Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
It is important to understand that
there are alternative treatments and options to Mohs. Additional treatment
choices include (but are not limited to) local radiation, prescription topical
creams, plastic surgery, curettage and desiccation (scrape and burn), regular
surgery, chemotherapy creams or injections, cryosurgery (deep freezing),
photodynamic therapy (uses a type of light and a light-activated chemical called
a photosenzitizer).
You may decide to have regular surgery with a
plastic surgeon instead of having Mohs.
Alternatively, you may also choose a hybrid option where your Mohs surgeon
removes the tumor and clears it for you and then you have the plastic surgeon
fix up the wound and stitch it up for you.
If you prefer to have your plastic surgeon repair the wound, you will want to
let your plastic surgeon and dermatologist know ahead of time and plan that into
your Mohs schedule.
What about insurance coverage and costs?
Mohs surgery is generally
considered a medical service and is not considered cosmetic. Currently, most
insurance plans cover the procedure under their provided benefits. However, with
the many changes in insurance plans, it is always advisable to contact your
insurance carrier prior to scheduling surgery and confirm your eligibility and
benefits.
Mohs, like any surgical procedure, will result in additional procedure
charges above the routine office-visit fees. These surgical fees may range from
$1,000-$2,000 depending on the area, number of Mohs levels, and
the type of closure or repair required. The greater the number of levels required, the
higher the cost. Surgical centers and hospitals usually have a much greater
costs associated with a facility fee in addition to the surgery fee.
Insurance benefits vary and reimbursement depends on what benefits you have
contracted for with your company. Currently, Medicare generally covers 80% of
Mohs cancer surgery. If you have a secondary insurance plan, that may help take
care of the remainder 20% not covered by Medicare.
Commercial or non-Medicare insurances currently generally cover a large
percentage of your surgery unless you have to meet an out of pocket deductible
first. You may want to get to know and understand your insurance benefits before
having surgery. In many cases, you may also ask the billing office at the
medical center or hospital for an approximate estimate of your charges before
scheduling the procedure.
Skin cancer is the most common form of cancer
in humans. There are three main types of skin cancer; basal cell carcinoma and
squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
Melanoma is a type of skin cancer which begins in skin cells called melanocytes and affects more than 53,600 people in the United States each year. These melanocytes can grow together to form benign moles which, after a change in size, shape, or color can be a sign of melanoma. Caused by sun exposure, early detection becomes extremely important to avoid a spread to other areas of the body. Diagnosis is confirmed through a biopsy of the abnormal skin and treatment depends on the extent and characteristics of the patient.
A keloid is a scar that doesn't know when to stop. When the cells keep on reproducing, the result is an overgrown (hypertrophic) scar or a keloid. A keloid looks shiny and is often dome-shaped, ranging in color from slightly pink to red. It feels hard and thick and is always raised above the surrounding skin.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Signs and symptoms of penile cancer include a lump on the penis and redness, irritation, or a sore on the penis. Risk of penis cancer is higher in uncircumcised men, due to a higher risk of HPV infection. Other risk factors include being over 60, having phimosis, having poor hygiene, using tobacco products, and having many sex partners. Prognosis and treatment depend upon the tumor's location and size, the stage of the cancer, and whether the cancer was recently diagnosed or if it recurred.
Scar formation is a natural part of the healing process after injury. The depth and size of the wound incision and the location of the injury impact the scar's characteristics, but your age, heredity and even sex or ethnicity will affect how your skin reacts.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
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