgery, we process it all in the office. But it’s all manual processing. It may take 30 minutes to an hour to process the tissue. And let’s say we didn’t get it all. Let’s say there was some on the edge. We would take another piece right there, not anywhere else, just right where the cancer is. Then we have to process that, and it’s another 30 minutes to an hour,” Mikell said.

“The average Mohs case is two stages. Rarely, but sometimes, we’ll be here to midnight. We don’t know when we’re going to finish. So you don’t do this on every skin cancer. You tell the patient to come in and don’t plan anything all day,” explained Mikell.

His advice to help people avoid skin cancer is simple: “Don’t get unnecessary sun exposure. Use reasonable sun protection. Solar radiation adds up over your lifetime. None of it goes away.”

A Savannah native, Mikell began practicing in Beaufort in 1982 while still in the U.S. Navy. He spent six years in San Diego, California, while doing his internships and dermatology residency at the Naval Regional Medical Center.

For more information, visit Dermatology Associates of the Lowcountry at www.dalcdermatology.com.

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