MedStar Health Blog

Some of the most unexpected injuries in medicine are due to orthopaedic trauma, which involves problems related to bones, joints, and soft tissues (muscles, tendons, and ligaments). The most common orthopaedic trauma injuries are the result of falls and car crashes, but we also see many injuries due to:

• Bicycle accidents
• Gunshot wounds
• Motorized scooter accidents

We see a lot of younger people in their late teens to mid-20s with orthopaedic trauma injuries, as well as people over 50. Younger people tend to engage in more high-energy activities that involve the risk of accidents, such as riding motorized scooters and bicycles. Older people are more likely to have balance disorders and weaker bones, which can lead to falls and bone fractures.

Related Reading: Electric Scooter Safety: Avoid These Common Injuries While on the Road

Our orthopaedic trauma team at MedStar Washington Hospital Center cares for these patients with the latest treatment options, helping them get back to their everyday lives. Read on to learn about the most common orthopaedic trauma injuries we see, how we treat them, and what people should do if they experience an orthopaedic trauma injury and are waiting for emergency medical professionals to arrive.

LISTEN: Dr. Golden discusses common trauma injuries and how they’re treated in the Medical Intel podcast.

How We Treat Common Orthopaedic Trauma Injuries

Lower Extremity Fractures

We see a large number of lower extremity injuries from individuals getting struck by cars, such as a tibial plateau fracture, which occurs when you break the bone on the top part of your tibia, right below your knee. This often happens because a car’s bumper strikes someone from the side at about knee level. Other common lower extremity injuries, such as a femur fracture and pelvic fracture, occur the most in the spring and summer, when people are out riding their motorcycles, bicycles, and motorized scooters.

Treatment for lower extremity fractures typically involves a surgeon realigning a patient’s affected bone and joints to their natural positions and holding them in place with plates and screws in a way that allows for them to heal properly.

While bones typically take about three months to heal, the hardware we insert during surgery sometimes is strong enough to support patients’ weight, allowing them to walk right after surgery. But speak to your doctor to see what to expect from your surgery, as some fractures, such as those close to joints, need to be fixed with hardware that is not designed to support the patient’s weight, resulting in people waiting weeks to months to put weight on their legs. Once patients are able to bear weight again, physical therapists can help them with strength and flexibility exercises to minimize stiffness and regain muscle loss. Social workers also can help patients plan for disability insurance or any time off work while they recover.

Wrist Injuries

We often see individuals with wrist injuries after they try to catch themselves when they slip and fall. This is especially common during the winter months, when snow and ice are on the ground. One of the most common wrist injuries we see is a fractured distal radius (broken wrist).

Treatment for a distal radius fracture typically involves patients either wearing a cast for around six weeks to allow the wrist to heal or undergoing surgery to better align the wrist and stabilize it  in order for it to heal properly.

Bones That Don’t Heal Properly

Some people are referred to us by their primary care doctors or other orthopaedic specialists because they’re having complications from previous fractures, such as a bone healing crookedly or not healing at all (nonunion).

To treat a nonunion, we first try to identify whether the patient’s bones aren’t receiving enough blood supply or the patient is lacking vitamins and minerals, such as vitamin D, which are necessary for proper bone healing. If neither is the case, we typically can get the bone to begin healing by retrieving bone from another part of the body and inserting it into the fracture site of the bone that isn’t healing properly.  We may need to also stabilize the bone differently from what was tried initially.

For bones that heal crookedly, we may need to cut the bone to realign it to the proper position.  We then stabilize it to hold it in that position. Depending on the situation, this can be performed all on the inside of the body or by using a system on the outside of the body that connects with a computer program.

Bone Infections

Some patients are referred to us because of osteomyelitis, a complicated bone infection. Osteomyelitis often can occur after trauma and can affect any bone. Without the proper treatment, osteomyelitis can spread to the tissues near the bone, kill the bone, and prevent any fractures from healing.

We treat these bone infections with surgery in which we open up the bone, remove as much of the infection as possible, and prescribe the patient antibiotics to both kill any remaining traces of the infection and keep it away long-term.

Can You Prevent Orthopaedic Trauma Injuries?

Unfortunately, many orthopedic trauma injuries are due to random events, such as someone running a red light and hitting another person’s car. There isn’t much we can do to prevent these types of events.

But it’s possible for you to avoid some traumatic injuries by carefully selecting what activities you want to participate in and understanding your physical limits. If you’re riding a motorcycle or bicycle, for example, make sure you’re moving at a safe pace and are always aware of your surroundings. If you’re on a ski trip, don’t ski on the hardest trail without having the appropriate skill level.

What Should People Do in an Emergency?

If an individual experiences an orthopaedic trauma injury, such as a severely injured limb, call 911 right away to request an ambulance. While the ambulance is on the way, it’s important for the injured person to stay calm and keep the affected arm or leg still. This can not only reduce the pain but also help prevent further injury to the soft tissues surrounding the injured bones. If there’s newspaper or cardboard nearby, try rolling it up to form a makeshift splint.

If someone has an open fracture—when there’s an open wound or break in the skin near the broken bone, what used to be referred to as a compound fracture—or has any injury that causes excessive bleeding, applying pressure on the area helps reduce the bleeding while they wait for emergency medical professionals to arrive.

Related Reading: How Bystanders Can Stop Severe Bleeding After Traumatic Injury

Expert Care at MedStar Washington Hospital Center

Our experienced orthopaedic trauma team at MedStar Washington Hospital Center offers patients expert care, as we successfully treat thousands of patients with a variety of traumatic injuries every year.  We also use a team approach in which we reach out to other specialties when patients have injuries outside of orthopaedic trauma. For example, when we see a patient with both a broken bone and torn ligament, we work with the sports medicine team so that the trauma team treats the bone issues while the sports medicine team treats the torn ligament.

Two of our more well-known instances of treating patients were following the Congressional baseball shooting in 2017 and the Navy yard shooting in 2013. Our team treated victims of these shootings by using a team approach in which the departments of orthopedic trauma, general surgery, and vascular surgery all worked together, ensuring that the victims we cared for survived and could eventually return to their everyday lives.

Not all cases of orthopaedic trauma are so publicized, but the patients still receive the same high level of care from our team. One patient visited us for a checkup seven years after we treated him following a car crash in which he injured both of his legs and feet, which resulted in some open (compound) fractures, or when bone comes out through the skin. He also sustained several injuries to internal organs. The general surgery trauma team treated him by stabilizing all his internal organ injuries and performing several surgeries that helped minimize his risk of infection. Then we stabilized his bones with plates, screws, and rods; and the plastic surgery team provided flap coverage to cover his injuries to allow them to heal properly.

While orthopaedic trauma injuries often are frustrating, painful, and unexpected, our team is dedicated to caring for you with treatments that get you back to your everyday life as soon as possible.

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one or more deep veins in your body—most often in the legs and sometimes in the arms. People who have DVT in the lower extremities often experience:

• A hot burning sensation in the legs
• New pain or intense cramping while walking
• Swelling in an extremity

DVT affects as many as 900,000 Americans each year. People often develop DVT because they have a known or undiagnosed bleeding disorder, recently had an invasive surgery, or have been temporarily immobile due to a long plane ride or bed rest.

Our team successfully identifies and treats people with DVT every day. Recently, we saw a patient who frequently flew all around the world for work. After her flight landed in Washington, D.C., the patient experienced a swollen, painful leg. Under our care, the patient was seen and diagnosed with DVT. We were able to perform minimally invasive rapid clot removal for her and also identified the reason for her DVT—a central venous compressive syndrome called May-Thurner Syndrome—which we were able to treat with a stent. The patient returned home that night and was back at work the next day.

LISTEN: Dr. Abramowitz discusses DVT treatment and prevention in the Medical Intel podcast.

How We Diagnose and Treat DVT

To diagnose DVT, we typically begin with taking patient’s history to identify potential provoking risk factors and perform a physical exam. We’ll often perform an ultrasound to detect any blood clots. The ultrasound is a considerably quick test that’s usually done at the bedside and doesn’t require patients to experience radiation exposure.

Most people with DVT are treated with an anticoagulation agent, also known as a blood thinner. Anticoagulation agents are effective because they reduce the chances of additional blood clots forming while patients’ bodies naturally break down the blood clot. The body’s own process can take three to six months to dissolve the clot. For some patients with extensive blood clot formation, we can use minimally invasive techniques to remove the clot using a catheter (a plastic tube or hose). This allows us to directly remove the clot in a procedure called mechanical thrombectomy, which removes the clot using retrieval devices, such as a vacuum suction. We use clot-busting medication to assist with this process.

Related Reading: How Mechanical Thrombectomy is Revolutionizing Stroke Care

The risk of leaving DVT untreated depends on where in the body the DVT is and how long it’s left untreated.  Blood clots below the knee usually cause swelling short-term but don’t necessarily result in long-term damage to the leg. However, blood clots above the knee, especially those that extend above the groin and into the veins in your belly and pelvis, can lead to long-term drainage problems from the leg. These issues sometimes result in post-thrombotic syndrome, or long-term swelling, wounds on the legs and pain. Untreated DVT can also result in clots breaking free. Once in circulation, clots can travel to the lungs and causing a pulmonary embolism, a potentially fatal condition in which one or more arteries in the lungs become blocked.

Can DVT Be a Sign of a More Serious Condition?

While DVT is a condition in and of itself, it’s important to determine what caused a patient’s blood clots to ensure they don’t recur and identify any serious underlying medical conditions. DVT can be caused by genetic conditions, inflammatory autoimmune disorders, or even be the first sign that someone has cancer.

Tips to Prevent DVT

The best thing people can do to prevent DVT is to get up and move around. If you travel long distances by car, train, or airplane, or if you sit at a desk during work for long hours every day, make sure you stand up and move every hour or so. If you’re immobile due to surgery or another health condition, keep your blood circulating by doing exercises, such as ankle flexes or leg lifts, to activate the muscles in your legs.

Our team at MedStar Washington Hospital Center offers the latest, most effective techniques for treating DVT. And after treating DVT, we make sure we identify the reason you developed it in the first place. Make sure to reach out to a doctor if you’re experiencing symptoms of DVT—we’re here to help.

As you head outside, it’s important to know the facts about Powassan virus and how to protect yourself against this serious tick-borne disease. While Powassan virus (POW) is still rare, the Centers for Disease Control and Prevention (CDC) reports growing numbers of infections with the virus in the eastern and Great Lakes regions of the United States.

First discovered in Powassan, Ontario, Canada, in 1958, POW virus is most common in the late spring, early summer, and mid-fall when ticks are most active. Warmer winters have also led to a rising tick population, which increases the risk of tick-borne diseases, including POW virus.

Related reading: 2017’s growing tick problem: How to protect yourself

What Is Powassan Virus?

POW virus is one of a group of arthropod-borne viruses or arboviruses—the same family responsible for mosquito-borne West Nile virus—that can cause encephalitis, an inflammation of the brain. Like Lyme disease, a more common tick-borne virus, patients contract POW virus through the bite of an infected tick. It is not transmitted directly from person to person.

POW virus can be spread by a variety of ticks, including the deer tick, though it’s important to know that not every tick is infected with the virus and not everyone who is bitten by a tick will get sick. But ticks that are infected with POW virus can spread the virus quickly—in as little as 15 minutes—compared to ticks with Lyme disease, which can take up to 24 or 48 hours to spread Lyme disease.

Symptoms of Powassan Virus

The symptoms of POW virus can vary. Some people infected with the virus will only have mild symptoms, while others can become seriously ill. In a few cases, people have died after becoming infected with POW virus.

The incubation period for POW virus, or the time between a tick bite and the onset of symptoms, is typically around one week to a month. The virus can impact the central nervous system, causing encephalitis (swelling of the brain) and meningitis (inflammation of the membranes that surround the brain and spinal cord).

Other common symptoms of POW virus include:

• Confusion
• Fever
• Headache
• Loss of coordination
• Vomiting
• Weakness
• Seizures
• Speech difficulties

About half of those individuals that contract POW virus will have permanent symptoms, including recurring headaches, muscle wasting, and memory problems. In about 10 percent of cases, an infected individual will not recover and will die from complications of POW virus.

Diagnosis and Treatment for Powassan Virus

Because POW virus is still rare, it can be difficult for healthcare providers to diagnose it. If a doctor suspects that a patient has POW virus, a diagnosis depends on a combination of signs and symptoms along with lab tests of the blood or spinal fluid. These tests detect antibodies the immune system make to fight the virus.

While there is no cure or specific medicine to treat POW virus, severe cases of POW virus typically require hospitalization. In the hospital, patients may receive breathing support, intravenous or IV fluids, and drugs to reduce the swelling around the brain and spinal cord.

How to Prevent Powassan Virus

Anyone who spends time outdoors is at risk of contracting tick-borne diseases like POW virus, although the elderly and those with weakened immune systems are at the highest risk of experiencing the most serious symptoms.

The best way to reduce your risk of POW virus is to prevent a tick bite.

• Wear protective clothing, including long pants with socks pulled up over them and a long-sleeved shirt. Light-colored clothing makes it easier to see ticks.
• Use insect repellant with DEET when visiting wooded areas or places where you’ll be walking through tall grass. Follow the repellant label for instructions on how to apply it to the skin.
• Perform a tick check on yourself and your pets after spending time outdoors. You may also want to consider taking a bath or shower to wash off any ticks. It’s important to remove ticks before they have a chance to bite and attach to the skin.
• Remove ticks carefully from the body using tweezers. Watch that area of the skin in the following days for any unusual signs, including redness or swelling. If you suspect that you have a tick bite, consult your doctor.

While POW virus can be serious, it’s important to remember this tick-borne disease is still rare. By taking some simple preventive steps, you can protect yourself from POW virus and enjoy the outdoors.

Benign prostatic hyperplasia (BPH), or an enlarged prostate, affects many men as they age. In fact, about 50 percent of men ages 50 to 60 and 90 percent of men over 80 have BPH. Because BPH is so common, it’s vital that people receive quality treatment such as GreenLight laser surgery that can help alleviate their symptoms.

GreenLight laser surgery relieves BPH symptoms that often interfere with men’s everyday lives, such as:

• Difficulty beginning urination
• Frequent or urgent need to urinate
• Urinary retention, or the inability to completely empty the bladder
• Waking up throughout the night to urinate
• Weak urine stream or a stream that stops and starts

The procedure is also less invasive than other BPH treatment options, so patients typically recover quicker.

We saw one patient who was in and out of emergency rooms for several months because he kept experiencing difficulty urinating and had a lot of pain due to urinary retention. While in the emergency room, he would have a catheter—a thin tube that drains the bladder—placed and removed, and he would be OK for a few days before symptoms returned. He eventually opted for GreenLight laser surgery. Following the procedure, his stream was normal, like it was in his 20s. Not only could he sit through meetings at work with no issues, but he could even watch nine innings of a baseball game without having to use the bathroom.

LISTEN: Dr. Marchalik discusses GreenLight laser surgery for BPH in the Medical Intel podcast.

How Does GreenLight Laser Surgery Work?

During GreenLight laser surgery, we vaporize prostate tissue that is blocking the outlet of the bladder. We do this by placing a scope near the prostate while patients are under anesthesia and using it to guide a laser fiber up to the prostate to gently vaporize the prostatic tissue. The laser is absorbed by hemoglobin molecules in the red blood cells during the process, which results in less bleeding than other treatments. After we eliminate the prostatic tissue, individuals return home with a urinary catheter that they either remove themselves or at the hospital the next day.

Other treatment options, such as transurethral resection of the prostate (TURP), surgically shaves the prostate down from the inside. Surgeons primarily used TURP to treat BPH in the past and typically it’s just as effective as GreenLight laser surgery in the long run. But TURP can be more invasive, requiring patients to stay the night at the hospital, and can result in longer recoveries. Patients who undergo TURP also often have a longer period until the bleeding in their urine resolves.

How is BPH Diagnosed, and Who’s a Candidate?

We typically diagnose BPH after hearing of a patient’s symptoms, most commonly the frequent or urgent need to urinate. We often ask patients to complete questionnaires to measure the extent to which their symptoms bother them, as well as the strength of their urine stream. Ultimately, if a man has problems urinating, we determine if it’s BPH by measuring the size of their prostate via an ultrasound and evaluate the appearance of their prostate with a cystoscopy, a procedure that uses a small camera to identify signs of BPH, such as the narrowing of the urethra where it passes through the prostate gland.

The best candidates for GreenLight laser surgery are men who want a treatment option that is going to last long-term. While most men are candidates for the surgery, it’s not the right option for everyone (for example, men with BPH who plan to have children). Following a GreenLight laser surgery, patients can experience retrograde ejaculation, where semen travels backward into the bladder during sex rather than exiting through the penis. Men who can’t or don’t want to go under anesthesia also are not good candidates for this procedure.

What Risks are There?

As with any surgery, there are inherent risks associated with anesthesia. But for the surgery itself, about three-quarters of guys we see who undergo this procedure develop the previously mentioned retrograde ejaculation, although, this complication doesn’t affect their ability to orgasm or have erections.

Furthermore, about three to five percent of men we see develop urinary incontinence, which is when a few drops of urine leak out when they sneeze, cough, or do some strenuous activity. For many guys, it goes away after a few weeks. For some, the side effects can be long-lasting.

We have an exceptional track record of performing advanced GreenLight laser surgery at MedStar Washington Hospital Center—even for some men who have especially large prostates. If you’re experiencing symptoms, speak to your doctor to discuss whether GreenLight laser surgery might be a good option for you.

Insomnia is habitual sleeplessness or the inability to sleep that isn’t explained by a medical condition (i.e. sleep apnea). It includes your habits or schedule causing you to not get enough sleep or your inability to sleep when you try to do so.

How Sacrificing Sleep Can Affect Your Quality of Life

Our work schedules and technology we use create a culture where we are frequently plugged in and connected, making it hard to unwind at the end of the day. We fill up our limited free time with additional tasks, often sacrificing our sleep to do it. While tolerable in the short term, this can lead to long term, negative effects on our health and impact quality of life.

The Centers for Disease Control and Prevention (CDC) recommends seven to nine hours of sleep per night. Anything less is considered “insufficient sleep”. Insufficient sleep affects:

• Physical Health: Poor sleep habits have been linked to diabetes, obesity, high blood pressure, and heart disease.
• Job Performance: Lack of sleep can also lead to poor mathematical capacity, logical reasoning, concentration, memory, and ability to learn.
• Mental Health: Poor sleep affects your ability to handle stress and anxiety, and it can cause the feeling of being “mentally exhausted.”

Tips for Creating Better Sleep Habits

1. Set aside eight hours for “sleep potential,” that is quiet and technology-free. You don’t need to be asleep the entire time, but this lets your body and mind rest.
2. Create a sleep routine. About 45 to 60 minutes before bedtime, unplug from devices and start unwinding. This includes self-care, stretching, listening to music, reading, or meditating.
3. Set up your room. Make it cold (between 60-67 degrees), dark (using black-out curtains, covering lights from devices, etc.), and quiet by silencing your phone or using white noise machines or fans.
4. Use light to your advantage. Try wifi-enabled, dimmable lights to brighten your room before your alarm goes off to help you wake up. If you’re traveling, get outside in the sun to adjust to new time zones.
5. Exercise. Vigorous exercise is best, but even light exercise can help you sleep better. It helps clear brain fog, helps you sleep more soundly, and can minimize jet lag. But, try to avoid exercise within three hours of sleep.
6. Limit naps and caffeine. While both can give you an energy boost, taking a nap or consuming caffeinated beverages in the afternoon, especially after 3 p.m., can make it more difficult to sleep at night.
7. If you cannot sleep, go in another room and do something relaxing. Try reading, stretching, or listening to music. Once you feel tired, get back into bed, and avoid digital screens or stressful tasks.
8. “Bank” sleep the night before travel or a long day. While you cannot completely catch up on sleep, sleeping one to two extra hours the night before has been shown to improve your cognitive performance compared to those who did not sleep that extra time.

Our skin is a sensitive organ that can be affected by the outside world, such as the UV rays produced by the sun.  Skin cancer—the most common type of cancer in America—can be caused by the sun, causing brown or red spots on our skin that:

• Are growing or changing
• Are sensitive or painful
• Bleed easily

The top reason people develop skin cancer is cumulative exposure to UV rays from the sun or a tanning bed. Individuals who are fair-skinned are most at risk (although, in rare cases, I’ve seen African Americans develop skin cancers!). Other common reasons people develop skin cancer include a:

• Family history of skin cancer
• History of radiation treatment for an underlying cancer
• History of taking medications that suppress the immune system, such as those for treating immune disorders or after organ transplant

Although we treat numerous rare skin cancers, the most common types of skin cancer we see are:

• Basal and squamous cell skin cancer: Also called non-melanoma skin cancers, these generally show up on sun-exposed areas as pimples, scaly spots, or bumps that don’t heal or as rough spots that bleed easily.
• Melanoma:. Melanomas typically appear as a new dark spot on the skin, or a sudden change in a long standing mole. Melanoma is the most dangerous type of skin cancer, and new or changing dark spots on the skin should prompt evaluation with a board-certified dermatologist.

LISTEN: Dr. Ronkainen discusses ways to prevent skin cancer in the Medical Intel podcast.

How to Help Prevent Skin Cancer

To minimize risk of skin cancer, prevent aging, and otherwise protect your skin, it’s critical to protect yourself from too much direct sun exposure. While it’s common for people to love spending time outside, the damage the sun does to our unprotected skin can add up over time. Some common tips I provide patients include:

• Stay out of the sun during peak times: The sun’s harshest hours are between 10 a.m. and 2 p.m.- seek shade between those hours!
• Wear sun-protective clothing: Broad brimmed hats are a great way to shade your face and neck from the sun. Not all fabrics are created equal in protecting you from the sun! If clothes get wet, that also reduces the protection they provide. If intensive outdoor activity is planned, I recommend investing in clothes that have a UPF (like SPF for clothes), to ensure photoprotection stays consistent.
• Wear sunscreen: Choose one that has a sun protection factor (SPF) of 30 or higher daily, with reapplication after swimming/toweling off, and every 2 hours when out in the sun.

How to Pick a Sunscreen

The number of different types of sunscreen has exploded—every five minutes, I hear about a new type of sunscreen that has come out. The main division is between chemical blockers which absorb the UV-rays or physical blockers which reflect them off the skin. I typically recommend physical blockers, such as zinc, titanium, or iron oxide, as they are less irritating to skin, however these can feel chalky, and can leave a visible white cast on the skin. Chemical sunscreens go on more smoothly, however there has been recent data from the FDA noting that these chemical sunscreens can be absorbed into the blood (though the significance of this is not known). At the end of the day, it’s a balance of risks and benefits- the best sunscreen to me is the one my patient doesn’t mind putting on!

How We Treat Skin Cancer

The way we treat skin cancer depends on the size, location, and subtype of skin cancer. Some superficial types of cancer can be treated with a topical cream, but often skin cancer needs to be cut out  through either conventional excision or Mohs surgery.

Conventional excisions involve dermatologists cutting out a little rim of healthy skin around the cancerous spot to ensure all of the cancer is removed. Mohs’ surgery is a specialized surgery done by a fellowship-trained dermatologic surgeon done to spare as much of the healthy skin around the cancer as possible.  Surgeons are able to do this by examining edges of tissue under the microscope  little by little until they reach tissue that isn’t cancerous. Not all skin cancers need Mohs’ surgery. Mohs’ surgery generally takes about half a day, and achieves a very cosmetically pleasing result.

Topical creams can be used to treat skin cancer when it only affects the very top layer of skin. People usually apply topical creams at home for several weeks while a dermatologist monitors the spot to ensure it heals. In many cases, the affected skin becomes red and inflamed when using the topical cream, which is a sign that it’s fighting off skin cancer cells.

A Success Story

We see people of all ages and from all walks of life who are often seeking screenings for marks on their skin—especially if they have a family history of skin cancer. One particular patient made an appointment to have a spot on his back examined because he had noticed it was rough and raised above the skin. We determined that the spot was a benign seborrheic keratosis, a warty growth that grows larger with age. But that’s not the only thing we spotted when he came in! We also identified a dark spot near the benign seborrheic keratosis that the patient hadn’t noticed. We tested the spot and realized it was a melanoma! He underwent excision of the melanoma and did quite well.

What if Skin Cancer Is Left Untreated?

Without treatment, skin cancer can continue to grow and become more difficult to treat. For example, over time, basal cell skin cancer can begin bleeding more frequently and eventually erode into tissue under the skin. In fact, I’ve seen basal cells go into bone if left untreated. Melanoma and squamous cell skin cancer, meanwhile, can travel to lymph nodes and become widespread and metastatic, which would require systemic treatment that targets cancer in the entire body, such as chemotherapy.

We have experts at MedStar Washington Hospital Center who are here to help you with your skin cancer—whether it requires Mohs surgery or a topical treatment. If you’re experiencing skin cancer symptoms, make sure to reach out to us so we can help address your condition.