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Skin cancer occurs when skin cells start growing abnormally, causing cancerous growths.
Most skin cancers develop on the visible outer layer of the skin (the epidermis), particularly in sun-exposed areas (face, head, hands, arms, and legs). They are usually easy to detect by examining the skin, which increases the chances of early treatment and survival.
WHAT TYPE OF CANCER ARE THERE?
There are different types of skin cancer, each named for the type of skin cell from which they originate. The majority of skin cancers fall into one of the following categories:
- Basal cell carcinoma (also called BCC) comes from the basal cells in lowest part of the epidermis. 80-85% percent of skin cancers are BCCs.
- Squamous cell carcinoma (also called SCC) comes from the skin cells (keratinocytes) that make up the top layers of the skin. About 10% of skin cancers are SCC.
- Melanoma comes from skin cells called melanocytes, which create pigment called melanin that gives skin its color. 5% of all skin cancers are melanoma. Although less common, it is a very dangerous type of skin cancer and is the leading cause of death from skin disease.
Basal cell and squamous cell carcinoma are sometimes referred to as "non-melanoma skin cancer" to distinguish them from melanoma.
Skin cancer is considered low risk when the affected cells remain clustered in a single group. It is considered high risk when the cells have invaded surrounding tissues. High risk forms of cancer require more aggressive treatments.
Almost all skin cancers start as small, low-risk lesions, but can grow and become high-risk lesions if left untreated. Melanoma is the most alarming type because it has a higher risk of invading surrounding tissues or spreading to other parts of the body (metastasis) before being detected. Squamous cell and basal cell skin cancer are more likely to be detected and treated effectively before they become malignant.
If skin cancer is detected before it has spread to surrounding tissues, chances of a complete cure are excellent.
WHAT ARE PRE-CANCERS?
Skin cancer may often be preceded by lesions called pre-cancers. The most well-known of these are actinic keratoses (AKs). AKs are considered an early form of squamous cell carcinoma.
AKs, a new or changing mole (nevi), and other unusual lesions on your skin should be carefully monitored and brought to the attention of your doctor.
HOW IS SKIN CANCER TREATED?
Diagnosing cancer usually requires a biopsy. A small piece of skin is removed for examination under a microscope and evaluated with other tests.
A treatment plan will be recommended based on several factors:
- The type of cancer
- The size of the cancer-treatments that may be effective for small cancers may not be optimal for larger cancers
- The extent of the cancer (localized to one area vs. spreading to surrounding tissues)
- The location of the cancer (face vs. arm)
- The number of lesions
- Your past history and family history of skin cancers
TREATMENT OPTIONS INCLUDE:
Medications
- Aldara (imiquimod) Cream, 5%
- 5-fluorouracil (Efudex, Carac)
Procedures
- Cryosurgery-A small amount of liquid nitrogen is used to "freeze" away the lesion.
- Curettage-electrodessication-The tumor is scraped off using a sharp-edged device called a curette. The surrouning skin is then cauterized (heated) to prevent bleeding and further remove the tumor.
- Excision-The tumor is surgically removed along with a small portion of surrounding skin. This usually requires stitches to control bleeding and close the wound.
- Mohs surgery-A specialized surgery that removes the tumor in stages. Each portion of removed tissue is examined under a microscope to make sure that cancerous cells have been removed while sparing as much normal skin as possible.
Radiation and chemotherapy may be recommended in cases when the cancer has spread, or when other medical conditions prevent the use of other treatments.
WHAT CAUSES SKIN CANCER?
Sunlight is composed of visible light (all the colors we see in daylight), infrared radiation (which provides warmth), and ultraviolet (UV) radiation, which is carcinogenic (cancer-causing). More than 90 percent of all skin cancer is caused by long-term exposure to UV radiation.
UV radiation damages the skin's DNA, causing a cell to behave abnormally. The body normally has mechanisms to repair damaged DNA but these repair mechanisms do not function normally after exposure to UV radiation. This allows the abnormal skin cell to replicate itself, making more cells with the same damaged DNA. This growing collection of abnormal cells is the beginning of a cancer.
The immune system can often detect and destroy cancer cells, just as it defends against infections by bacteria or viruses. However, UV radiation disrupts the immune system so that our natural defenses may not detect the cancer, allowing it to grow unchecked.
Melanin in the skin, which gives skin its tan to brown color, can block the damaging effects of UV radiation. The more melanin, the darker the skin. And the darker the skin, the better protected it is from UV radiation. This is why a body darkens when exposed to sunlight (tanning). It is trying to build a better shield.
HOW CAN I PREVENT SKIN CANCER?
The best protection against skin cancer is to minimize sun exposure, especially between 10 a.m. and 4 p.m. If you do go out in the sun, use a broad-spectrum sunscreen. Wear a wide-brimmed hat, sunglasses, and protective clothing.
Because skin cancer can resemble other skin conditions, be sure to tell us about unusual skin changes or lesions, especially these:
- A sore that comes and goes but never completely heals
- A shiny bump or nodule, especially if it appears pearly or translucent (these can look brown or reddish and resemble a mole)
- A slightly raised pink growth with a crusted depression in the center, possibly with tiny blood vessels (capillaries) visible on the surface
- A patch of skin that is red or irritated, especially on the chest, shoulders, or limbs
- A white or yellow-ish waxy scar with poorly defined borders
Tanning booths increase the risk of developing skin cancer, despite any claims of their being a safe alternative to natural sunlight. The skin doesn't tan unless it is first damaged by UV radiation. Intentional tanning should be avoided like any health hazard, such as smoking.
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Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. These usually appear on the face, neck, back, chest, and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent scarring.
WHAT CAUSES ACNE?
Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell.
Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.
Bacteria called Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect the sebum. This causes the skin to become swollen, red, and painful.
Infected sebaceous glands may burst, releasing sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts may form in the deeper layers of the skin.
WHAT ARE THE DIFFERENT TYPES OF ACNE?
Acne can be categorized by its severity:
- Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).
- Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).
- Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.
WHO GETS ACNE?
Anyone can get acne, but it appears most often in teenagers, whose surging levels of androgen (a type of hormone) create larger and more active sebaceous glands. Acne may continue for people in their twenties and thirties, and even women over forty. Acne also appears more commonly in people whose parents had acne.
WHAT FACTORS MAKE ACNE WORSE?
Acne lesions can come and go. These factors can cause acne to flare:
- Changing hormone levels in women 2 to 7 days before their menstrual period, during pregnancy, or when starting or stopping birth control pills
- Oil from skin products (moisturizers or cosmetics) or grease in the workplace (for example, a kitchen with fry vats)
- Pressure from sports helmets or equipment, backpacks, tight collars, or tight uniforms
- Environmental irritants, such as pollution and high humidity
- Squeezing or picking at blemishes
- Hard scrubbing of the skin
WHAT ARE THE TREATMENT OPTIONS FOR ACNE?
Almost all cases of acne can be effectively treated. Treatment goals are to heal existing lesions, stop new lesions from forming, and prevent scarring.
Acne treatments aim to control one or more of the underlying causes of acne. For instance, topical retinoids, such as Differin or Retin A Micro, may help unclog sebaceous glands and keep pores open. Antibiotics may be used to fight the P. acnes bacteria. Accutane or hormonal agents, such as birth control pills, may be used to reduce sebum (oil) production.
TOPICAL MEDICATIONS (applied to the skin)
Over the counter
- Benzoyl peroxide – This is found in many products including Clearasil and Proactiv. It is a mild antibiotic that kills the P. acnes bacteria. It is available in different concentrations. Higher concentrations are more likely to irritate the skin. It does not unclog blocked pores so is not as helpful for reducing whiteheads and blackheads.
- Sulfur and salicylic acid – These have some mild ability to break down whiteheads and blackheads.
Prescription
- Topical retinoids (Differin, Retin A Micro, Tazorac, tretinoin)-These are among the most effective and commonly used acne medications. Topical retinoids are unique in their ability to unclog swollen pores. They may be used alone for mild acne or combined with other medications for moderate-to-severe acne. They may also be recommended for long-term use, even after the acne is under control, to keep the skin clear.
- Topical antibiotics – Antibiotics applied to the skin, such as clindamycin (Clindagel) and erythromycin, kill the P. acnes bacteria that leads to inflammation.
Oral medications (taken by mouth)
- Oral antibiotics – These medications, which include tetracycline, doxycycline (Adoxa, Doryx), and minocycline (Dynacin, Solodyn), act systemically and can reach bacteria in the deep layers of the dermis. They are also used for their anti-inflammatory effects.
- Oral contraceptives (Ortho Tri-Cyclen, Yaz) – For women who experience hormonally triggered acne, birth control pills may be prescribed to reduce sebum production.
- Anti-androgen drugs – Some drugs used for other medical conditions are known to reduce androgen levels, such as spironolactone (Aldactone). These may be used in some cases of acne.
- Isotretinoin (Accutane, Sotret) – Isotretinoin remains the most effective treatment for severe acne or acne that does not respond to other treatments. Isotretinoin treats all causes of acne: excess sebum, clogged pores, bacterial overgrowth, and inflammation. Most patients take the medicine for 15-to-20-week periods that may be repeated if necessary.
For persistent lesions that are inflamed or unresponsive to medications, we may recommend additional methods, including extraction, light therapy, or corticosteroid injections.
HOW WILL I CHOOSE A TREATMENT PLAN?
We will recommend a treatment based on these factors:
- Severity of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with an oral retinoid (Accutane, Sotret).
- Results of previous treatments. Medications may be added in a step-wise fashion, only if previous treatments are found to be ineffective.
- Degree of scarring. More aggressive therapies may be started earlier if acne scars have already started developing.
- Gender. Some treatments are available only for females, such as birth control pills.
HOW CAN I KEEP MY ACNE UNDER CONTROL?
After your acne clears, we may recommend that you continue therapy with a topical retinoid to keep it under control. It is always a good idea to maintain good skin care and use skin care products labeled as "non-comedogenic" (do not promote acne)
What about self care and prevention?
For ongoing self-care and prevention of acne, follow a few simple guidelines:
- Clean skin gently – Use a mild skin cleanser twice a day, and pat skin dry. Harsh cleansers and astringents can actually worsen acne.
- Do not pop, squeeze, or pick at acne lesions, as this can promote inflammation and infection. Keep hands away from your face and other acne-prone parts of the skin.
- Limit sun exposure – Tanning only masks acne at best. At worst, sun exposure can lead to skin damage, especially if you are using an acne treatment that makes your skin more sensitive to sunlight and UV rays (this includes tanning booths).
- Choose cosmetics with care – As mentioned above, choose non-greasy skin products, and look for words like "non-comedogenic," "oil-free," and "water-based." Some facial products contain active acne-fighting ingredients, such as benzoyl peroxide or salicylic acid, to help keep mild acne at bay.
- Be patient with your treatment – Find out how much time it should take for your acne treatment to work (generally 6-8 weeks) and then stick with it. Stopping treatment early may prevent you from seeing good results or even cause a relapse of symptoms. Your skin may look worse before it begins to improve. You may need to try more than one type of treatment.
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WHAT IS EVOLENCE®?
EVOLENCE® dermal filler represents a breakthrough in treating the effects of aging by replacing the collagen you've lost with collagen that lasts. A truly novel dermal filler, EVOLENCE can immediately improve and refresh your appearance by smoothing out and softening unwanted wrinkles and folds, and restoring structure and facial contour in volume-depleted areas. The visible, natural-looking results are achieved immediately, with minimal-to-no downtime, so you can get right back to your daily activities. These immediate results last for at least 6 months.
EVOLENCE is injected by our trained professionals, and your desired results may be achieved in just 1 visit. Our professionals can determine the best treatment approach for achieving your desired results.
WHY IS COLLAGEN SO IMPORTANT FOR ACHIEVING A REFRESHED, YOUTHFUL APPEARANCE?
Collagen is nature's most fundamental and abundant building block. In fact, collagen makes up 70% to 80% of the skin's dermis, providing structure, strength, and support. Collagen depletes naturally over time as we age, leading to a tired or aged appearance. This happens through the formation of new wrinkles and folds, and changes in facial contour and structure. The natural pace of collagen loss can be accelerated by such factors as sun exposure, genetics, hormonal changes, and smoking. By replacing lost collagen with an advanced collagen compound, EVOLENCE dermal filler can help enhance and maintain the structure, volume, and naturally younger-looking appearance of your skin.
WHAT MAKES EVOLENCE DIFFERENT?
EVOLENCE dermal filler is made of natural collagen, one of the most prevalent materials in your body. The advanced collagen in EVOLENCE has been naturally cross-linked, so it mimics the 3-dimensional structure of your skin's own collagen. This allows it to integrate beautifully and support your skin's own existing collagen network by adding structure, strength, and volume for a natural look and feel that lasts.
THE UNIQUE COLLAGEN OF EVOLENCE:
- Achieves immediate, natural-looking results, so you can walk out of your aesthetic professional's office looking beautifully refreshed
- Causes minimal-to-no swelling or bruising, so you can get right back to daily activities
- Lasts for at least 6 months
- Does not require a skin pre-test, so you can get results in 1 visit
Although new to the US, EVOLENCE has been used extensively in Canada, Europe, and Israel for several years.
WHERE IS EVOLENCE USED?
EVOLENCE is recommended for the correction of moderate-to-deep facial wrinkles and folds, such as nasolabial folds, the ones that appear from your nose to the corners of your mouth ("smile lines").
IS EVOLENCE RIGHT FOR ME?
We will help you determine the best treatment approach for achieving your desired results. Together, you may decide EVOLENCE dermal filler is right for you if you are seeking a refreshed and naturally younger-looking you. The visible results are immediate-with minimal-to-no downtime post-treatment- and lasts at least 6 months. Evolence is one of the many dermal fillers our professionals recommend. Call for a free consult to talk to us about Evolence, Radiesse, Juvederm, Restylane, Perlane and Botox.
Find out more about our services:
For more information on our dermatology, medical and advanced cosmetic services, please contact
Water's Edge Dermatology at (561) 694-9493 or online at wederm.com.
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Health and beauty are closely related issues. Just as your health may affect your appearance and outlook on life, how you feel about yourself and your looks may influence your mental and even physical well-being.
