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.
Your personal physician
will let you know the preoperative instructions specific for your condition.
Smoking is discouraged for at least one to two weeks before surgery. Smoking can
slow down wound healing and cause more wound infections.
Heavy alcohol use is not advised at least one week before surgery. Heavy
alcohol use can cause more bleeding and thin your blood. An occasional glass of
wine or small cocktail may not cause severe bleeding. Your physician will want
to know of any factors that may affect your surgery or wound healing.
For many typical outpatient Mohs surgeries in a physician's office, most
patients are advised to eat a good breakfast on the day of surgery and take all
of their regular daily medications. Patients are advised to wear comfortable
casual clothes and bring a sweater or small blanket.
In most cases, patients are usually able to drive after most procedures and
do not necessarily need a driver unless they feel uncomfortable. Diabetic
patients may need to be more cautious about maintaining good blood sugars and
avoiding dangerous lows in their sugars from fasting.
Since you will be in the office for several hours, you may want to bring some
personal snacks, drinks, and reading or knitting material. Personal music
headsets or iPods may also provide relaxation and help pass time between Mohs
levels.
For surgery center or hospital-based procedures requiring any type of
sedation or general anesthesia, patients may be required to not eat or drink
anything past midnight the night before surgery. Your plastic surgeon or
anesthesiologist will advise you of specific instructions before surgery.
Most patients continue all doctor prescribed medications including aspirin
and any blood-thinning medication unless specifically advised otherwise only by
the primary physician or plastic or Mohs surgeon. Patients with a significant
history of stroke, heart attacks, or even heart pain (angina) under a doctor's
care must discuss their medications with their doctor before making any changes.
It is important to not discontinue blood thinners without a doctor's specific
instructions because of a potential greater risk of a heart attack and/or
stroke.
For otherwise healthy (non-cardiac and non-stroke patients) nonessential,
nonmedically prescribed medications that thin the blood such as Advil
(ibuprofen), Motrin, aspirin, vitamin E, garlic supplements, Alka-Seltzer,
Pepto-Bismol, other aspirin-containing medications, etc., can be stopped at
least seven to 14 days before undergoing Mohs surgery to minimize bleeding and
bruising. These medications can thin your blood and make you more prone to
bleed during and after surgery. Again, it is important to not discontinue or
start any medication without a doctor's specific instruction.
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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