JOHN R. LUCKASEN, M.D. BERT C. FRICHOT III, M.D. JASON S. PAPENFUSS, M.D.

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1 visit us online at midwestderm.com The Newsletter for Medically Sound Information from MIDWEST DERMATOLOGY CLINIC JOHN R. LUCKASEN, M.D. BERT C. FRICHOT III, M.D. JASON S. PAPENFUSS, M.D. OMAHA: MIDTOWN OFFICE Doctors Building North Tower 4242 Farnam St., Ste. 360 (402) OMAHA: LAKESIDE OFFICE Lakeside Hills Plaza, Suite 218 (402) OMAHA: OAKVIEW OFFICE 2727 S. 144th St., Suite 225 (402) BELLEVUE OFFICE: 720 Fort Crook Road North (402) NORFOLK OFFICE: 109 North 15th St. (402) WHAT S InYOUR beach bag? Want to make the most of your summer? Midwest Dermatology recommends that you take some essentials with you this summer so you get maximum enjoyment and skin protection whether you re in the pool, on the beach or just out and about! 24/7 Medically Sound Advice midwestderm.com do awaywith sun damage Sunscreen lotion with an SPF, or Sun Protection Factor, of at least 30, that s also water-resistant and protects against UVA and UVB rays Lightweight protective clothing that can be worn when the sun rays are the most dangerous, between 10 a.m. and 2 p.m. Wide-brimmed hat to protect facial skin Smart phone so you can call and make your appointment with Midwest Dermatology or check us out on the Web at midwestderm.com. Summer reading material (Download and print archive issues of the Midwest Dermatology newsletter.) When you re relaxing in the WeAther that s FinALLy turned WArM, check A FeW More items off your summer to-do List With help FroM MiDWest DerMAtoLogy: s U M M e r To do list restore sun-damaged skin with fractional laser treatment (Page 4) reverse hair loss with prescription propecia (Page 6) take aim at sun spots and melasma with targeted treatments (Page 6) remove outdated tattoos (Page 6) share the news with friends about the v-beam laser s ability to erase birthmarks and broken blood vessels! (Page 6) Make an appointment today to learn more about BotoX, restylane and Juvaderm...and see if one is right for me! (Page 6) midwestderm.com 1

2 everything you need to know about s Midwest Dermatology physicians are specialists dedicated to the care and we we ve put together this comprehensive summary of everything you need t more than 1 million Americans each year. Here you can find out what that n the most serious of skin cancers; and discover what really happens after a skin cancer di Kn w your ABCDEs you can remember the WArning signs of MeLAnoMA if you know your ABcDes: A Asymmetry is one side of a mole the not the same as the other side? B Borders are the edges of a mole ragged or blurred? C color has a mole changed color? does a single mole have multiple colors, especially, blue, red, purple and white? D Diameter is a mole larger around than a pencil eraser? E evolving is a mole s appearance changing? its size, color or shape? 2 midwestderm.com SPOT THE WARNING SIGNS if you can identify with any of the warning signs especially the signs of melanoma contact midwest dermatology for a full examination. SYMPTOMS MeLAnoMA Bleeding or breaking open of an existing mole. growing colored skin spots or moles, especially those that are black or deep blue. Changes in color of an existing mole, especially the spread of red, white, brown or blue color to the surrounding skin. Changes in size or shape of a mole, especially its borders or diameter. melanoma can be aggressive and spread quickly to other parts of the body. the secret to making melanoma treatable. YOU. OKAY, you ve heard melanoma is a very serious disease. You ve seen the warning signs. What may get lost amid the statistics and the fear of developing melanoma is that it s both treatable and preventable! BAsAL cell CaRCinoma What makes the disease more treatable is if it s caught early and if treatment begins right away. This means you should keep a close eye on your skin and know the warning signs of melanoma (see the know your ABcDes ). If you see changes, you shouldn t procrastinate. Waiting too long gives melanoma, which is known to be aggressive and fast-spreading, the time it needs to move to other parts of the body. When it spreads and develops, it becomes much more difficult to treat effectively. Another plus? Treatment for small melanomas may be as simple as removing a small growth on the skin. If you wait longer, melanoma may spread. Then treatment is more involved and challenging. open sore that bleeds, oozes or crusts, and doesn t heal. smooth growth with raised, rolled border and dimple in the middle. shiny bump that looks pearly or translucent; may be pink, red or white in color. Bump can also be tan, black or brown, in dark-haired people especially, and confused with a mole. scar-like patch with poorly defined borders. the skin itself looks shiny and stretched. Reddish patch on the chest, shoulder, arms or legs that may crust, itch or hurt. Basal cell carcinoma are slow-growing and unlikely to spread, especially if treated. squamous cell CaRCinoma sore that doesn t heal. In addition to being aware of the warning signs, the key to preventing melanoma is simply being smart about the risk factors you can control, including: avoiding exposure to the sun s (uv) rays avoiding the sun when it s the most damaging, between the hours of 10 a.m. and 3 p.m. using sunscreen with an spf of at less 15 Preventing childhood sunburns wart-like growths on the skin. thickened skin on the lower lip. Red, scaly patches or bumps or crusted, scaly areas with a red, inflamed base. squamous cell carcinoma are relatively slow-growing, but are more aggressive and can spread without treatment. Performing monthly skin self-exams, Regular skin examinations conducted at midwest dermatology Midwest Dermatology wants to help dispel the fear and spread the news melanoma can be prevented, treated if it does develop and it doesn t have to be deadly. And you re the secret weapon! (If you re wondering what happens after diagnosis, see page 3.). For more information, visit midwestderm.com.

3 kin cancer but were afraid to ask. ll-being of your skin and your overall health. Which is exactly why o know and might be afraid to ask about a disease that affects ew mole might be telling you; get a dash of reality about melanoma, agnosis. Read on you and your skin will be glad you did! your Best step KNOWING WHAT COMES NEXT! FORTUNATELY, most skin cancer situations can be easily resolved with prompt medical attention. Midwest Dermatology takes treatment one step further and enhances patients well-being with clear information about what you can expect and the next steps you should take when the diagnosis is skin cancer. STEP ONE: SKIN BIOPSY. During the biopsy, your doctor takes a small sample of the visible portion of the cancer to help make a diagnosis. STEP TWO: PATHOLOGY EXAM. This is where the sample is examined under a microscope to determine what type of cancer is present and how developed the cancer is. STEP THREE:TREATMENT. Your dermatologist has several choices about how to remove your cancer, and fortunately, most of today s treatments have a very high cure rate when the condition is caught early. Your doctor will help you decide on the procedure that best meets your medical and lifestyle needs. STEP FOUR: FOLLOW-UP. After treatment (which if it s surgery, is often done right in our offices), your care doesn t end. Midwest Dermatology routinely checks areas that have been treated to make sure that cancer doesn t reoccur and that new lesions don t develop. Melanoma patients are monitored for changes, and care is coordinated with other doctors, as necessary. The most important step out of all of these is the first one you taking action. Instead of worrying or procrastinating, just pick up the phone, make that appointment, see your dermatologist. Whatever you do, don t let fear or a busy schedule derail the health and well-being. Always remember, skin cancer is the most treatable cancer there is. And Midwest Dermatology is here to help. TODAY dermatologic surgeons at Midwest Dermatology can do more than ever before to treat skin cancer thanks to a type of surgery called Mohs. Mohs is actually considered micrographic surgery a fancy name for a very refined treatment that lets surgeons see beyond the visible cancer to precisely identify and remove cancerous tissue. The beauty of Mohs is that it s the most effective way for doctors to leave the surrounding skin alone and unharmed. absolutely effective There s no doubt Mohs is effective. Patients undergoing Mohs treatment have five-year cure rates upward of 90 percent for both new and recurring basal cell and squamous cell cancers. Because of its high effectiveness, Mohs is often recommended for: Cancer that was treated previously and has come back Cancer on the skin that involves scar tissue Large skin cancers mohs does MORE skin cancers with edges that are difficult to define skin cancers that are fast-growing Cancer on body areas where healthy skin is especially important (for example, the face) Beyond the statistics, however, is how Mohs works to preserve normal tissue. Because the treatment is so precise, doctors can remove the minimum amount of skin tissue and still get it all. That s why Mohs is especially advantageous when used to treat skin cancers on the face. Obviously, preserving as much skin as possible on the nose, ears, eyelid, lips and around the mouth is vitally important to patients and physicians alike. mapping the way To understand how Mohs works to get the roots of cancer, consider this: skin cancer typically grows in a pattern similar to the roots of a tree. Mohs ensures that surgeons go wide enough and deep enough to remove all of the cancer. Tissue is examined microscopically as it is removed to determine that the skin is clear of cancer cells. Generally, Mohs surgery can be done in a single morning or afternoon. After the procedure, the treated area may be closed up or left to heal by itself. Patients are often asked to avoid physical activity for a few days. Fortunately, cosmetic repairs are completed during surgery. Midwest Dermatology surgeons are skilled in making repairs that minimize scarring and provide the best cosmetic option. midwestderm.com 3

4 PEEL AWAY THE YEARS! It s a good thing to act your age, but it doesn t mean you have to show it! Chemical peels done by the experienced Midwest Dermatology team are another option for those interested in reversing the signs of aging. peels Are An ideal choice For ADDressing: Wrinkling Dryness Acne scarring Blemishes Uneven skin texture Depending upon the skin condition you d like Midwest Dermatology to help you improve or resolve, there are a number of different peels to choose from, including: Mini glycolic peels that can be done quickly, over a single lunch hour. Jessner s peels that offer the best of both worlds they re relatively gentle on the skin, but penetrate deeper into the skin than a regular mini peel. Deep & Active FX LAser: do away WITH sun damage Asun-kissed appearance can enhance your appearance, but too much sun does nothing but damage. If you want to do away with the leathered look and more that the sun has wrought, consider Sun Damage Laser treatment at Midwest Dermatology. Sun Damage Laser treatment, which comes courtesy of Midwest Dermatology s fractional Deep FX and Active FX laser, dramatically reverses the effects of aging and spurs the production of brand new skin. The laser uses a fraction of the energy found in a laser beam, delivered in tiny microbeams, to: erase lines and wrinkles around the mouth and eyes Lessen the appearance of age spots and freckles Lighten acne scars Restores skin s youthful appearance through the production of new collagen enhance skin s appearance, making it look tighter and smoother Treatment with the Deep FX and Active FX is effective for both smaller wrinkles and deeper wrinkles and discolorations. Even the appearance of longtime acne scars can often be significantly improved. The factors that improve are uneven skin color and skin texture. After FX treatment, facial skin will typically have a more consistent color without reddish and brown marks. The scarred area of the skin will often feel and look smoother. LittLe time, Big impact Because Sun Damage Laser treatment is so effective, treatments can be done in less than an hour right in the Midwest Dermatology office. Patients experience rapid healing after treatment and return to active lifestyles in about three to four days. Seven days after treatment, patients treated with the Sun Damage Laser see a dramatic enhancement in their appearance. But that s not all. One of the biggest advantages of Deep FX and Active FX laser treatments are their ability to stimulate new collagen growth in the skin. Simply, the treated skin bridges with brand new skin. As a result patients overall appearances continue to improve over the next several weeks. To find out more about the exciting Sun Damage Laser treatment, contact us today! salicylic acid peels that penetrate the top layer of skin and help reveal a fresh, rejuvenated complexion. vitalize peels that combine the powerful alphahydroxy agents that cause skin to peel away with antiaging components. tca peels, that go deeper, under the skin s surface, to remove more significant damage. The beauty of peels is that they re a great way to enhance your appearance without a lot of downtime. The lighter peels glycolic, Jessner s, salicylic and Vitalize let you return to your daily activities the same day the procedure is done. With glycolic peels, you can even apply makeup the very next day! While the recovery time is longer with TCA peels, the results are more dramatic and longer lasting. The peel procedure you undergo is best determined after consultation with your Midwest Dermatology physician. midwestderm.com 4 PRSRT STD U.S. POSTAGE PAID OMAHA, NE PERMIT NO. 983 MIDWEST DERMATOLOGY CLINIC, P.C. Doctors Building North Tower 4242 Farnam St., Ste. 360 Omaha, NE 68131

5 FAST FaCts did you Know that people with fair skin, lots of moles or freckles and blonde or red hair are more likely to develop skin cancer in their lifetimes? that s because people with these physical characteristics produce less of the skin pigment called melanin. Melanin helps protect skin against exposure from the sun and, up to a point, blocks the sun s damaging rays. even though some people may have more melanin in their skin and have darker skin, they can still develop skin cancer. Also at higher risk for developing skin cancer are those who live in sunny environments year-round, those who have experienced a high number of bad sunburns and people who have a family history of skin cancer. if you fall into one of these categories, you should regularly monitor your skin for any changes. But just because you may be at higher risk don t assume that you ll develop skin cancer. it s still preventable. in fact, Midwest Dermatology can help you stay on top of these risk factors with regular examinations. call today for an appointment! P Re-C ancers: Where skin cancer starts SKIN cancers don t just happen overnight. Rather, they start out as pre-cancerous growths on parts of the body commonly exposed to the sun and slowly develop over a number of years. Also called AKs (short for actinic keratoses), pre-cancers can be deceiving. You might feel or see a rough, dry patch of skin when in reality what you re dealing with is an AK lesion. To help you prevent and spot these pre-cancers before they ever evolve into actual skin cancer, Midwest Dermatology advises: Looking closely at spots that are sore or painful when they rub against clothing Performing regular self exams, especially if you are light-skinned and have spent lots of time outdoors over the years minimizing sun exposure if and when possible talking to your dermatologist and your family physician if you feel you re at risk for pre-cancers Pre-cancerous AKs can be removed in the comfort of your nearby Midwest Dermatology office. The growths may be treated with liquid nitrogen or cauterization, which both destroy the skin cells. For patients with multiple lesions, topical creams can be prescribed to chemically remove the cancer cells. If you want to get a head start on stopping skin cancer, see your Midwest Dermatology physician today for a pre-cancer examination. MOLEWATCH Contact Midwest Dermatology to schedule a FREE no-obligation, initial skin cancer examination. MoleWatch is an initial screening for first-time patients only, and cannot be used as a substitute for an annual skin examination. Please check the location you prefer and then mail this coupon back. You will be contacted within two weeks of returning this form. [ ] Omaha Midtown [ ] Omaha Lakeside [ ] Omaha Oakview [ ] Bellevue your first time SKIN CANCER EVALUATION name: DAte of Birth (Month/DAte/yeAr) ADDress: city: state: zip: telephone (DAytiMe): cell number: midwestderm.com 5 MIDWEST DERMATOLOGY SKIN CANCER CLINIC 4242 FARNAM ST., STE 360 OMAHA, NE Includes only examination of moles and skin growths. Any additional diagnostic testing or treatment will be provided at the regular charge. Patients with additional dermatologic problems will be charged for that portion of their visit.

6 WAY S Y O U C A N LOOKGOOD ALL summer Long check them out! MiDWest DerMAtoLogy knows you ve got A BUsy summer AheAD, AnD We hope At LeAst part of your time WiLL Be spent taking care of yourself. toward that end, consider checking one of the items BeLoW off your to-do List. every single one can help you Look good AnD FeeL Better ABoUt yourself! GRAND ISLAND Office Closing; Patients Welcome At Other Locations Midwest Dermatology is closing its office in Grand Island in June and is currently encouraging all Grand Island patients to continue their care with their preferred dermatologist at our other office locations. Patient records will be kept in Grand Island for a period of time and then relocated to our midtown Omaha office in the Doctors Building. To have medical records forwarded, contact Midwest Dermatology at The entire Midwest Dermatology team appreciates the support that Grand Island residents have offered over the years. propecia For BALDness For those suffering from malepattern baldness, Propecia is thought of as a wonder drug. Why? Because it helps keep hair from falling out, and in some cases actually encourages new hair growth. Midwest Dermatology can prescribe Propecia. Try it and you ll see results with minimal side effects. v-beam For BirthMArks All of us can probably remember going to school with someone who had a birthmark. Today, children don t have to suffer the same unwanted attention. Talk to Midwest Dermatology today to find out how birthmarks and port wine stains can be erased with the powerful V-Beam Laser. tattoo removal Midwest Dermatology has the most powerful lasers available and they can safely remove every tattoo ink color under the rainbow without damaging the skin underneath. Whether you re looking to remove an outdated design or take a tattoo off for good, Laser Tattoo Removal works. sun spot removal Once you hit a certain age, sun spots are a part of life. That s because the body continues producing melanin as part of its defense against sun exposure. While the spots aren t harmful to your health, they may mar your appearance. Midwest Dermatology can remove them safely and with minimal downtime with our Pigmented Lesion Laser. MeLAsMA topical treatment If you developed melasma, a discoloration of facial skin, while pregnant or on birth control pills, you know how mysterious the condition can be. Midwest Dermatology can prescribe effective treatments, including creams that help fade the discolored areas, as well as topical scrubs that slough the discolored skin away. BotoX injections Wrinkles be gone! BOTOX injections done in the Midwest Dermatology office can reduce the appearance of aging by relaxing wrinkles away. BOTOX injections are also an effective treatment for hyperhidrosis, or excessive sweating. For both uses, the results are long lasting, from three to six months. FAciAL rejuvenation Restylane and Juvaderm injectables are just what the Midwest Dermatology doctors order for filling in lines on the face (around the nose and mouth) and firming up sagging skin. Plumped up skin looks years younger, and the results can last for up to six months. Plus, Juvaderm treatment now comes with a light anesthetic so the procedure is even more comfortable! midwestderm.com 6