Skin Deep

A Conversation with Skin Specialist Dr. Mordechai Tarlow

 

Can you tell us a little about your background?

My medical education and training were primarily at the Albert Einstein College of Medicine in New York City and at Rutgers University in Newark. I’ve been in practice in Lakewood for close to 18 years, baruch Hashem. I’m both a dermatologist and a skin cancer and reconstructive surgeon, as I have additional board certification in Micrographic Dermatologic Surgery.

What does that mean?

Micrographic Dermatologic Surgery is also known as Mohs surgery. It’s a specialized technique for removing high-risk skin cancers and those in cosmetically sensitive areas with the highest possible cure rate. The process involves a surgeon who not only removes the cancer properly, but who acts as the pathologist with an on-site laboratory and can process the cancer in real-time with the tissue mapped out in relation to the patient. It also means that the least amount of skin necessary is removed.

The specialty includes the reconstruction of the resulting defect of missing tissue, which is often as complex as the cancer removal. Common areas are locations such as the nose, lips, ears, and other areas of the face. The reconstruction can often involve plastic surgery techniques such as intricate flaps, tissue rearrangement or skin grafting.

Coming from a classic yeshivah background, was there anything in your earlier life that might have foreshadowed this professional calling and all the years of training? Is anyone else in your family a doctor?

No one in my immediate family was, but I was pretty sure from as early as age 10 that I wanted to be a doctor. I was diagnosed with scoliosis as a young child and needed to wear a large back brace through most of my teen years. I was very inspired by my physician, Dr. Richard Ulin, a world specialist in his field. It’s funny, and I also didn’t realize at the time, but because I had no sisters, my mother taught me embroidery at a young age, so I was already practicing my fine suturing skills early on.

Getting back to what you mentioned about the micrographic surgery that you do, is skin cancer particularly common?

Most definitely. People might be shocked to know that skin cancer is more common than all other cancers combined. In our practice alone, we diagnose more than a thousand new cases of skin cancer each year. As the broader Lakewood population ages, we’re seeing more and more diagnoses among the frum segment of the population, and unfortunately, we’re seeing a significant rise among younger people as well. Thankfully, the vast majority of cases are very curable with proper care.

Aside from all the involvement with skin cancer treatment, can you elaborate on the general dermatologic care your office provides?

Absolutely. I’m blessed to work alongside three incredible Dermatology Practitioners—Esther Stern, Fay Prag, and Aviva Drillick. They’re NPs with many years of experience in our practice. As a matter of fact, they have more than 25 combined years of practicing dermatology here. They’re unusually highly trained in the field and have achieved widespread acclaim for their diagnostic acuity and treatment skills in addition to their amazing bedside manner. They’re all very adept at using dermoscopy extensively; that’s a critical diagnostic device that helps with cancer diagnosis.

We’re also unique in keeping the practice limited to one clinical location. This means that we’re always working side-by-side, collaborating on cases, and allowing patients to benefit from total focus by the entire practice, with none of our providers juggling their time rotating among multiple locations.

I understand that in addition to the typical skin care your practice offers, such as acne and eczema, you see many complex cases too.

Dermatology is so much more than acne, warts, and rashes. A dermatologic practice that operates on an academic level will see many complex medical and surgical cases and interact with many specialties. On any given day, we may interact with an oncologist, rheumatologist, ophthalmologist, OB/GYN, or any other specialist. We pride ourselves on addressing conditions that aren’t straightforward, and there’s a particular sense of fulfillment in helping a patient who’s been to so many places looking for help and finally sees a yeshuah.

Is there anything specific to which you can attribute success in treating patients and the reputation Advanced Dermatology enjoys?

Well, first and foremost, I can say that we’re blessed with tremendous siyata d’Shmaya. It’s sometimes so obvious that we can’t help but comment about it to each other.

But proper hishtadlus goes hand-in-hand with that. A physician shouldn’t expect to have ruach hakodesh. Success requires spending an appropriate amount of time with each patient to fully evaluate all the information and perform a thorough and comprehensive examination. There’s often much background information to discover, and so much of a patient’s daily life can influence both the cause and the worsening of illness as well as successful treatment.

Time must also be spent to sit with a patient and fully explain the treatment plan. This is obviously true for the complex cases we often see, but even the simpler things such as acne and the like, there are many nuances that can make a very big difference in a patient’s outcome.

You were discussing the various aspects of surgery for skin cancer. Are there procedures that your office provides that are for less serious concerns?

Sure. We regularly remove benign growths and other lesions on people for concerns such as appearance or discomfort. In addition, we often treat people for other cosmetic concerns as well. This is something that’s common among every aspect of our kehillah—daughters of ba’alei batim, spouses of yungerleit, and family members of chashuve rabbanim and poskim—it’s not limited to any one segment.

We use a step-back approach to cosmetic evaluation and treatment. Our practice philosophy is “less is more.” We absolutely value the natural look and truly abhor anyone looking “done.” This applies not only to surgical work, but to the thousands of patients we’ve seen for procedures such as Botox, fillers, lasers, and the various other cosmetic measures we provide.

We want patients to have top-notch professional work done, but we also want them to look natural. And of course, so do they.

You mentioned the patients you see within our community, but your office is always full of a real mix of people. Can you elaborate on where your patients are from?

Well, we definitely see a broad spectrum of people from all over. We have many patients living throughout Ocean and Monmouth counties, but we also have patients coming in from New York and Pennsylvania. We have patients from every profession and background imaginable. Commercial airline pilots, federal law enforcement, professionals in the cosmetic industry; as a matter of fact, we’ve even had an active major league baseball player as our patient. We absolutely love being able to interact with such a variety of people. It enriches our lives while we play a role in helping theirs.

On the topic of Pennsylvania, can you tell us a little about your teaching at U. of Penn?

I’ve been on the clinical faculty at the University of Pennsylvania Perelman School of Medicine for more than 15 years. I teach medical students, primarily the dermatology residents. These residents are the ones that you would see at both HUP and CHOP if you’re ever a patient there with a skin issue. Although I do give some formal lectures, my primary method of teaching is hands-on in the hospital where I run teaching clinics. These are general dermatology training sessions and advanced surgery on live patients in the hospital. Teaching surgery is a particular joy, as there’s so much more to offer than what can be read in textbooks.

Thank you for this enlightening conversation. Are there any final thoughts about your practicing in our area all these years?

There are so many parts of what I do and see daily for which I have much hakaras hatov, but one aspect often stands out. We’re very fortunate to have a broad cross-section of patients from many different communities and so many walks of life. It’s a true pleasure to be able to observe this United Nations of patients interact with each other while in the waiting room and in the hallways and to see how vastly different people can genuinely enjoy and appreciate each other despite their external differences when they find themselves in a nurturing environment. I hope these healthy interactions find a continuation well beyond Advanced Dermatology and Skin Surgery.

 

Skin Cancer: The Basics

Basal Cell Carcinoma (BCC)

• Most common type:
• Often presents as a pearly bump
• May sometimes show spontaneous bleeding
• Typically on the face, neck, or other sun-exposed area. However, can be found anywhere
• The highest cure rate with treatment, almost never spreads

Squamous Cell Carcinoma (SCC)

• Next most common type
• Can be a red firm bump, may have a rough surface
• Can have spontaneous bleeding at times
• Most commonly in sun-exposed areas, often on the face, neck, arms, and hands
• Can spread in about 5 percent of cases, can also grow locally faster than BCC

Melanoma

• Usually (but not always) pigmented, typically shades of brown, black, gray, or other colors
• Will have other atypical features; the ABCDE rule can be helpful:
• Asymmetry
• Border irregularities
• Color variation
• Diameter greater than 6 mm or Different
• Evolving

Some other skin cancers seen in our practice to a lesser extent include:

• Merkel Cell Carcinoma
• Cutaneous Lymphoma
• Dermatofibrosarcoma Protuberance
• Microcystic Adnexal Carcinoma