Dermatology and Cosmetic Laser Center of Huntington

Skin Cancer
The following information has been provided by the Skin Cancer Foundation.

Facts about Skin Cancer

More than 1.3 million skin cancers are diagnosed yearly in the United States.
One in 5 Americans and one in 3 Caucasians will develop skin cancer in the course of a lifetime.
More than 90 percent of all skin cancers are caused by sun exposure, yet fewer than 33 percent of adults, adolescents, and children routinely use sun protection.
A person's risk for skin cancer doubles if he or she has had five or more sunburns.

Risk Factors Associated with Skin Cancer

Sun Exposure
Sunlight is responsible for over 90 percent of all skin cancers. Working primarily outdoors, living in an area that gets a lot of high intensity sunlight, spending time in tanning booths all increase your exposure to UV rays and thus increase your risk for developing skin cancer. Blistering sunburns in early childhood increase risk, but cumulative exposure also is a factor.

Skin Type
Fair-skinned individuals who sunburn easily have a higher incidence of skin cancer than dark-skinned individuals.

Moles
There are two kinds of moles that a person can have: normal moles - the small brown blemishes, growths, or "beauty marks" that appear in the first few decades of life in almost everyone - and atypical moles, known as dysplastic nevi. Regardless of type, the more moles you have, the greater your risk for melanoma.

Previous Skin Cancer
If you have had a skin cancer of any type, it increases your risk of developing another one.

Family History
If your mother, father, siblings, or children have had a melanoma, you are in a melanoma-prone family. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history. If the cancer occurred in a grandmother, grandfather, aunt, uncle, niece or nephew, there is still an increase in risk, although it is not as great.

Reduced Immunity
People with weakened immune systems due to excessive unprotected sun exposure, chemotherapy, or those with certain illnesses such as HIV are more likely to develop skin cancer.

Types of Skin Cancer

Basal Cell Carcinoma (BCC)
Basal Cell Carcinoma (BCC) is the most common form of cancer, with more than 800,000 new cases estimated in the US each year. Basal cells are cells that line the deepest layer of the epidermis. An abnormal growth - a tumor - of this layer is known as Basal Cell Carcinoma. Basal Cell Carcinoma can usually be diagnosed with a simple biopsy and is fairly easy to treat when detected early. However, 5 to 10 percent of BCCs can be resistant to treatment or locally aggressive, eating away at the skin around then, sometimes even into bone and cartilage. When not treated quickly, they can be difficult to eliminate. Fortunately, however, this is a cancer that has an extremely low rate of metastasis, and although it can result in scars and disfigurement, it is not usually life-threatening. The sun is responsible for over 90 percent of all skin cancers, including BCC, and chronic overexposure to the sun is the cause for most cases of Basal Cell Carcinoma. BCCs - the tumors themselves - occur most frequently on the face, ears, neck, scalp, shoulders, and back.

Warning Signs
The five most typical characteristics of Basal Cell Carcinoma are shown below. Frequently, two or more features are present in one tumor. In addition, BCC sometimes resembles non-cancerous skin conditions such as psoriasis or eczema. Ask us if you are unsure about a lesion or sore.

An Open Sore that bleeds, oozes, or crusts and remains open for three or more weeks. A persistent, non-healing sore is a very common sign of an early Basal Cell Carcinoma (BCC).

A Reddish Patch or irritated area, frequently occurring on the chest, shoulders, arms, or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.

A Shiny Bump or nodule that is pearly or translucent and is often pink, red, or white. The bump can also be tan, black, or brown, especially in dark-haired people, and can be confused with a mole.

A Pink Growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.

A Scar-like Area which is white, yellow or waxy, and often has poorly defined borders. The skin itself appears shiny and taut. This warning sign can indicate the presence of an aggressive tumor.

Squamous cell carcinoma (SCC)
Squamous cell carcinoma (SCC) is the second most common form of skin cancer, with over 200,000 new cases per year estimated in the United States. Squamous cells are cells that compose most of the epidermis. An abnormal growth of these cells is known as a squamous cell carcinoma.

Most SCCs are not serious. When identified early and treated promptly, the future is bright. However, if overlooked, they are harder to treat and can cause disfigurement. While 96 to 97 percent of SCCs are localized, the small percentage of remaining cases can spread to other parts of the body, and the results are often fatal.

Like all skin cancers, chronic overexposure to the sun is the primary cause of nearly all cases of squamous cell carcinoma. Tumors appear most frequently on the face, neck, bald scalp, hands, shoulders, arms and back: all places that are exposed to the sun. The rim of the ear and the lower lip are especially vulnerable to these cancers. Squamous cell carcinomas may also occur where skin has suffered certain kinds of injury: burns, scars, long-standing sores, sites previously exposed to X-rays or certain chemicals (such as arsenic and petroleum by-products). In addition, chronic skin inflammation or medical conditions that suppress the immune system over an extended period of time may encourage development of squamous cell carcinoma.

Occasionally, squamous cell carcinoma arises spontaneously on what appears to be normal, healthy, undamaged skin. Some researchers believe that a tendency to develop this cancer may be inherited.

Warning Signs
Squamous cell tumors are thick, rough, horny and shallow when they develop. Occasionally, they will ulcerate, with a raised border and a crusted surface over a raised, pebbly, granular base. Any bump or open sore in areas of chronic inflammatory skin lesions indicates the possibility of squamous cell carcinoma, and a doctor should be consulted immediately if this is the case. Usually, the skin in these areas reveals telltale signs of sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity. That is why tumors appear most frequently on sun-exposed parts of the body.

Melanoma
Melanoma is the most serious form of skin cancer. However, if it is recognized and treated early, it is nearly 100 percent curable. If it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. The American Cancer Society estimates that in 2006, there will be over 60,000 new cases of melanoma in the United States.

Melanoma is a malignant tumor that originates in melanocytes, the cells which produce the pigment melanin that colors our skin, hair, and eyes and is heavily concentrated in most moles. The majority of melanomas, therefore, are black or brown. However, melanomas occasionally stop producing pigment. When that happens, the melanomas may no longer be dark, but are skin-colored, pink, red, or purple.

Evaluating Your Moles
Moles, brown spots and growths on the skin are usually harmless - but not always. Anyone who has more than 100 moles is at greater risk for melanoma. The first signs can appear in one or more of these moles. That's why it's so important to get to know your skin very well, so you can recognize any changes in the moles on your body. Look for the ABCDEs of melanoma, and if you see one or more, make an appointment with us.

symmetry
If you draw a line through this mole, the two halves will not match, meaning it is asymmetrical, a warning sign for melanoma.

order
The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.

olor
Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, white or blue.

iameter
Melanomas usually are larger in diameter than the size of the eraser on your pencil (1/4 inch or 6 mm), but they may sometimes be smaller when first detected.

volving
Any change - in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting - points to danger.

Common moles and skin cancers do not look alike. Consult us if you are concerned!

Photodynamic Therapy (PDT)
Photodynamic therapy (PDT) is a new medical procedure for photorejuvenation of the skin. It is a medical skin treatment to reverse the signs of aging and thereby improve the health and vitality of skin. Ideal candidates have either sun damaged skin, preskin cancers (actinic keratosis), rosacea, acne, acne scars, hyperpigmentation, poor skin texture, or enlarged pores. This therapy combines the application of a photosensitizer (5 ALA) with a Blue Light, with dramatic improvements and little "down time" and minimal discomfort.

How does the treatment work?
The procedure involves a microdermabrasion followed by application of Levulan^® (5 ALA) to the skin for 15 to 60 minutes. This allows the Levulan^® to concentrate into the damaged skin, glands, and follicles. We then use Blue Light to activate this photosensitizer. As a result, diseased areas are treated selectively with minimal damage to surrounding normal skin.

How many treatments will I need?
For photorejuvenation, 2-3 treatments spaced 3-4 weeks apart are necessary for optimal results. For acne, 4 to 6 treatments 2-3 weeks apart are needed to achieve results. Some patients see significant improvement in 1 or 2 treatments; others require more.

Are there any possible side effects?
Redness, mild swelling, increased warmth, and tingling like a mild sunburn may occur for 1-2 days after treatment, with rapid recovery. Brown pigmented spots may appear darker and capillaries may be more visible before they fade. Sun avoidance is absolutely necessary for 48 hours after the procedure.

What improvement will I see?
Skin is smoother and softer, pore size is reduced, skin becomes more even toned, and acne resolves as sebaceous glands are diminished.

BLUE Light Therapy
Acne is a common medical condition that affects up to 80 percent of adolescents and adults at some point in their lives. Adult onset acne has become a growing concern for people in their 20�s, 30�s, and 40�s. Although acne is not a grave disease, it can leave permanent scarring on the skin, and negatively impact an individual�s self-esteem. Clearing up acne can help relieve these issues, but many people don't realize that something can be done. If the commonly prescribed treatments of astringents, topical creams, or antibiotics have not been successful in treating your moderate acne thus far, BLUE Light Therapy just may be an effective alternative.

What is acne?
Acne is one of the most common of all skin problems, characterized by whiteheads, blackheads, pimples and, in some people, deep painful bumps that look and feel like boils. When it's severe, acne can cause permanent scarring of the skin. And those are just the physical problems.

Here�s how acne (clogged pores) occurs:
The lining of the wall of the hair follicle sheds skin cells, which then stick together with the sebum produced by the sebaceous glands. This causes a plug to form below the surface of the skin. This plug cannot be washed away. This process can take days to weeks for a visible lesion to form. Whiteheads and blackheads are the result. The sebum and cell debris together contribute to the growth of bacteria that naturally live in your pores.

Your body's own immune system will naturally attempt to clear the clogged pores by sending in certain specialized cells that invade the follicle to help clean it up. However, in the process, the wall of the follicle may weaken and rupture, emptying the contents of the follicle into the surrounding tissue. When this occurs, swelling or redness can develop around the affected follicle, resulting in the larger bumps or pimples characteristic of acne. These are known as papules and pustules and can sometimes cause scarring.

What is BLUE Light Therapy?
P. acnes, the bacteria responsible for causing acne inflammation, pump out tiny molecules called porphyrins. When those porphyrin are exposed to certain wavelengths of light (blue light in this case), they produce free radicals that kill the bacteria. Without P. acnes around to cause inflammation, acne clears up.

BLUE Light therapy involves the use of visible blue wavelengths of light that create a toxic environment inside the pore that kills the acne-causing bacteria. It is used to treat active lesions and helps prevent dormant glands from becoming active lesions. Without the P. acnes bacteria present, and allowed to grow, inflammation diminishes and acne clears up.

What does treatment involve?
A BLUE Light treatment is quite simple. The procedure involves a series of pain-free exposures to high-intensity blue light and consists of sitting in front of the source for approximately sixteen minutes. Treatments are conducted in weekly intervals. Your frequency and level of treatment may vary based on your desired outcome and situation.

BLUE Light therapy can also be used in conjunction with additional pre-treatments. Most commonly, topical applications of ALA or Levulan® (aminolevulinic acid) are used with the BLUE Light source to help treat acne vulgaris. To better prepare your skin, the ALA solution, which helps increase photosensitivity, is applied and remains on the skin for roughly 30-60 minutes. The BLUE Light treatment is then delivered and lasts for approximately 16 minutes. The severity of your condition will determine the necessary amount, frequency, and duration of treatment.

What are the benefits?

100% natural and non-invasive
Drug-free with no adverse side effects
Safe for all ages
Painless
No downtime

Is it safe?
BLUE Light therapy is gentle, safe, and effective with rare, if any, adverse side effects or discomfort. The therapy was FDA approved in 2003 to treat mild acne.

What results can I expect?
Improvement is noticeable after the very first treatment. Your acne will diminish and continue to clear following subsequent treatments. Some patients who have undergone BLUE Light therapy are acne-free for up to two years after ten treatments. Other patients need occasional treatments for flare-ups. Using ALA in conjunction with BLUE Light therapy has also been proven to have long-term effects in clearing acne.

Levulan PDT System
The Levulan® PDT System is a non-surgical procedure for the treatment of pre-cancerous skin lesions known as actinic keratoses (AKs). This advanced system combines the application of the Levulan® Kerastick®, with blue light illumination to or intense pulsed light destroy AKs, while leaving healthy skin unharmed.

Actinic keratoses are small, rough, scaly patches most commonly found on areas that are heavily exposed to the sun, such as the face, scalp, arms, and back of the hands. AKs are directly related to past sun (ultraviolet) exposure and generally develop in fair-skinned people during midlife and beyond. They usually appear red but may be the same color as the surrounding skin. If left untreated, some AKs may increase in size and pose a significant risk of developing into a form of skin cancer called squamous cell carcinoma, requiring more extensive surgical treatment.

The first step in the Levulan PDT System is having Dr. Koreen or the staff apply the Levulan® Kerastick®, a photosensitizer stick, which contains 20% aminolevulinic acid with an applicator tip for precise administration directly to the lesion or to the entire face. This unique solution is an acid that occurs naturally in your body; it makes the AKs more sensitive to light.

In fifteen minutes to an hour you are ready for the second step. The trained team of therapists will then expose the treated AKs to the BLU-U� Blue Light Photodynamic Therapy Illuminator, a non-laser fluorescent blue light source, that emits specialized blue light and destroys these AKs. More and more patients are having full face Levulan PDT/ Blue Light therapy for photorejuvenating effects with Levulan.

Patients should protect treated lesions from the sun by wearing light-protecting clothing such as a wide-brimmed hat. Sunscreens will not protect against sensitivity to light in the area to which Levulan® Kerastick® solution has been applied.

Clinical studies with the Levulan® PDT Blue Light System have shown significantly high success rates in treating AKs, with complete clearance or dramatic improvement within four weeks. The photorejuvenation treatments work over time.

Precancerous growths
Precancerous growths, small areas of discrete roughness to the skin, come from too much sun. Particularly when a person has a lot of them, they tend to become squamous cell carcinomas: skin cancer. Up to 20 percent of precancerous spots can go on to become skin cancer. The severity of your condition will dictate which treatment is best. Treatments range from freezing with liquid nitrogen cryotherapy to creams to photodynamic therapy.

Moles
The medical term for a mole is a NEVUS (mole is Latin for "spot."). Nevi are the plural of nevus. Congenital nevi are moles present at birth; acquired nevi develop anytime later. Nevi are made up of a particular type of cell, and the name is used to distinguish them from other, similar appearing fleshy growths.

Acquired Nevi
Most moles that are acquired during life are usually less than 1/4 inch in size. Many of those that form in childhood and early adult life are now thought to be due to sun damage. Most people think of a mole as being a dark brown spot, but moles have a much wider range of appearance. They can be raised from the skin and very noticeable, or they may contain dark hairs. Having hairs in a mole does not make it more dangerous. Moles can appear anywhere on the skin, alone or grouped. They usually are brown in color and can be various sizes and shapes. Special cells that contain the pigment melanin cause the brown color.

Facial moles are probably determined before a person is born. Some may not appear until later in life, but moles that appear after age 50 should be regarded with suspicion. Moles may darken, which can happen after exposure to the sun, pregnancy and sometimes during therapy with certain steroid drugs. There is little risk of melanoma cancer developing in these moles.

Atypical moles (dysplastic nevi or Clarks nevi)
An estimated one out of every ten Americans has at least one atypical mole. These moles are larger than common moles, with borders that are irregular and poorly defined. Atypical moles also vary in color, ranging from tan to dark brown shades on a pink background. They have irregular borders that may include notches. They may fade into surrounding skin and include a flat portion level with the skin. These are some of the features that one sees when looking at a melanoma. When a pathologist looks at an atypical mole under the microscope, it has features that are in-between a normal mole and a melanoma.

Congenital nevi
Only a few babies, about one in hundred, are born with a mole, the congenital nevus. These can vary in size from being less than 1/4 inch to covering almost the entire body. Large nevi can vary greatly in size, shape, color, surface texture, and hairiness. Some are reddish-tan; others are almost black. Most are shades of brown. Some have fine downy hair; many have long, thick, darker hair. Some have a permanent "goose bump" appearance.

Nevi measuring four inches (10 cm) or more at birth occur in about one in every 20,000 children. Giant congenital nevi involving much of the body surface are less common, possibly around one in every 200,000 to 500,000 births. Many people with a giant nevus will have anywhere from several to hundreds of smaller "satellite" nevi. In a very few persons with giant moles, nevus cells can also be found in the spinal cord and near the brain, a condition called neurocutaneous melanosis.

The exact risk of melanoma developing in a giant congenital nevus is not known but is thought to be at least six percent. There has not been any melanoma in the satellite nevi, and those on the arms and legs are also less dangerous in general. Small and medium sized congenital nevi have a much lower risk and are rare. Small congenital nevi rarely turn malignant before puberty. Congenital moles will grow in proportion to body growth. Their color may stay the same, lighten slowly, or darken slowly over time. Changes in growth, in color, in surface texture, pain, bleeding, or itching are all of concern. Any such changes should be evaluated medically if they last longer than a few weeks.

Treatment
Surgical excision of nevi should be done where cancer is a reasonable concern. Improving cosmetic appearance is another reason for excision, but all surgery leaves some scarring. Smaller nevi can be "shaved off". Larger ones can be cut out directly and the wound edges sewn together. Much larger nevi may be excised in stages by taking a little more out each time until the entire nevus is removed. This is called "serial excision." Cutting out very large nevi will leave behind a raw area that is too big to be sewn together and must be covered. This can be done with a split thickness skin graft from some other normal area of the body. The skin-grafted area will have varying degrees of scarring and will usually be thinner and more fragile than normal skin.

There have been several reported cases of melanoma developing underneath a skin graft from nevus cells left behind. Occasionally, thickened scars called keloids may appear. Laser treatment, chemical peels and dermabrasion, also destroy nevus cells before they can be checked for cancer under a microscope. They also leave nevus cells behind and the pigment often seems to reappear.

Warts
Warts are caused by the human papilloma virus (HPV). There are several different types of warts. Warts can grow anywhere on the body but are most common on the hands. It is estimated one in twenty school children have warts.

Plantar warts are ingrown in the feet and are also known as verrucas. Mosaic warts are tiny and can spread all over the sole of the foot.

Common warts have a raised surface with a cauliflower-like head. If the wart is touched or scratched the virus can spread to another area of skin. However, it can take up to one year for a new wart to appear.

Warts are no threat to health and do not lead to any illness, however, they can cause embarrassment and are painful in some cases.

How are warts removed?
Warts can be removed by several different methods, or they can also go away of their own accord. Fifty percent of childhood warts disappear within six months and 90 percent within two years. However, they may last many years in adults. Some warts do not respond to treatment, even if another wart on the same person is easily removed. Plantar warts (verrucas) may take longer to disappear and removal may be recommended for these. Warts on the face may also require professional advice.

Treatments for Wart removal

Cryotherapy (Freezing)
Liquid nitrogen is used to freeze the wart. The treatment is repeated at 3 to 4 week intervals. This method has a 70 percent success rate, and limited scarring.

Excision
Cutting out the wart is generally not recommended because the incision leaves a scar and is not any more effective than other methods. The wart virus can extend through the scar and cause a bigger area of warty skin.

Laser
A pulsed dye laser is used to destroy warts. This is mainly used for multiple plantar warts. Repeat treatments are likely to be necessary.

Rashes
A rash is a change in skin which affects its color, appearance, or texture. A rash may be localized to one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, dry, cracked or blistered, swell and may be painful. The causes, and therefore treatments for, rashes vary widely. Diagnosis must take into account such things as the appearance of the rash, other symptoms, what the patient may have been exposed to, occupation, and occurrence in family members.

The presence of a rash may aid diagnosis of the patient's condition. Not only the appearance and sensation of the rash but also the distribution (which parts of the body are affected and where it arose and spread to) and evolution of the rash may be important as certain patterns of rashes and their associated signs and symptoms are diagnostic of certain diseases. For example, the rash in measles is an erythematous, maculopapular rash that begins a few days after the fever starts; it classically starts at the head and spreads downwards.

Eczema
There are a variety of types of eczema as well as causes. Eczema is associated with very dry, itchy skin. It can become red and bleed, particularly if the area becomes broken from scratching. Eczema is not contagious and can be treated. Mild cases can usually be treated with topical remedies and a mild skin care routine. More advanced cases may require oral medications.

Eczema
Atopic dermatitis, also called atopic eczema, is the name given to a stubborn, itchy rash that occurs in certain persons with sensitive or irritable skin. Eczema is common in infants and young children, and may disappear before adulthood. Eczema may clear for years, only to reappear later, often on the hands.

How can Eczema be treated?
Although eczema cannot be cured, we have effective ways of controlling eczema. Most people are able to live comfortably with this skin disease. Cortisone compounds applied to the skin are the best medicine for controlling eczema. Most cortisone salves can be used safely for years. When large areas are treated for a number of years, periodic medical check ups are necessary. Other medications are sometimes used.

Psoriasis
Psoriasis is a skin condition characterized by inflammation, pain, itching, and bleeding when the skin is broken. There are multiple types of psoriasis but they are commonly distinguished by elevated, red plaques of skin that are covered with white to silver scale. Psoriasis is frequently associated with pain, discomfort, and social embarrassment. There is no cure for psoriasis, but recent therapeutic advances have given new hope to patients who suffer from this disease.

What is Psoriasis?
Psoriasis is a common and recurring condition in which the skin develops red patches of various sizes, covered with dry, silvery scales. Most often, it affects the scalp, the trunk of the body and the outer side of the arms and legs, especially the elbows and knees. The palms and soles may also be involved. Fortunately, the face is usually spared.

How is it treated?
Naturally, your doctor knows best what is likely to help your particular case. He or she will discuss your psoriasis with you and choose the treatment that seems most suitable.

The XTRAC® excimer laser offers new hope to individuals suffering from psoriasis, vitiligo, and other skin conditions.

Using an intense beam of focused laser light, the XTRAC® laser gets right to the area of concern, leaving healthy surrounding tissue alone.

Medical treatment photos courtesy of Candela® Corporation, Sanofi Aventis, and Allergan®.