Saving Your Skin

Wendy Lewis

by Wendy Lewis | August 17, 2010 @ 09:00AM

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What You Really Need To Know About Skin Cancer

The incidence of skin cancer is growing at an alarming rate, making it the single most common form of cancer today. According to the American Academy of Dermatology, over one million new cases of skin cancer were diagnosed last year alone. Sun exposure is universally cited as the primary cause of skin cancers because ultraviolet rays can damage DNA cells. Most cancerous lesions tend to be found on areas of the body that have been exposed to sunlight, like the face, nose, lips, neck, arms, legs, and chest. "If detected and treated early, skin cancer has a cure rate of over ninety percent, according to Albert Lefkovits, MD, Assistant Clinical Professor of Dermatology at New York's Mt. Sinai Medical Center. The most important thing to know about skin cancer is that although fair-skinned people who sunburn easily are more prone to developing lesions, anyone can be at risk. One twenty-minute annual visit to your Dermatologist for a full body check from the top of your scalp to between your toes may actually save your life.

If you have any doubts about whether it can happen to you, just ask Brenda, 52, a kindergarten teacher from Roslyn. She was diagnosed with a melanoma two years ago during a routine glycolic peel treatment. "My doctor saw something on my shoulder which he didn't like the look of. When he suggested that we do a biopsy, I just thought he was being extra cautious because my daughter's wedding was a month away," says Brenda. A few days later, she got the bad news. "I was devastated," she says now. "It was the last thing I expected." Brenda was one of the lucky ones. Her melanoma was small, in its early stages and treatable. A lifetime of summers at the beach club covered in tanning gel with an SPF of eight finally caught up with her.

The Many Faces of Skin Cancer

By definition, skin cancer is the uncontrollable growth of abnormal cells in a layer of the skin. It comes in many shapes, sizes and colors, and the three major types have names that have become all too familiar. 'Basal Cell Carcinoma' the most common form, usually looks like raised, translucent lumps or growths. 'Squamous Cell Carcinoma' is characterized by crusty or scaly reddish patches, which can spread to other areas of the body. 'Malignant Melanoma' is the least common but also the most deadly form of skin cancer. It can look like a dark mole or blemish and ranges from brownish to black, and can spread through the bloodstream and the lymphatic system. Without treatment, any of these skin cancers can cause serious damage and even death. 'Actinic Keratoses,' or 'Solar Keratoses,' are dry, crusty, flaky, often brown or pink, rough patches appearing on the face, hands, lips, or elsewhere. These lesions signal that the sun has damaged the skin, and are considered a precursor to skin cancer that one in six people will develop in their lifetime. Although you may think of 'AK's' as a sign of old age, they can show up even in young people. If left untreated, AK's can develop into any form of skin cancer.

Detecting Skin Cancers

Dermatologists use sight and touch to diagnose skin cancer. If they spot a lesion that looks and feels suspicious, a skin biopsy may be indicated to rule out malignancy. A biopsy is done by removing a small piece of skin large enough to contain hair follicles and sweat glands for microscopic analysis by a Dermatopathologist. There are four different basic types of skin biopsy from the least invasive, in which the smallest segment of skin is removed, to the most extensive. The Punch biopsy removes a portion of a lesion or an entire small lesion, while a Shave biopsy involves 'shaving' off the part of the lesion that protrudes above the surface of the skin with a surgical blade. An Excisional biopsy 'excises' or removes the lesion in its entirety, and the Wedge or Incisional biopsy, is done by making a small incision on the skin's surface that goes deep down to the 'subcutaneous' tissue in a 'wedge-like' shape.

Skin Cancer Cures

When skin cancers are detected early in their development, there are more effective options for treatment and cure. The biopsy is usually the first step to determine the best form of treatment depending on the size, location, and type of skin cancer. Cancerous growths can be surgically removed and excised, scraped away with a sharp instrument, and treated with liquid nitrogen to freeze the tissue. Laser technology can also be used to vaporize cancerous tissue in the layers of the skin and reduce pre-cancerous lesions like actinic keratoses.

The technique known as Mohs micrographic surgery, developed over forty years ago, is now used to treat close to one quarter of all skin cancers, including the melanoma on Brenda's shoulder. Mohs surgery offers the highest cure rate while sacrificing the least amount of surrounding healthy tissue. This extremely accurate technique is performed under local anesthesia, and allows the surgeon the advantage of removing all of the cancerous tissue while creating the least amount of damage. The tissue is flattened, frozen, and divided into horizontal sections to check for the presence of tumor. Repeated thin slices or layers of diseased tissue are taken until the margins of the lesion are clear and all the cancer has been safely removed. Depending on the depth of the lesion removed, you may be referred to a plastic surgeon after Mohs to repair the area, particularly on the face, nose or lip. It may require a simple closure or more advanced skin grafts if the deformity is deep or large.

Another popular method that can save patients from some of the scars and side effects of surgery is Superficial Xray Therapy. The amount of radiation used is less than in a chest xray, mammography, or dental xrays. These short office treatments are usually done in a series of 10 during a three-week period. This technique is particularly useful for patients who have recurring skin cancers, and for facial areas like the eyelids and nose, which require the greatest degree of preservation. The cure rate is about the same as Mohs surgery, ninety-five percent.

Skin Cancer Prevention

If you spend any time in the sun, there are no more excuses for not protecting yourself from the sun's harmful rays. Dermatologists universally recommend using a full spectrum sunblock containing Parsol 1789 or Titanium Dioxide which, block UVA and UVB rays, an SPF of at least 15 or higher, staying out of the sun at peak times between 10 AM and 4 PM, and wearing a wide-brimmed hat and sunglasses with UV protection. See your Dermatologist every year for a comprehensive skin cancer screening. If you have a lot of moles, a fair complexion or family history of skin cancer, you should also be doing monthly self-exams at home. Use a full-length mirror to check your entire body, and don't forget the soles of the feet, back, and back of legs. Try a handheld mirror to look into less conspicuous places, or ask a partner, parent or child to help you.

Digital Epiluminescence Microscopy (DELM), is a new technology developed in Vienna and available in Europe and the US for detection and evaluation of pigmented skin lesions. Dermatologists now rely on sight and touch to diagnose skin cancer, and perform biopsies and excisions if they think there is a possibility that a lesion is malignant. According to Albert Lefkovits, M.D., "This technology represents a giant leap in melanoma detection. It advances our ability to isolate malignant lesions, which improves the chances for early diagnosis and treatment. It can save lives." DELM captures an image with a video camera and allows the doctor to take precise measurements of shape, color, and size, providing a baseline for comparison, and stores the image in the patient's record. Nothing drives the point of sun protection home more than looking at an enlarged image of your own skin and comparing it to healthy skin that has not been exposed to UV light.

Brenda points to the thin, barely visible scar on her left shoulder as a faint reminder of the melanoma that once appeared there. "Mohs surgery allowed me to dance at my youngest daughter's wedding. If my doctor hadn't been paying attention, I might not be able to say that today," she says.

Warning Signs

Look for spots that:

  • Change color or get darker
  • Grow in size or thickness
  • Change in texture
  • Have an irregular shape
  • Are larger than the size of a pencil eraser
  • Don't heal
  • Scabs, crusting, or itching
  • Bleeding or oozing
  • Appear after age 21

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