Get to Know Our Dermatology Experts

Dr. Hibler calls North Lake Tahoe home and sees patients at the practice’s Incline Village location. Specializing in medical, pediatric, surgical, and cosmetic dermatology, his approach as an osteopathic physician focuses on treating the whole person. 

In private practice since 1997, Dr. Wallach treats patients at the practice’s Truckee location. He diagnoses a full range of dermatologic problems for both adults and children, specializes in medical and cosmetic dermatology, and is well known for treating many types of skin cancer. Dr. Wallach and his family live in the North Tahoe area.

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J. Hibler, D.O.

Q: What types of skin cancer are there?

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A: There are several different types of skin cancer, but the two main categories are: 1) malignant melanoma and 2) non-melanoma. The second category is divided into basal cell carcinoma and squamous cell carcinoma. Basal and squamous cell carcinoma are much more common than melanoma, but typically not as dangerous as melanoma. Melanoma can grow on any area of the body, even where sunlight does not reach, which is why we are so keen to encourage our patients to not only perform monthly self-exams, but also get full skin exams at least once per year with a dermatology provider. For those with a family history of skin cancer or who have been treated for skin cancer before, full skin exams should happen more frequently.

Q: Is skin cancer hereditary? 

A: Some very rare types of skin cancer are hereditary, and there is a genetic component to some melanoma types of skin cancers. Talk to your dermatologist about your family’s history of skin cancer as it is an important factor.

Q: Are there common places that skin cancer is found in men or in women?

A: Most skin cancers are found on sun-exposed areas. In men it is often the chest or back areas and in women the legs are most frequently affected. But it is important to know that melanoma, the most dangerous form of skin cancer, can be found anywhere, including unusual and non-sun exposed areas which makes thorough full skin exams so critical.

Q: What should we know about practicing sun safety during the winter months?

A: Living in the Sierras and surrounding desert areas such as Reno, Carson, and the central California valley, brings a unique dimension to our daily sunscreen usage. Both altitude and the amount of sun days in these areas make sunscreen an integral part of our daily routines in every season, including winter. Sun exposure and the damage it causes is cumulative, so getting into the practice of wearing sunscreen year-round is highly recommended.

Q: Is light therapy safe to use? Can it increase the risk of skin cancer? 

A: The light therapy prescribed by dermatologists to treat certain conditions is a specific wavelength of light that is beneficial to the skin and it acts as an overall anti-inflammatory. Natural sunlight contains the whole spectrum of light which includes the good and bad wavelengths, so only small 20–30-minute doses of natural sunlight without protection is okay.

Adam Wallach, M.D.

Q: What should I be looking for to help detect skin cancer? 

A: The most important starting point is knowing the existing spots on your skin. If you are over the age of 40, the moles you have should be unchanging, although you may acquire or have changeable spots like sunspots or liver spots or keratoses as you age. The trick for all age groups is to identify spots that look different than your usual crowd of spots. Put another way, look for the ugly duckling or lone wolf on your body. Not infrequently, cancers may bleed, and on occasion a mole that is becoming malignant will itch. Here is where I emphasize the importance of getting to know your spots through regular self-exams. Check your entire body at least once per month and have a family member help check those hard-to-reach spots or use a mirror.

Q: What are the most unusual places that you have detected skin cancer on a patient? 

A: Skin cancer can occur in almost any area of the body, including those areas where the sun does not reach. I have detected skin cancer on the eyelid, between the toes, on genitalia, within the nose, and under the fingernail.

Q: What is Mohs micrographic surgery? 

A: First developed in the 1930s by Dr. Frederic E. Mohs, this type of dermatologic procedure is considered the gold standard for skin cancer surgery. It differs from standard dermatologic surgery in that the tissue is examined histologically at the time of removal.  If there is still cancer remaining, successive stages of skin are removed until the histology is clear. This technique is used principally for large or recurrent cancers, cancers located in difficult locations like the nose, eyelids, and ears, and for cancers with aggressive pathology. It is an out-patient surgery that can be relatively quick, or take all day, based on how complicated and how large the cancer is. Your dermatologist will prepare you with their expert tips on how to prepare for the day of surgery.

Q:  If I have scars from skin cancer treatment, are there ways to diminish their appearance? 

A: The most common scars that result from skin cancer removal are the white lines one sees where the excision occurred. Fractionated carbon dioxide lasers do a great job at blurring these white scars. The other common scarring that one sees around excision sites is the secondary development of blood vessels or telangiectasias. These vessels most often are triggered because of the healing process, but they often give an exaggerated redness to the surgical area. Pulse dye and KTP lasers, which we use at Skin Cancer & Dermatology Institute, do a great job at removing these post-surgical excessive vessels.

Q: Tell us your three favorite sunscreens and why? 

A: My favorite sunscreens are from EltaMD®. My daily use sunscreen is EltaMD UV Clear SPF 46. It is super lightweight and a favorite among my patients with normal to oily skin. This is also the only tinted sunscreen I have found that almost all men like and which blends upon application without any unusual trace of color. For outdoor sports, I use EltaMD UV Sport SPF 50 which is an amazing water-resistant sunscreen that does not feel tacky like most sport-type sunscreens. Remember to reapply sunscreen liberally and frequently. Finally, I love EltaMD UV Lip Balm SPF 36 for lip protection. Do not forget that every part of our skin needs protection, including the lips.

Learn more about skin cancer, schedule a full skin exam, and get to know Skin Cancer & Dermatology Institute’s medical providers online.