November 2007

Biopsies & Botox

Sometimes hype’s benefit is the serendipitous diagnosis

By Nancy A. Melville
Cosmetic Surgery Times

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.

“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.”

The key to spotting a problem with a cosmetic patient, of course, is having cosmetic procedures performed by professionals who are able to diagnose such conditions. Dr. Lupo says the high frequency of medical issues that are spotted in a cosmetic consult underscores to her the potential problems with nondermatologists performing these procedures.

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, California

“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.”


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.”

For more information contact Lloyd Krieger, M.D.;

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