Squamous Cell Carcinoma Treatments

Most squamous cell carcinomas may be treated by one of the following methods. More healthy tissue around the lesion is removed than for basal cell carcinomas because of the potential of squamous cell carcinomas to spread. Nearby lymph nodes are also examined carefully. The choice of treatment is influenced by:

* size, location, grade, and type of tumour
* whether the tumour is primary or is recurring
* person’s age and health
* people with organ transplants are at a high risk of aggressive squamous cell carcinoma, which is considered in their treatment plan
* availability of the treatment

Surgery (Wide Excision)

# used for:
- most small lesions that are less than 2 cm
- superficial or SCC that has not spread
- verrucous carcinomas (slow growing and less aggressive)
- tumours that have previously been treated with radiation therapy
- lesions on the eyelid, forehead, scalp, lip, penis, vulva and anus

Mohs Micrographic Surgery

* used for all types of squamous cell cancer
* commonly used for:
- areas that are at high risk of recurrence (eyelids, nose, ears, forehead, scalp), as well as areas that have - already recurred
- areas where it is important to keep function and appearance
- lesions that are larger than 2 cm, and lesions with poorly defined borders
- aggressive tumours, and invasive lesions that have spread to nerves, cartilage or bone
- tumours that have been left untreated for a long time
- lesions that had not been completely removed with prior surgery it involves a meticulous study of tissues removed by a  pathologist at the time of surgery

Radiation Therapy

* used after surgery for:
- elderly individuals
- ensuring cancer free margins
- treatment of involved lymph nodes
- squamous cell carcinoma that has recurred after surgery
- to relieve or control the symptoms of very large tumours
- for people who are unwilling or unable to undergo surgery
- tumours on the eyelid, cheek, earlobe and nose not used for verrucous carcinomas (slow growing and less aggressive)

Chemotherapy

* systemic chemotherapy is used for squamous cell cancer that has spread to other parts of the body
* drugs used most often in chemotherapy:
- cisplatin
- doxorubicin
- bleomycin

Curettage And Electrodesiccation (C & E)

used for
- small areas that are less than 2 cm
- lesions that haven’t spread
- squamous cell carcinoma with distinct margins in Actinic Keratosis should not be used for:

- larger lesions that are greater than 2 cm
- recurrent tumours
- aggressive squamous cell carcinoma
- lesions with poorly defined borders
- hairy areas like the underarms, scalp, and the pubic area
- areas where it is important to keep function and appearance uncommonly used

Wart Treatment by Type of Drug and Procedure

The new advance in treatment of genital warts has been imiquimod (Aldara). This encourages the patient’s autoimmune system to attack the wart. This is particularly helpful in the moist areas of the skin or mucosal surfaces.

Salicylic acid
Salicylic acid can be applied either in the form of plasters or as liquid on to the warts. This will break down the thickened skin on the surface. It is more effective if the area is covered. These are useful for warts on the hands, knees and feet. They do turn the skin white. They can be used in combination with paring of the warts. Treatment with these at nighttime and covering with duct tape can be effective although slow.

Podophyllin

Podophyllin has a long history of use. It is useful mostly in genital warts. It should be applied very carefully on the warts, trying to prevent spread on to normal skin. It should be washed off after a few hours. There is irritation usually for a few days. Repeat treatments are usually required. A more purified form of podophyllin called podophyllotoxin is available for patient use. It can be used once or twice daily for a few days in succession. This produces some irritation. It has the advantage of not being as irritating as podophyllin and can be applied by the patients themselves.

Vitamin Acid

Vitamin acid (Tretinoin) is a vitamin A preparation. It is used in the treatment of acne and photo damage. Vitamin A products tend to regulate the surface of the skin, generally trying to keep the epidermis behaving normally. It may also cause some inflammation. In some individuals it can help reduce or even eliminate warts.

Cantharone

Cantharone (cantharidin) is derived from an insect. It can be very helpful in children but the application is painful. Inflammation and
blistering usually occurs later in the day, after application. Multiple treatments may be required. There are two concentrations. The
stronger version combines Cantharone with podophyllin and salicylic acid. Very occasionally the blistering reaction can be quite severe
and associated with swelling and pain. It is often very effective even in resistant warts.

Cryotherapy

Cryotherapy is the use of liquid nitrogen. This can be applied either with a Q-Tip or it can be sprayed on to the skin. It causes destruction by freezing water inside the cells. This damages the cell causing death. It is painful to apply and there is blistering associated with this. Multiple treatments may be required. Thawing and freezing again makes this therapy more effective. It can be a problem in dark skin in that it can either increase or decrease pigmentation, which can be permanent. This treatment can be used in combination with other therapies.

Electrodesiccation

Electrodesiccation is the use of an electric needle to burn warts. It usually requires a local anesthetic. It does have a potential risk of scarring. Very large warts can sometimes be scraped off before they are cauterized.

CO2 Laser

The CO2 laser has been used for many years. It essentially vaporizes water in the skin and causes destruction. It leaves a hole in the skin which will heal. There is often scarring with this technique. Other lasers such as the pulse dye laser are easier to use. The yellow light is absorbed by blood in the vessels that feed the warts. This is a similar laser used in the treatment of red birthmarks. The pulse dye laser at a high power setting can be effective particularly if multiple pulses are used in succession.

Aldara

Aldara is an immune response modulator. It boosts the patient’s immune response to viruses. It can also encourage the production of a lasting immune memory. It has been available in Canada since 1999. It works best in the genital area as penetration into the skin is easier. When it is used elsewhere it often has to be covered to help with penetration into the skin. It has been shown to work well particularly in women. It is applied three times weekly. There will be some inflammation associated with this. The results may be enhanced by combining this with liquid nitrogen. This drug has added a very significant tool in treating genital warts.

Treating Actinic Keratoses and Nonmelanoma Skin Cancers

Methyl Aminolevulinate-PDT for Actinic Keratoses and Superficial Nonmelanoma Skin Cancers

Methyl aminolevulinate-hydrochloride cream (Metvix® [in Canada] and Metvixia® [in the US], Galderma) in combination with photodynamic therapy (PDT) provides an effective treatment option for actinic keratoses (AKs), superficial basal cell carcinoma (sBCC), and Bowen’s disease (BD). Good clinical outcomes have been reported in the literature. Complete responses (CRs) in AK range from 69% to 93% at 3 months. In sBCC, reported CR rates were from 85% to 93% at 3 months and almost on par with cryosurgery at 60 months (75% vs. 74%). In BD, CR rates were 93% at 3 months and 68% at 2 years. Current evidence has shown that this noninvasive treatment is superior in terms of cosmetic outcome to other management strategies such as surgery. It also offers the advantages of relative simplicity, low risk of side-effects and decreased complications due to scar formation.

Topical Methyl Aminolevulinate (MAL)-PDT

Photodynamic therapy (PDT) treats superficial skin cancers and pre-cancerous lesions through photosensitized reactions requiring oxygen. Over the past several decades, PDT has been extensively investigated as an experimental therapy for human cancers. There is now growing interest in the use of PDT not only for nonmelanoma skin cancer (NMSC), but also for other skin tumors such as lymphoma, as well as for nononcological indications, such as psoriasis, localized scleroderma, acne, and skin rejuvenation.^1-4 In Europe, as well as in the US, porphyrin-inducing precursors, such as 5-aminolevulinic-acid (ALA) and MAL have been proven effective for the treatment of actinic keratoses (AKs) and basal cell carcinomas.^5-7 Both ALA and MAL induce protoporphyrin IX (PpIX) locally in the skin. Photodynamic therapy combines the simultaneous presence of a photosensitizer activated by an appropriate wavelength of light. For topical PDT, upon illumination, PpIX is transformed to the excited state and then returns to its ground state through a type-II photo-oxidative reaction.5 In this reaction, these molecules transfer energy to oxygen producing highly reactive oxygen species (ROS), singlet oxygen in particular. ROS accumulates locally within the affected tissue leading to direct cellular damage by apoptosis or necrosis, and indirect stimulation of inflammatory cell mediators.⁶

Previous studies have shown that MAL in combination with red light (570-670nm) has provided good clinical outcomes in the treatment of NMSC (both sBCC and Bowen’s disease) and AKs.⁷ MAL, the methylated ester of ALA, is a new topical photosensitizer that may offer advantages over ALA in terms of its deeper skin penetration (up to 2mm in depth) due to potentially enhanced lipophilicity and greater specificity for neoplastic cells.⁸ In a typical PDT session, the lesion surface is prepared by light curettage of any surface crusts and scales. The 3 hour application of 160mg/g MAL prior to irradiation with 37J/cm2 from a light-emitting diode system (emission peak of 632nm) corresponds to the time point of the highest ratio of fluorescence depth to tumor depth2 under occlusion. Two treatments 1 week apart for AKs, sBCC, and BD have been recommended; however, a single treatment session is possible and may be potentially sufficient for very thin AKs. For partially cleared responses, a second treatment course (consisting of two weekly PDT sessions) at 3 months may be considered.⁹ This article reviews key published trials of topical MAL-PDT for AK, sBCC, and BD.

AKs

A US randomized, multicenter, double-blind, placebo controlled study was performed in 80 patients with mild-to-moderate AKs on the face and scalp. Forty-two patients (260 lesions) were treated with MAL-PDT and 38 patients (242 lesions) received the placebo cream. MAL was applied for 3 hours followed by illumination with noncoherent red light (75J/cm2). Treatment was repeated after 1 week. A complete response rate of 89% with MAL-PDT and 38% with placebo was assessed after 3 months follow-up. An excellent or good cosmetic outcome was reported in more than 90% of patients treated with MAL.¹⁰

Tarstedt et al.11 reported response rates in an open label, prospective study that compared 2 regimens:

1. A single treatment session 2. 2 MAL-PDT sessions 1 week apart.

One hundred six patients received the single treatment and 105 patients received the second regimen. For thin lesions, clearance rates showed no significant difference (93% with single session vs. 89% with double sessions) For thicker lesions, clearance rates were higher for double sessions (84%) when compared with single treatment (70%). The authors concluded that single treatment is effective for thin AKs. Repeated treatments were needed for thicker or resistant lesions.

In another randomized, multicenter study, MAL-PDT (n=360 lesions) was compared with a single-thaw cycle of cryotherapy (n=421 lesions) or placebo (n=74 lesions). The PDT treatment arm consisted of 2 treatment sessions 1 week apart using 75J/cm2 with a noncoherent red light (570-670nm). After 3 months, clearance rates for MAL-PDT were significantly higher (91%) compared with cryosurgery (68%) and placebo (30%). Of the MAL-PDT treated patients, 83% were rated as having an excellent cosmetic outcome by an investigator vs. 51% of those treated with cryotherapy; the corresponding patient assessments were 76% and 56% respectively.¹²

A large randomized, intraindividual, right-left comparative study of 119 patients with face/scalp AKs was performed.14 The aim of the study was to compare 1 MAL PDT session to double freeze-thaw cryotherapy. After a 3-hour application of MAL using 37J/cm2 with double treatment 7 days apart, cure rates were seen when using MAL-PDT (87%) compared with cryotherapy (76%). Of patients treated with MAL-PDT, 10% required re-treatment after 3 months vs. 21% for cryotherapy. Cosmetic outcome significantly favored MAL-PDT (i.e., 77% vs. 50%).13 A recent study, however, showed lower efficacy with MAL-PDT (78% clearance) on the extremities compared with cryotherapy (88% clearance).¹⁴

In a recent multicenter, double-blind, randomized study by Pariser,15 the efficacy of MAL-PDT using a red light-emitting diode (n=363 lesions) was evaluated vs. placebo (n=360 lesions) for grade 1 (slightly palpable) and grade 2 (moderately thick) AKs on the face and scalp. Lesion complete response rates were significantly superior for MAL-PDT (86.2%) vs. placebo (52.5%). The patient complete response rate was 59.2% for MAL-PDT subjects, and lower for those who had vehicle PDT alone (14.9%). Scalp lesions responded better with MAL-PDT (93%) than did facial lesions (87%). Grade 1 lesions had slightly higher complete response rates than grade 2 lesions (89% vs. 80%). Furthermore, larger lesions with diameters of >20mm had poorer response rates compared with smaller lesions (74% vs. 86%).

When treating AKs, biopsies should be considered for thick, keratotic lesions to rule out squamous cell carcinoma. Calzavara-Pinton et al.¹⁶ have shown that even if squamous cell carcinoma is limited to microinvasive involvement, the treatment outcome is poor.

Superficial BCCs

The recent British Photodermatology Group guidelines for topical PDT concluded MAL-PDT to be effective for sBCC.⁹ In an attempt to compare clearance rates and cosmetic outcomes between MAL-PDT (n=60) and double freeze-thaw cryotherapy (n=58) in sBCC, a 5-year European randomized trial was performed in 118 patients. This protocol used MAL applied for 3 hours at 75J/cm2 with noncoherent red light (570-670nm) for 1 session. Partially treated patients at 3 months were given 2 further MAL-PDT sessions (n=20) or repeat cryotherapy (n=16). Complete clinical response rates after 3 months’ follow-up for MAL-PDT were 97% of 102 lesions, while that of cryotherapy was 95% of 98 lesions; the difference between these 2 treatments was not statistically significant. At 5 years’ follow-up, clearance rates were similar for the MAL-PDT group (75%) and cryotherapy (74%). Of the lesions initially cleared with MAL-PDT, 22% had recurred vs. 20% after cryotherapy. Cosmetic outcome was judged superior following PDT (87% vs. 49%).¹⁷ Double MAL-PDT treatment cycles for ‘difficult-to-treat’ sBCC (and nBCC) were reported by 2 prospective multicenter studies. This included recurrent, large-sized lesions and/or those occurring on the mid-face or ears. In the first study, 87% of patients (n=94) had ‘difficult-to-treat’ lesions occurring on the face or scalp. The protocol was a single cycle of MAL-PDT (MAL 3h, 75J/cm2, 570-670nm or 580-740nm, 50-200mW/cm2) involving 2 treatment sessions 1 week apart. For partially treated lesions after 3 months’ follow-up, a second cycle was repeated. Complete clearance at 3 months was 85% for sBCC after histological review (75% for nBCC). After 2 years, the recurrence rate was 22% for sBCC (14% for nBCC). Ninety-four percent of patients were assessed to have a good to excellent cosmetic outcome.¹⁸ In the second study, efficacy, safety, and cosmetic outcomes were examined in 95 patients with BCCs that were ‘difficult-to-treat’ and at high risk for surgical complications. A total of 148 BCCs (sBCC and nBCC) were treated with the same PDT protocol (MAL 3h, 75J/cm2, 570-670nm, 50-200mW/cm2) with re-treatment for non-complete response lesions at 3 months. Overall, histologically-confirmed lesion complete response rate was 89% (93% sBCC and 82% nBCC) after 3 months’ follow-up. Fifteen percent of lesions had histologically confirmed recurrence within 2 years increasing to 20% within 4 years. Ninety-seven percent of patients rated their cosmetic outcome as good to excellent at 3 months.¹⁹

Bowen’s Disease

A large randomized, controlled, multicenter study reported similar clearance response rates following MAL-PDT (86%), single freeze-thaw cryotherapy (82%), and 1 month application of 5-fluorouracil (83%) in 225 patients with histologically confirmed Bowen’s disease. MAL-PDT (MAL 3h, 75J/cm2, 570-670nm, 70-200mW/cm2) was given as a single cycle 1 week apart. Lesions with a partial response at 3 months were re-treated. Cosmetic outcome was superior for MAL-PDT in 94% of patients vs. 66% with cryotherapy, and 76% with fluorouracil.²⁰ Clearance rates after 2 years for MAL-PDT was 68% vs. 60% with cryotherapy and 59% with fluorouracil.⁷

Conclusion

MAL is an effective low molecular weight topical porphyrin-inducer that is typically used in combination with a red light-emitting diode for PDT. It offers therapeutic benefit for thin and moderate thickness AKs. It should be considered as a treatment option for superficial BCCs and Bowen’s disease, particularly in situations where surgery may be problematic or where patients have multiple lesions. However, long-term cure rates, as mentioned above for Bowen’s disease and sBCC, are only 68% and 75% respectively. Because of the appreciable nonresponse and recurrence rates, patients treated with PDT for either disease should be monitored closely during the first 2-3 years after PDT, which is when most lesion recurrences occur. According to studies, patients’ high preference for MAL-PDT may be mainly due to its good to excellent cosmetic outcome and general tolerability of side-effects. No direct comparative studies have yet been reported with MAL and ALA. Important parameters, such as the depth of penetration of MAL-PDT, tumor thickness, location, and careful patient selection are key elements for efficacy. In the US, MAL-PDT is currently FDA-approved for the treatment of AKs only, whereas in Canada, MAL-PDT is officially indicated for the treatment of both AKs and sBCCs.

P. Lovell, RN, BScN1; R. B. Vender, MD, FRCPC²
1. Michael DeGroote School of Medicine McMaster University
2. Dermatrials Research, Hamilton, ON, Canada

Identifying Common Skin Conditions; Warts, Moles and More

A reader of our sites recently commented, “I know that the people often mistake warts, skin tags and moles but these are three different skin disorders. I am trying to find out information to convince people that skin tags and warts and moles are not and the same.”

The internet can be a valuable resource to finding answers to most our skin treatment issues. But if you just want a quick overview of the most common skin conditions; warts, moles (nevis), dark spots (dpn), skin tags, and Seb-Ks (seborrheic keratoses), then the information provided here can be a great place to start.

Identifying Common Skin Conditions; Warts, Moles, DPN, Skin Tags and Seb-Ks

There are several skin lesions that are very common and almost always benign (non-cancerous). These conditions include moles, freckles, skin tags, benign lentigines, and seborrheic keratoses.

What is a skin tag?

A skin tag is a common, acquired benign skin growth that looks like a small piece of hanging skin. Skin tags are often described as bits of skin- or flesh-colored tissue that projects from the surrounding skin from a small, narrow stalk. They typically occur in characteristic locations including the neck, underarms, eyelids, and under the breasts (especially where underwire bras rub directly beneath the breasts). Although skin tags may vary somewhat in appearance, they are usually smooth or slightly wrinkled and irregular, flesh-colored or slightly more brown, and hang from the skin by a small stalk. Early or beginning skin tags may be as small as a flattened pinpoint-sized bump around the neck. Some skin tags may be as large as a big grape.

Moles, Dysplastic Nevus and Dermatofibroma

Moles are growths on the skin that are usually brown or black. Moles can appear anywhere on the skin, alone or in groups. Most moles appear in early childhood and during the first 20 years of a person’s life. Some moles may not appear until later in life. It is normal to have between 10-40 moles by adulthood.

As the years pass, moles usually change slowly, becoming raised and/or changing color. Often, hairs develop on the mole. Some moles may not change at all, while others may slowly disappear over time.

A dermatofibroma is a benign skin bump that occurs most commonly on the legs. A dermatofibroma is a firm, slightly elevated, dome-shaped, often darker-colored papule.

Sometimes a dermatofibroma is confused with a mole. The way to tell the difference between the two is to pinch the bump. If you pinch a dermatofibroma it creates a dimple because it is attached to the underlying subcutaneous tissue. On the other hand, if you pinch a mole, it projects up away from the skin.

Dysplastic Nevus

A dysplastic nevus, (or naevus; pl. nevi or naevi) is an atypical melanocytic nevus; a mole whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they usually are flat, but parts may be raised above the skin surface. Dysplastic nevi can be found anywhere, but are most common on the trunk in men, and on the calves in women.

Dermatosis Papulosa Nigra?

Dermatosis papulosa nigra (DPN) is a benign, cutaneous (relating to the skin) condition common among blacks. It is usually characterized by multiple, small, hyperpigmented, asymptomatic papules on the face of adult blacks. Histologically, dermatosis papulosa nigra resembles seborrheic keratoses. The condition may be cosmetically undesirable to some patients.

Dermatosis papulosa nigra affects up to 35% of the African American population. Blacks with a fair complexion have the lowest frequency of involvement. Dermatosis papulosa nigra also occurs among Asians, although the exact incidence is unknown.

What is a Wart?

A wart (also known as verruca) is generally a small, rough tumor, typically on hands and feet but often other locations, that can resemble a cauliflower or a solid blister. Warts are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV) and are contagious when in contact with the skin of an infected person. It is also possible to get warts from using towels or other objects used by an infected person. They typically disappear after a few months but can last for years and can recur.

What is Seborrheic Keratosis?

Benign lesions that don’t ever turn into cancer, seborrheic keratoses, or Seb K’s for short, can look dangerous. In reality they are just annoying. Also irreverently called barnacles, they come in all different shapes and sizes from large black growths to barely noticeable raised areas.

Characteristics of Seborrheic Keratosis
The wicked witch with a wart on her nose probably had a Seb K not a wart. So how can you tell if that bump on your face or chest is actually a Seb K? They do have some defining characteristics. Warty surface - Seborrheic keratoses may look like warts but they don’t contain human papilloma viruses that cause warts. As they develop some can have a very rough surface with deep pits and fissures almost like cauliflower being pulled apart.

Hopefully, this helps clear up any misnomers or confusion you may have about a wart or mole or any skin condition you are worried about. If any skin condition persists, changes or grows painful, seek medical attention or the professional advice of a doctor immediately.

Dysplastic Nevi Prevention Guidelines

Anyone who has an increased risk of developing melanoma must be particularly vigilant. Do any of these risk factors apply to you: light eyes, hair, and/or skin; freckles; many moles; personal or family history of melanoma or nonmelanoma skin cancer; sun sensitivity; inability to tan; repeated and intermittent sunburns; a very large mole present at birth, or dysplastic nevi?

The best advice is “Know your skin.” Each family member should become aware of all moles on his/her total skin surface to minimize the risk of melanoma progressing to life-threatening stages.

Anyone, especially someone with an increased risk of developing melanoma, should:

* Examine the skin completely each month, using a good light source (to illuminate the areas being examined), a full-length mirror and a hand-held mirror. Ask a family member or friend to help in examining hard-to-see parts of the body. A hair dryer is useful when checking the scalp. Also, examine the bottom of the feet and between the toes.
* Seek prompt medical attention if any of the warning signs of melanoma described earlier are found.
* Have a head-to-toe skin examination by a physician annually or more often. If moles are changing, as they may during adolescence, they should be checked at more frequent intervals. Inform your doctor about any moles that have suspicious signs, symptoms, or changes.

SUGGESTIONS FOR PEOPLE WITH DYSPLASTIC NEVI

If your doctor suspects dysplastic nevi, one or more moles may be biopsied — removed in a minor surgical procedure for microscopic examination. It is not necessary to remove all dysplastic nevi. However, if moles show significant change or signs of melanoma, or if new moles appear after age 40, they may be considered for removal by your physician.

When the diagnosis of dysplastic nevus is confirmed microscopically, it is advisable to:

* write down a complete family history of unusual moles, melanomas or other cancers. Discuss it with your doctor.
* have regular complete skin examinations at intervals suggested by your doctor, and advise family members to do the same.
* supplement regular medical checkups with monthly selfexamination of the skin.
* reduce sun exposure. Excessive exposure may stimulate formation of new moles or even cause melanomas.
* check with your doctor about having a set of full-body photographs taken, especially if family members have dysplastic nevi or melanoma and/or you have many moles. Changes can be more easily spotted in this way.
* have any unusual or changing skin growth examined promptly by your doctor.
* check with your physician to see if an eye examination is recommended, since moles and melanomas may also arise in the eyes.
* be concerned, but don’t worry excessively.

With regular self-examination, professional examination, and common sense, you greatly reduce your chances that a melanoma will grow to a threatening size before it can be detected and removed.

PREVENTING SKIN CANCER

While skin cancers are almost always curable when detected and treated early, the surest line of defense is to prevent them in the first place. Here are some sun safety habits that should be part of everyone’s daily health care:

* Seek the shade, especially between 10 A.M. and 4 P.M.
* Do not burn.
* Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
* Use a broad-spectrum sunscreen with an SPF of 15 or higher every day.
* Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours.
* Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
* Avoid tanning parlors and tanning devices.
* Examine your skin head-to-toe every month.
* See your doctor every year for a professional skin exam.

A PUBLICATION OF THE SKIN CANCER FOUNDATION
For more information or to order this article as a brochure, contact:
The Skin Cancer Foundation
149 Madison Ave., Suite 901,
New York, NY 10016

Healthy Diet, Healthy Skin

By: Van Le
The saying “you are what you eat” didn’t happen by accident.  More Americans are realizing that what we put in our bodies dictates how well we think, look and feel.  Eating is the body’s way of obtaining the nutrition and vitamins required in order for the body to function properly.  Consuming the right kind of food can increase our energy level, lead to healthier-looking skin, and boost our self-confidence.

Americans spend billions of dollars each year on beauty products that promise to hide blemishes, cover under-eye circles, and conceal wrinkles; however, these products only temporarily fix what’s on the outside.  In order to have truly healthy skin, we must monitor our food intake and eat food that allows our body to naturally generate that coveted healthy glow.

Water: Everyone knows that we should drink at least eight 8-ounce glasses of water each day, but not everyone does.  Seventy percent of the body is comprised of water, which is vital to cellular replenishment.  Water also helps flush bodily toxins and regulate our body temperature.   Try to limit caffeine and alcohol intake, as they can lead to dehydration and cause dull, dry skin.  If you think water is too plain, try adding lemon slices or cucumber for a hint of taste.

Low-fat dairy products: Milk, low-fat yogurt, and low-fat cheese all contain vitamin A, a key ingredient in most anti-aging, anti-acne and anti-wrinkle products.  Vitamin A strengthens the skin, helps repair and restoration processes and prevents wrinkles.  The recent frozen yogurt craze has helped increase consumption of dairy products, however, it is important to remember that a cup of yogurt topped with candy, caramel, and other processed sugary treats can be counterproductive.  Instead, choose healthier fresh fruit toppings such as blueberries and strawberries.

Antioxidants: Fruits like berries and pomegranates are filled with antioxidants, which have been proven to protect the skin against UV damage such as wrinkles and dark spots.  They also protect the skin from free radicals, which are organic molecules responsible for tissue damage and aging.  According to antioxidantskincare.org, “when free radicals attack healthy skin cells, they cause the cell to decay,” which can lead to cancer, cardiovascular disease and speed up aging.  Antioxidants neutralize the production of free radicals.

Omega 3: Walnuts, flaxseeds and salmon contain essential fatty acids that prevent harmful substances from entering cells.  They help regulate cell functions and maintain skin elasticity, leading to soft and healthy skin.  A diet filled with omega 3 will result in radiant skin, stronger hair and overall good health.  Our bodies cannot produce omega 3, therefore, it is important to add omega 3 to our diet.

Whole grain: Wheat products such as bread, pasta, and cereal contain plenty of vitamin B, which can even out skin tone and help the skin maintain moisture.  Whole grain products help replace dead skin by stimulating cell growth on the epidermis, the skin’s outer layer.  Increase your consumption of whole grains by replacing white bread, pasta and bagels with wheat products.  Most likely, you won’t even taste the difference.

Makeup can create the illusion of healthy skin, but true healthy skin starts and ends with a proper diet.  A healthy diet is an essential way to achieve not only radiant skin, but also a radiant lifestyle.

Van Le is a staff writer for the CSU Daily Titan and writing intern for Vivoderm Laboratories in Los Angeles, California. She is currently pursuing a Journalism degree at California State University, Fullerton.

For the latest findings on natural skincare, you can also link to http://bestskincareforme.com

Sunscreens, UVB and UVA Rays

With summer lurking just around the corner, it’s almost time to tie up that new bathing suit, fire up the grill, and most importantly, slather on the sunscreen. The importance of sun care escalates as knowledge of skin cancer increases in the United States, and the National Cancer Institute estimates that there are more than one million new cases of skin cancer in 2009 alone. Still, loyal sunbathers and frequent beach-goers are able to enjoy some fun in the sun thanks to the vast array of sunscreen available. Sunscreens are available in several forms, including lotion, sprays, ointments, and sticks, and are often labeled with a Sun Protection Factor (SPF), which can range from 2 to 50. The higher the SPF, the more sun protection, and most dermatologists recommend using a sunscreen with an SPF 15 or higher.

Sunscreen protects the skin from harmful UVA and UVB rays from the sun, and too much exposure to these rays can cause sunburn and wrinkles. Long term sun exposure can lead to cancer, which is the most common type of cancer, according to the American Cancer Association. Most sunscreens contain zinc oxide, which as the ability to filter UVA and UVB rays to protect the skin. Zinc oxide has been used in skin products for many years and can be used with all skin types.

UVradiation, a known carcinogen, can have a number of harmful effects on the skin. The two types of UV radiation that can affect the skin—UVA and UVB—have both been linked to skin cancer and a weakening of the immune system. They also contribute to premature aging of the skin and cataracts (a condition that impairs eyesight), and cause skin color changes.

UVA Rays

UVA rays, which are not absorbed by the ozone layer, penetrate deep into the skin and heavilycontribute to premature aging. Up to 90 percent of the visible skin changes commonly attributed to aging are caused by sun exposure.

UVB Rays

These powerful rays, which are partially absorbed by the ozone layer, mostly affect the surface of the skin and are the primary cause of sunburn. Because of the thinning of the ozone layer, the effects of UVB radiation will pose an increased threat until the layer is restored in the latter half of the 21st century.

The following table from the FDA lists these ingredients and includes information regarding the type and amount of ray protection that they provide and their class.

Is a Suntan Healthy?

Just remember, there is no such thing as a healthy suntan. Any change in your natural skin color is a sign of skin damage. Every time your skin color changes after sun exposure, your risk of developing sun-related ailments increases.

Milia and Seborrheic Keratosis

Milia, also known as milk spots or oil seeds, are benign, keratin-filled cysts that can appear just under the epidermis or on the roof of the mouth. They are commonly associated with newborn babies but can appear on people of all ages. They are usually found around the nose and eyes, and sometimes on the genitalia, often mistaken by those infected as warts or other STDs.

In children milia often disappears within two to four weeks. In adults it may require removal by a physician or an esthetician. Milia can sometimes be a result of harsh face washes or from repeated heat stress from hot showering on people with sensitive skins. Milia can be confused with stubborn whiteheads.

A seborrheic keratosis (also known as “Seborrheic verruca,” “Senile keratosis,” and “Senile wart”) is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age. In fact they are sometimes humorously referred to as the “barnacles of old age”.

They appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across. They can resemble warts, though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma as well. Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a “pasted on” appearance. Some dermatologists refer to seborrheic keratoses as “seborrheic warts”, however these lesions are usually not associated with HPV, and therefore such nomenclature should be discouraged.

Classification

Seborrheic keratoses may be divided into the following types:

* Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
* Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)

Reticulated seborrheic keratosis (also known as “Adenoid seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with keratin cysts seen histologically.

* Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic

keratosis) Stucco keratosis (also known as “Digitate seborrheic keratosis,” “Hyperkeratotic seborrheic keratosis,” “Serrated seborrheic keratosis,” and “Verrucous seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with church-spire-like projections of epidermal cells around collagen seen histologically.

* Clonal seborrheic keratosis
Clonal seborrheic keratosis is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.

* Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)

* Seborrheic keratosis with squamous atypia

Seborrheic keratosis with squamous atypia is a less common cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.

* Melanoacanthoma (Pigmented seborrheic keratosis)

Melanoacanthoma (also known as “Pigmented seborrheic keratosis”) is a common, benign, darkly pigmented cutaneous condition characterized by a skin lesion with a dull or lackluster surface.

* Dermatosis papulosa nigra

Dermatosis papulosa nigra (DPN) is a condition of many small, benign skin lesions on that face that closely simulate seborrheic keratoses, a condition generally presenting on dark-skinned individuals.

They should not be confused for Leser-Trélat sign, a sudden explosion of lesions due to a growing tumor.

* The sign of Leser-Trélat

The Leser-Trélat sign is the explosive onset of multiple seborrheic keratoses (many pigmented skin lesions), often with an inflammatory base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome. In addition to the development of new lesions, preexisting ones frequently increase in size and become symptomatic. It is named for Edmund Leser and Ulysse Trélat.

Although most associated neoplasms are gastrointestinal adenocarcinomas (stomach, liver, colorectal and pancreas), breast, lung, and urinary tract cancers, as well as lymphoid malignancies are associated with this impressive rash. It is likely that various cytokines and other growth factors produced by the neoplasm are responsible for the abrupt appearance of the seborrheic keratoses. In some cases, paraneoplastic acanthosis nigricans accompanies the sign of Leser-Trélat.

Variances of Seborrheic Keratosis:

Dermatosis Papulosis Nigra: Often are small papules. Pinpoint to a few millimeters in size. More commonly found in dark-skinned persons.

Stucco Keratosis: Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.

Diagnosis: Visual diagnosis is made by the “stuck on” appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas. If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy.

Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, differentiation between condylomas and seborrheic keratoses can be difficult and may require a skin biopsy.

Treatment
When correctly diagnosed, no treatment is necessary. There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed by cryosurgery.

Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodessication and curettage, shave excision, or cryotherapy. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in darkly colored persons.

Cause
The cause of seborrheic keratosis is unclear. Because they are common on sun-exposed areas such as the back, arms, face, and neck, ultraviolet light

may play a role, as may genetics.[8] A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.

Etymology
The term “seborrheic keratosis” combines the adjective form of seborrhea, keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.

What is a skin tag?

A skin tag is a common, acquired benign skin growth that looks like a small piece of hanging skin. Skin tags are often described as bits of skin- or flesh-colored tissue that projects from the surrounding skin from a small, narrow stalk. They typically occur in characteristic locations including the neck, underarms, eyelids, and under the breasts (especially where underwire bras rub directly beneath the breasts). Although skin tags may vary somewhat in appearance, they are usually smooth or slightly wrinkled and irregular, flesh-colored or slightly more brown, and hang from the skin by a small stalk. Early or beginning skin tags may be as small as a flattened pinpoint-sized bump around the neck. Some skin tags may be as large as a big grape.

Where do skin tags occur?

Skin tags can occur almost anywhere there is skin. However, favorite areas for tags are the eyelids, neck, armpits, upper chest (particularly under the female breasts), and groin folds. Tags are typically thought to occur in characteristic locations where skin rubs against skin or clothing.

Who tends to get skin tags?

Nearly half of the population is reported to have skin tags at some time. Although tags are generally acquired (not present at birth) and may occur in anyone, more often they arise in adulthood. They are much more common in middle age and they tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags in the underarm and neck areas. Since they are thought to arise more readily in areas of skin friction or rubbing, tags are also more common in overweight people.

Picture of skin tags

Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags, as skin tags are more frequent in pregnant women. Tags may be easily removed during or after pregnancy.

Skin tags are a benign condition and not directly associated with any other major medical conditions, since tags are commonly found on healthy people.

Is a skin tag a tumor?

Skin tags are a type of growth or tumor, albeit a completely benign and harmless one. Tags are not cancerous (malignant) and not found to have potential to become cancerous if left untreated.

What does a skin tag look like under a microscope?

The outer layer of the skin (the epidermis) shows overgrowth (hyperplasia), and it encloses an underlying layer of skin (the dermis) in which the normally-present collagen fibers appear abnormally loose and swollen. Usually there are no hairs, moles, or other skin structures present in skin tags.

What problems do skin tags cause?

These tiny skin growths generally cause no symptoms unless they are repeatedly irritated as, for example, by the collar or in the groin. Cosmetic removal for unsightly appearance is perhaps the most common reason they are removed. Occasionally, a tag may require removal because it has become irritated and red from bleeding (hemorrhage) or black from twisting and dying of the skin tissue (necrosis). Sometimes they may become snagged by clothing, jewelry, pets, or seatbelts, causing pain or discomfort. Overall these are very benign growths that have no cancer (malignant) potential.

Occasionally a tag may spontaneously fall off without any pain or discomfort. This may occur after the tag has twisted on itself at the stalk base, interrupting the blood flow to the tag.

Proper care of your skin

Those who have never had skin issues or were blessed to even have beautiful skin for most of the lives, are now desperate to address the skin wrinkles and many run to the dermatologist feeling a lot of regret. Although genes certainly play a role in one’s skin condition, decades of neglect, or even mistreatment of their skin is most frequently the source of their skin problems.  Many say that if they knew then what they know now, they would have done things very differently and taken better care of their skin.
There are numerous explanations for unhealthy skin but the main causes tend to be an unhealthy diet, an ineffectual cleansing routine, and poor lifestyle choices.

“Is it too late to save my bad skin? I never paid much attention to my skin because I never had any skin problems. I never bothered with skin care products because I didn’t need to. Now I’m seeing wrinkles and spots forming, I guess it’s just too late to anything about it.” If this sounds like you, you may want to keep reading.Never fear, because there is still much that you can do to help your skin. If you are lost in sea of product choices, you can still be assured cosmetic dermatology can offer many alternative treatments.

Not surprisingly, many adults rarely consult a dermatologist that is until AFTER the signs of aging have appeared. Wrinkles, of course, are the chief complaint. Your skin may feel  rough to the touch, and even sore, especially in drying environmental  conditions such as on an airplane or in a low-humidity environment like the desert or high-altitude cities. In the winter, when indoor heating is used, your skin gets even more dehydrated, making the wrinkles look worse. Your skin may catch on rough clothing. You may also notice wrinkles on your neck or others parts of your body.

Poor Diet
Your skin is a living, breathing organ of the body and it needs proper nourishment and hydration to look and feel its best. When your skin is deprived of the necessary vitamins, minerals, and nutrients that it needs it is unable to functional at optimal levels and the structure slowly begins to break down. This breakdown results in dry skin, blemishes, discoloration, wrinkles, and premature ageing.

In order to avoid this breakdown you need to feed your skin a varied mix of important nutrients each day. Ingesting sufficient amounts of vitamin A, a nutrient that can be found in citrus fruits and orange vegetables, can help you avoid dry skin and blemishes. Eating foods rich in the vitamin B group like brewer’s yeast or breads, or taking a vitamin B group supplement, can help you ward of skin discoloration, dry skin, dermatitis, shallow skin, and premature ageing.

To help discourage wrinkles, pale skin, sun damage, blemishes, and other unhealthy skin symptoms, nutrients like calcium, protein, iodine, niacin, folic acid, iron, and copper are very important to a healthy diet. Get these effective skin helpers by enjoying foods like mild, eggs, cheese, chicken, fish, leafy vegetables, fruits, and grains.

Poor Hygiene
Another common cause of unhealthy skin is poor hygiene. Whether this involves the failure to clean your skin often enough or the use of an ineffective cleansing routine, built-up dirt and grime can lead to blemishes, premature ageing, shallowness, dry skin, and wrinkles.

When your skin is not properly cleaned on a regular basis, dirt, pollution and other harmful substances are allowed to build up on your skin and clog the pores. Clogged pores result in breakouts, dry skin, and the reduction of cell renewal.

To get the most out of your cleansing routine make sure that you wash your skin twice a day, everyday. Also, make sure that you are using an effective cleanser like a soap that is specially formulated for deep cleansing. Make sure that you use gentle pressure when cleaning the skin, do not scrub or pull on the skin since this can result in tiny tears that are susceptible to irritation and infection. Finally, always follow your cleansing routine with a hydrating moisturizer that also contains a sunscreen in order to hydrate your skin and protect it from sun damage.

Bad Lifestyle Habits
Even if you enjoy a healthy diet and pay special attention to your skin care regime you can still be sabotaging the health of your skin by indulging in unhealthy habits. Habits like sun tanning, smoking, choosing fizzy drinks or sodas over water, and wearing heavy makeup can lead to the development of unhealthy skin. Avoid excessive sun exposure, always wear sunscreen with an SPF (sun protection factor) of at least 15, stop smoking and avoid those who smoke, drink plenty of water, and choose light cosmetics if you want your skin to stay young and healthy looking for years to come.

Next Page »