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Skin Cancer
Skin Cancer Expert for Diagnosis and Treatment of Basal Cell | Squamous Cell Carcinoma

Dr. Raffy Karamanoukian is the preferred plastic surgery partner for numerous dermatologists, skin cancer screening centers, and skin cancer specialists in Los Angeles, Beverly Hills, and Santa Monica. He has demonstrated exceptional expertise in skin cancer management using a multi-disciplinary team of dermatologists, dermatopathologists, and skin cancer specialists.  Dr. Karamanoukian will ensure that your ultimate results are aesthetically pleasing and conform to the latest advancements in plastic surgery. 


Beverly Hills and Santa Monica skin cancer specialist Dr. Raffy Karamanoukian diagnoses and manages skin cancer.  His plastic surgery skills help minimize scars and maximize the margins of surgical excision for skin cancers.  Dr. Karamanoukian works with many of the best dermatologists in Los Angeles and can co-manage your skin cancer with a dermatologist to maximize long term care and follow-up.

Skin cancer specialists divide skin cancers into two basic groups, melanoma and non-melanomatous skin cancers (NMSC). Non-melanomatous skin cancers are so common they comprise more than 30% of all cancers in the United States.  These NMSC's include the common basal cell skin cancer, squamous cell skin cancer, and other less common skin cancers such as Merkel cell cancer and cutaneous lymphoma. 

There are several types of skin cancers that are commonly found in healthy adults with a history of sun exposure.  The most common areas for skin cancer development are the face, arms, back, and neck. The three main types of skin cancers include 1) Basal cell skin cancer, 2) squamous cell skin cancer, and 3) melanoma. 



There are many warning signs for skin cancer and Santa Monica plastic surgeon Dr. Karamanoukian can help you identify and spot skin changes that may be suggestive of skin cancer.  There are many different types of abnormal growths on the skin, and many of these have the potential, or sometimes no potential, to become dangerous.


  1. Spontaneous bleeding or growth of a mole on the skin
  2. Rapid increase in size or shape of a mole on the skin
  3. A birthmark or brown spot on the skin that begins to change in shape and size
  4. A skin growth that becomes an open sore or wound
  5. A skin growth that is always inflamed, never quite healing correctly



  1. Genetics and Family History (Most likely related to tumor fighting ability and susceptibility to UV exposure).
  2. Age (skin cancers increase with advancing age).
  3. Chemical carcinogens (some exposure to chemicals in the past may lead to skin cancers).
  4. Radiation (exposure to therapeutic radiation may lead to skin cancer).
  5. UV radiation (cumulative exposure to UV radiation and severe sun burns).
  6. Hedgehog signaling pathway defect (Mutations in this gene pathway may contribute to skin cancers).
  7. p53 mutation (molecular abnormality that assists in tumor fighting, associated with sporadic basal cell skin cancers).




There are over 20 different types of basal cell skin cancers that have been identified by skin cancer specialists and pathologists.  Dr. Karamanoukian is an expert on the management of basal cell cancers on the head, neck, and body and will advise you of your options for treatment of basal cell cancer during your consultation. 


Our office is also a secondary and tertiary consultation and referral center for dermatologists who request plastic surgery closure of complicated basal cell cancers.  This is most commonly requested on areas of the face that are aesthetically important.   


The most common types of basal cell cancers include the following:


1) Nodular, which is the most common type of basal cell cancer found. Nodular basal cell skin cancer usually arises as a small nodule on the skin with a pearly rim and central crater.  The difference in the color of the nodular basal cell skin cancer versus the surrounding tissue is that the skin cancer usually has small blood vessels on its surface.


Often a nodular basal cell skin cancer can be ulcerated at the center and can have scabbing associated with a non-healing area of skin.  The most common presentation is a patient who notices scabbing and persistent redness and bleeding over an area that does not heal over time.  Initially, the nodular skin cancer can be confused for a scratch or a small area of skin damage.  A chronically non-healing scratch on sun-exposed areas is likely associated with precancerous or cancerous skin changes


2) Superficial spreading basal cell skin cancer.  This type of basal cell skin cancer is usually less noticeable on the skin, as it does not form a nodule or bump.  Unlike a nodular type of basal cell skin cancer, a superficial spreading skin cancer is usually flat and scaly and involves only the epidermis. It may look very similar to an eczematous patch or area of actinic keratosis.  A biopsy done in Dr. Karamanoukian’s office will confirm the diagnosis.


3) An infiltrative basal cell skin cancer is a less common type of basal cell skin cancer that is associated with small infiltrative nodules of locally widespread tumor. The irregularity of the infiltrative basal cell skin cancer makes it more difficult to excise in one piece.  These types of tumors may benefit from Moh’s excision.


4) Pigmented basal cell skin cancer.   Although basal cell skin cancers are usually the same color as skin, a pigmented basal cell skin cancer has been confused with a melanoma on initial examination.  The pigment in some basal cell skin cancers are due to over production of melanin by melanocytes.


5) Morpheaform or sclerosing basal cell skin cancer is often the most difficult type of basal cell skin cancer to treat.  Morpheaform basal cell skin cancers often appear as irregular or slightly elevated skin edges that are often thick and scar-like.  Rarely, there may be ulceration of the skin. Morpheaform basal cell skin cancers often have positive margins on initial excision, making them very hard to excise in one stage. In the majority of cases, Dr. Karamanoukian will work closely with a dermatologist who specializes in Moh’s surgery in order to coordinate the excision and closure of the skin cancer.


The ultimate goal of skin cancer management is to achieve complete clearance of the skin cancer and maximize the aesthetic result of the excision.  In the Santa Monica and Los Angeles areas, Dr. Karamanoukian is a specialist in the diagnosis and management of basal cell and squamous cell skin cancers.  Please call our officeat (310) 998-5533 to schedule a comprehensive consultation. The treatment of basal and squamous cell skin cancer is facilitated by early diagnosis.


There are several types of basal cell skin cancers that are more difficult to treat because they can be more aggressive in their growth pattern.  Morpheaform, infiltrating, and micronodular basal cell skin cancers can exhibit aggressive growth patterns that often obscure the skin cancer borders, thus making them difficult to excise in one session.  These types of basal cell skin cancers often require wider margins of excision and Dr. Karamanoukian will assist you in making the right decisions about your skin cancer.  The goal of treatment will be to completely excise the skin cancer and minimize visible scarring afterwards.  All tissue specimens are evaluated by a board certified pathologist who is an expert in skin cancer diagnosis.  This careful approach has earned Dr. Karamanoukian a strong reputation for skin cancer surgery in Beverly Hills, Santa Monica, and Los Angeles.  


A new FDA medication called Erivedge may also be deemed appropriate for certain metastatic or recurrent basal cell cancers.  Erivdege is indicated for the treatment of adults with metastatic basal cell cancer carcinoma, or with locally advanced basal cell cancer that has recurred following surgery; or for patients who are not candidates for surgery or radiation.  If you are seeking a second opinion for skin cancer or recurrent skin cancer in the Santa Monica or Los Angeles areas, please schedule a consultation with Dr. Raffy Karamanoukian at (310) 998-5533.


Actinic keratosis is one of the most common signs of sun damage and is characteristically a precancerous lesion. The transformation of actinic keratosis to skin cancer is fairly unpredictable and we are unsure whether actinic keratosis will transform to something more dangerous within days, months, or years. Actinic keratosis typically shows up as scaly, roughened areas of skin that tend to be reddish in color.  Sometimes, these abnormal plaques of skin will bleed or bruise easily, lending to a general transformation into malignancy. 


Skin cancer arises from a combination of cumulative sun exposure and immediate sun exposure.  Sunburns can exacerbate chronic sun damage and should thus be avoided. Sun protection is a necessary daily routine in Southern California and Beverly Hills and Santa Monica plastic surgeon Dr. Raffy Karamanoukian advises patients to use sunscreen daily.  Here are some basics to avoid unwanted sun exposure, particularly if you are very fair and have a family history of skin cancer. 

  1. Use daily sunscreen and apply regularly if you are under direct sun or are very active.
  2. Cover the back of the neck, arms, and shoulders with a garment.
  3. Avoid tanning booths altogether unless it is an absolute must. 
  4. Check that your sunscreen has both UVA and UVB protection.
  5. Schedule routine skin examinations. 



 raffy karamanoukian

Example of a Punch Biopsy of a Skin Cancer; Image Courtesy of the US Gov. and National Cancer Institute


There are several non-invasive methods of treating non-melanomatous skin cancers, but most surgeons and dermatologists would agree that surgical excision of skin cancer remains the gold standard.  Lesser treatments may result in inadequate ablation or destruction of the skin cancer and may lead to higher rates of recurrence.  Due to the fact that skin cancer margins can often resemble normal skin, it is imperative that surgical resection include a microscopic examination of the specimen to determine cancer free status. This is true of both basal cell skin cancers and squamous cell skin cancers. About two thirds of all non-melanomatous skin cancers are basal cell carcinoma and about one-third are squamous cell carcinoma. The non-surgical options for the treatment of non-melanomatous skin cancers include Diclofenac, Ingenol mebuate, photodynamic therapy for skin cancers, vismodegib, and electrobrachytherapy.


Skin cancer prevention begins with daily use of sunscreen which is at least an SPF 30.  Our office recommends the Melaquin AM. Daily UV Protect with SPF 30.  This unique daily protection should be applied every few hours if you anticipate going outside in direct or indirect sun.  The SPF number refers only to the protection factor against UVB rays.  Recent studies have shown that UVA radiation which was thought to correlate with premature signs of aging has been linked to skin cancer.  Melaquin AM Daily UV Protect with SPF 30 contains avobenzone and oxybenzone, which have both been shown to be broad spectrum UVA blocking active ingredients.  A lifelong attention to sunscreen and abating direct UV radiation will decrease your risk of developing skin cancers.


Almost anyone can develop skin cancer, whether their skin is fair, olive toned, or dark.  Skin cancer is related to genetics, environmental exposure, and most importantly UV radiation.  Sun protection is always a necessity even when you do not anticipate direct sun exposure.  A cloudy day still places someone at risk for UV exposure.  If you have any of the following, you may be at increase risk of developing skin cancer.  1) Fair skin that burns easily with blond or red hair or blue, green, gray or hazel eyes.  2) A family history of skin cancer or a personal history of skin cancer.  3) Severe sunburns as a child or teenager.  4) Chronic use of tanning beds.  5) Chronic exposure to medications that increase photosensitivity and diminish one’s natural body defense against UV radiation.  5) A history of multiple dysplastic moles on the body.


Dr. Raffy Karamanoukian offers consultation for scar revision after skin cancer surgery.  Unfortunately, we cannot always predict where a skin cancer will develop, and some patients will have skin cancer surgery in very important aesthetic areas of the face, including the areas of the eyes and nose.  For those patients, Dr. Karamanoukian performs laser scar revision and surgical scar revision to improve scars that developed after Moh's surgery or skin cancer surgery.  Scar can also develop from cryotherapy, biopsies, or surgical removal of skin cancer.


If you have scars from a skin cancer biopsy or surgery, you may be a candidate for surgical scar revision.  These scars can often be thickened, discolored, or hypopigmented, leading to increased visibility.   Schedule a consultation for scar revision with Dr. Karamanoukian by calling our Los Angeles plastic surgery office at (310) 998-5533.  Read More about Los Angeles Scar Revision. 


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