Precautions for Individuals with Dysplastic Nevi

Cancer

According to the National Cancer Institute, doctors believe that dysplastic nevi are more likely than ordinary moles to develop into a type of skin cancer called melanoma. However, currently, most dermatologists do not believe that dysplastic nevi develop into melanomas. But individuals with multiple dysplastic nevi are at much higher risk for developing melanomas. Because of this, moles should be checked regularly by a doctor or nurse specialist, especially if they look unusual; grow larger; or change in color, or outline; or if any changes occur.

Today, most dermatologists believe that an individual with multiple dysplastic nevi do not need to have them all removed. The patient and doctor simply need to be exceedingly careful in identifying a melanoma growing among the dysplastic but benign lesions.

Self skin exam monthly is very important. Some dermatologist recommend that an individual with either histologic diagnosis of dysplastic nevus, or clinically apparent dysplastic nevi should be examined by an experienced dermatologist with dermatoscopy once a year (or more frequently).

To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see “ABCDE” mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy^.

A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”:

• Asymmetrical skin lesion.
• Border of the lesion is irregular.
• Color: melanomas usually have multiple colors.
• Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
• Evolution: The evolution (ie change) of a mole or lesion may be a hint that the lesion is becoming malignant.

The E is sometimes omitted, as in the ABCD guideline. A weakness in this system is the D. Many melanomas present themselves as lesions smaller than 6 mm in diameter; and likely all melanomas were melanomas on day 1 of growth, which is merely a dot a millimeter in size. An astute physician will examine all abnormal moles, including ones less than 6 mm in diameter. Unfortunately for the average person, many seborrheic keratosis, some lentigo senilis, and even warts breaks most if not all of the ABCD rules, and can not be distinguished from a melanoma without a trained eye or dermatoscopy.

A recent and novel method of melanoma detection is the “Ugly Duckling Sign” ^[6][7] It is simple, easy to teach, and highly effective in detecting melanoma. Simply, correlation of common characteristics of a person’s skin lesion is made. Lesions which greatly deviate from the common characteristics are labeled as an “Ugly Duckling”, and further professional exam is required. The “Little Red Riding Hood” sign, ^[8] suggests that individual with fair skin and light colored hair might have difficult to diagnose melanomas. Extra care and caution should be rendered when examining such individuals as they might have multiple melanomas and severely dysplastic nevi. A dermatoscope must be used to detect “ugly ducklings”, as many melanomas in these individuals resemble non-melanomas or are considered to be “wolves in sheep clothing”^[9]. These fair skinned individuals often have lightly pigmented or amelanotic melanomas which will not present with easy to observe color changes and variation in colors. The borders of these amelanotic melanomas are often indistinct, making visual identification without a dermatoscope (dermatoscopy) very difficult.

People with a personal or family history of skin cancer or of dysplastic nevus syndrome (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma.

Biopsy

When an atypical mole has been identified, a skin biopsy takes place in order to best diagnose it. Local anesthetic is used to numb the area, then the mole is biopsied. The biopsy material is then sent to a laboratory to be evaluated by a pathologist. A skin biopsy can be a punch, shave, or complete excision. The complete excision is the preferred method, but a punch biopsy can suffice if cosmetic or practical concern (i.e. the patient does not want a scar) prevents it. A scoop or deep shave biopsy is often advocated, but should be avoided due to risk of causing a recurrent nevus, which can complicate future diagnosis of a melanoma.

Some pathologists follow the traditional method of classifying a melanocytic nevus. It is either benign nevus or a dysplastic nevus (Clark’s nevus) or a melanoma. Some pathologist follow Dr. Ackerman’s philosophy - a nevus is either a benign nevus, or a melanoma.

Most dermatologists and dermatopathologists use a classification scheme devised by the NIH. In this classification, a nevus can be defined as benign, having atypia, or being a melanoma. A benign nevus is read as (or understood as) having no cytologic or architectural atypia. A dysplastic nevus is read as either having or not having architectural atypica, and having (mild, moderate, or severe) cytologic (melanocytic) atypia^[10]. Usually, cytologic atypia is of more important clinical concern than architectural atypia. Usually, moderate to severe cytologic atypia will require further excision to make sure that the margin is completely clear.

The most important aspect of the biopsy report is that the pathologist indicates if the margin is clear (negative or free of melanocytic nevus), or if further tissue (a second surgery) is required. If this is not mentioned, usually a dermatologist or clinician will require further surgery if moderate to severe cytologic atypia is present - and if residual nevus is present at the surgical margin.

Dysplastic nevus syndrome

“Dysplastic nevus syndrome” refers to dysplastic nevi with familial malignant melanoma, or risk factors for it. Dysplastic Nevus Syndrome is an autosomal dominant hereditary condition which causes the person to have a large quantity of nevi (moles), often 100 or more. There is a propensity for these nevi to become dysplastic in these individuals. Dysplastic nevi are a precursor to malignant melanoma, and these patients are therefore at a higher risk of developing this malignant form of skin cancer. A slight majority of melanomas do not form in an existing mole, but rather create a new growth on the skin. Nevertheless, those with more dysplastic nevi are at a higher risk of this type of melanoma occurrence. Such persons need to be checked regularly for any changes in their moles and to note any new ones. In 40-50% of cases, the disorder has been linked with germline mutations in the CDKN2A gene, which codes for p16 (a regulator of cell division).

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.

Skin Tags and Seborrheic Keratoses

Nuisances You don’t have to put up with. As time goes on, we all acquire tiny bits of extra skin called skin tags. These can range in size from 1-10 mm, and are flesh colored or brown.

Skin tags can be found on any part of the body, but are most common on the eyelids and neck, and in the armpits and groin, and under the breasts.  While skin tags are benign they can be annoying if they become irritating or rub on sporting equipment, and skin tags can interfere with shaving and can detract from one’s appearance and self-image.

Fortunately, we don’t have to put up with skin tags. These little annoyances can be easily removed in an office visit with little or no discomfort. Skin tags can almost always be removed without needing stitches, and the treated areas usually have healed completely in a week or two.

The cost of removing skin tags is quite reasonable - ranging from about $80 for a few tiny ones to about $200 for a larger number scattered over several areas.

Seborrheic keratoses are firm flat or raised, sometimes scaly or crusty flesh-colored, brown or black “barnacles” which accumulate (usually on the face and trunk) as time goes on. Some people start to develop seborrheic keratoses in their thirties, and most people have at least a few by the time they are sixty. To look at pictures of different types of moles, click on www.SkinCancerGuide.ca .

Seborrheic keratoses are usually just a nuisance, but - like skin tags — they can rub on clothing and equipment, and their appearance can sometimes be so distressing that they interfere with choice of clothing, sports like swimming, and intimacy.  Because seborrheic keratoses grow above the skin (but not down into the skin) they can be easily scraped off, and the treated areas heal up nicely within a few weeks. Sometimes the healed area remains pink for a few months after the seborrheic keratosis is removed.

The cost of removing seborrheic keratoses is similar to that for removal of skin tags: about $80 for one or two, with the cost gradually increasing depending on the number and size of seborrheic keratoses to be removed.

The cost of removing skin tags and seborrheic keratoses is a tax-deductible medical expense, just like things like dental bills.  So, if you are annoyed by skin tags or seborrheic keratoses you can be confident that it is simple and inexpensive to rid yourself of these nuisances.

By Kevin C. Smith MD FACP FRCPC

Identifying Skin Lesions - Warts, Moles and SebKs

By Van Le |  While freckles can add to a person’s beauty and uniqueness, other skin lesions such as large moles, skin tags, warts, and seborrheic keratoses can be unsightly and embarrassing. Most lesions are malignant (non-cancerous), however, it is important to be aware of and track any skin abnormalities on your body as a preventative measure.

Freckles

Freckles are irritating for some and embraced by others. They are pigment cells that retain within the skin to form light brown spots, and individuals with lighter complexions are more susceptible to freckles since their skin contains less melanin. Freckles, also known as ephelides, can appear on the face, arms and other sun-exposed areas. Excessive and continued exposure to harmful UV rays can cause more freckles and cause them to appear darker. While they are harmless, it is important to distinguish between freckles and symptoms of melanoma, a type of skin cancer that can grow from an existing freckle. Consult your doctor if you notice any change in freckle size, shape and color.

Skin tags

Skin tags are pieces of skin that hang from the surface of a surrounding area. Like freckles, they are benign, but can cause irritation if located on an area that is exposed to constant contact, such as the eyelids or areas where they can be snagged by jewelry or clothing. Skin tags can vary from a small pin-point size to a large grape size. While some can fall off on their own, there are several ways to medically remove skin tags, including freezing and burning. There are home remedies as well as creams available on the market to remove unwanted and embarrassing skin tags.

Seborrheic keratoses

Seborrheic keratoses, another benign skin lesion, can form anywhere on the body, but is commonly found on the chest and back. They can be distinguished from other types of lesions due to their waxy, stuck-on-the-skin appearance and often described as brown candle wax stuck on the skin. While the cause is still unknown, scientists have found that they can be hereditary and not affected by sun exposure.

Warts

Most warts are skin infections caused by viruses of the human papillomavirus (HPV) family. Basically, warts are benign tumors of the epidermis (outer layer of skin), and can occur in people of all ages, but are most commonly found on children and teenagers. There are different types, including flat and plantar warts. Flat warts are small in size but can be high in quantity, can spread to other areas of the body by shaving or scratching, and can be transferred person-to-person by physical contact. Plantar warts grow on the heel, ball or sole of the foot, and pressure from standing or walking pushes them into the deeper layers of skin.

Skin lesions like warts, seborrheic keratoses and skin tags are often harmless, but they can be embarrassing. While they can be surgically removed, there are creams and ointments available on the market to remove and reduce their appearance. If you have further questions about a particular skin lesion, consult your doctor or pharmacist for proper diagnosis and treatment.

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 skin lesions and treatments, you can also link to http://www.removalofwart.com

The Warning Signs of Melanoma

The A, B, C, D, Es of Melanoma.  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 atypical moles. That’s why it’s so important to get to know your skin very well and to 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 a physician immediately.

Melanoma - What You Need to Know

Hearing the words “It’s cancer” can be overwhelming. Often, people are too stunned to be able to ask physicians for the information they need. When discussing your diagnosis and treatment options with your physician, it can be helpful to have questions prepared ahead of time, so that you don’t forget anything important. Take a pen and paper to write down the answers, or a portable tape recorder so that you can play back the answers later. Studies have shown that people who are more informed about their cancer have a more positive attitude and respond better to treatment.

Questions to Ask Your Physician

• How advanced is my melanoma? What stage is it in?
• What are my chances of recovery?
• What treatments are available?
• Will I be given a choice of options?
• If I need surgery, will there be a scar?
• Which treatment do you think is best for me? Why?
• What are the side effects? Can they be treated, too?
• Will my health insurance or Medicare/Medicaid cover the cost?
• Will I be able to work and lead a normal life during treatment?
• What tests will be performed to show that the melanoma is cured?
• What are the chance of it coming back?
• Is there anything I can do to prevent a recurrence?

	Asymmetry If you draw a line through this mole, the two halves will not match.
	Border The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
	Color 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, blue or some other color.
	Diameter 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.
	Evolving Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger.

Prompt action is your best protection. The pictures below show atypical normal moles and melanomas.

	Benign	Malignant
Symmetrical			Asymmetrical
Borders are even			Borders are uneven
One shade			Two or more shades
Smaller than 1/4 inch			Larger than 1/4

Actinic Keratosis and Other Precancers

THE MOST COMMON PRECANCER :  More Than Ten Million

This figure is generally accepted as the best current estimate of the number of Americans with actinic keratosis (AK). People with a fair complexion, blond or red hair, and blue, green or grey eyes (Identify Your Skin Type) have a high likelihood of developing one or more of these common precancers if they spend time in the sun and live long enough. Location makes a difference: The closer to the equator you live, the more likely you are to have actinic keratoses.

The incidence is slightly higher in men, because they tend to spend more time in the sun and use less sun protection than women do. African-
Americans, Hispanics, Asians and others with darker skin are not as susceptible as Caucasians (Skin Cancer and Skin of Color).

Is There Cause for Concern?

Actinic keratosis can be the first step leading to squamous cell carcinoma and is therefore known as a “precancer.” Although the vast majority of actinic keratoses remain benign, some studies report that up to ten percent may advance to squamous cell carcinoma. This percentage does not sound very large, but it has a large impact. When it comes to squamous cell carcinomas, 40-60 percent begin as untreated actinic keratoses and may advance to invade the surrounding tissues. About 2 to 10 percent of these squamous cell carcinomas spread to the internal organs and are life-threatening.

Another form of actinic keratosis, actinic cheilitis, develops on the lips and may evolve into squamous cell carcinoma.

The more keratoses you have, the greater the chance that one or more may turn into skin cancer. In fact, some scientists interpret actinic keratosis as the earliest form of squamous cell carcinoma.

What Is Actinic Keratosis?

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion). It most often appears on the bald scalp, face, ears, lips,
backs of the hands and forearms, shoulders, neck or any other areas of the body frequently exposed to the sun. You’ll most often see the plural,
“keratoses,” because there is seldom just one.

In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper. There are many times the number of invisible (subclinical) lesions as visible ones on the skin surface.

Most often, actinic keratoses develop slowly and reach a size from an eighth to a quarter of an inch. Early on, they may disappear only to reappear later. Most become red, but some will be light or dark tan, pink, red, a combination of these, or the same color as your skin. Occasionally they itch or produce a pricking or tender sensation. They can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.

If you have actinic keratoses, it indicates that you have sustained sun damage and could develop any kind of skin cancer – not just squamous cell carcinoma.

Actinic keratosis on the back of the hand. These precancers commonly occur on the face and the back of the hands.

A closeup shows elevation, roughness, and crusting. Some keratoses, like this one, are quite discrete and difficult to distinguish clinically from squamous cell carcinoma.

How to Recognize Actinic Keratosis

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple:

Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly.

Numerous actinic keratoses can reveale chronic sun damage. They are elevated, rough in texture, and resemble warts.

Two typical keratoses on rim of ear. The top lesion is crusted, the lower one rough in appearance.

While most keratoses have a fine sandpapery roughness, others such as this lesion have an obviously scaly, crusty surface.

Chronic sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin is cumulative, so even a brief period in the sun adds to the lifetime total. Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so dermatologists warn against indoor tanning.

Occasionally, actinic keratoses may be caused by extensive exposure to X-rays or a number of industrial chemicals.

What Age Has to Do with It

Because the total amount of time spent in the sun adds up year by year, older people are most likely to develop actinic keratoses. However, nowadays, some individuals in their 20s are affected. Still, actinic keratoses become much more common in people over the age of 50. Some experts believe almost everyone over 80 has actinic keratoses.

Also, individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or excessive UV exposure are less able to fight off the effects of the radiation and thus more likely to develop actinic keratoses.

A PUBLICATION OF THE SKIN CANCER FOUNDATION
For more information or to order this article as a brochure, please contact:
The Skin Cancer Foundation
149 Madison Ave., Suite 901,
New York, NY 10016
© 2008

Photos courtesy of:
Pearon G. Lang, Jr., MD, and
MSKCC Dept. of Dermatology
Photos courtesy of:
Pearon G. Lang, Jr., MD, and
Memorial Sloan Kettering Cancer Center
Deptartment of Dermatology

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

Actinic Keratosis Treatments

What Is Actinic Keratosis?

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion). It most often appears on the bald scalp, face, ears, lips,
backs of the hands and forearms, shoulders, neck or any other areas of the body frequently exposed to the sun. You’ll most often see the plural,
“keratoses,” because there is seldom just one.

In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper. There are many times the number of invisible (subclinical) lesions as visible ones on the skin surface.

Most often, actinic keratoses develop slowly and reach a size from an eighth to a quarter of an inch. Early on, they may disappear only to reappear later. Most become red, but some will be light or dark tan, pink, red, a combination of these, or the same color as your skin. Occasionally they itch or produce a pricking or tender sensation. They can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.

If you have actinic keratoses, it indicates that you have sustained sun damage and could develop any kind of skin cancer – not just squamous cell carcinoma.

How to Recognize Actinic Keratosis

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple:

Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly. Numerous actinic keratoses can reveale chronic sun damage. They are elevated, rough in texture, and resemble warts.

Two typical keratoses on rim of ear. The top lesion is crusted, the lower one rough in appearance.

While most keratoses have a fine sandpapery roughness, others such as this lesion have an obviously scaly, crusty surface.

Chronic sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin is cumulative, so even a brief period in the sun adds to the lifetime total. Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so dermatologists warn against indoor tanning.

Occasionally, actinic keratoses may be caused by extensive exposure to X-rays or a number of industrial chemicals.

What Age Has to Do with It

Because the total amount of time spent in the sun adds up year by year, older people are most likely to develop actinic keratoses. However, nowadays, some individuals in their 20s are affected. Still, actinic keratoses become much more common in people over the age of 50. Some experts believe almost everyone over 80 has actinic keratoses.

Also, individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or excessive UV exposure are less able to fight off the effects of the radiation and thus more likely to develop actinic keratoses.

Why Is It Treated?

While actinic keratosis is the most common precancer, not all keratoses turn into cancers. Unfortunately, there is no way to know ahead of time which actinic keratoses are precursors of squamous cell carcinoma. That is why it is fortunate that there are so many effective treatments for eliminating actinic keratoses.

When an actinic keratisis is suspected to be an early cancer, the physician may take tissue for biopsy. This is done by shaving off the top of the lesion with a scalpel or scraping it off with a curette. Local anesthesia is required. Bleeding is usually stopped with a styptic agent.

TOPICAL MEDICATIONS

Medicated creams and solutions are very effective by themselves or in combination with another form of treatment when a person has many actinic keratoses.

5-fluorouracil (5-FU) ointment or liquid in concentrations from 0.5 to 5 percent has FDA approval and is the most widely used topical treatment for actinic keratoses. It is effective against not only the surface lesions but also the subclinical ones. Rubbed gently onto the lesions once or twice a day for two to four weeks, it produces cure rates of up to 93 percent. Reddening, swelling and crusting may occur, but they are temporary. The lesions usually heal within two weeks of stopping treatment. There is rarely scarring and the cosmetic result is good.

Imiquimod 5% cream, also FDA-approved, works in a different way: It stimulates the immune system to produce interferon, a chemical that destroys  cancerous and precancerous cells. It is rubbed gently on the lesion twice a week for four to sixteen weeks. The cream is generally well tolerated, but some individuals develop redness and ulcerations.

Diclofenac is a non-steroidal anti-inflammatory drug used in combination with hyaluronic acid, a chemical found naturally in the body. The resulting gelis applied twice a day for two to three months. The diclofenac prevents an inflammatory response, so this topical is well-tolerated, and the hyaluronic acid delays uptake of the diclofenac, leading to higher concentrations in the skin. It is used in persons who are oversensitive to other topical treatments.

CRYOSURGERY

This is the most commonly used treatment method when a limited number of lesions exist. No cutting or anesthesia is required. Liquid nitrogen, applied with a spray device or cotton-tipped applicator, freezes the growths. The lesions subsequently shrink or become crusted and fall off. Temporary redness and swelling may occur after treatment, and in some patients, white spots may remain permanently.

COMBINATION THERAPIES

If one form of therapy is good, two may be better; some of the treatment options described here are especially effective when used together or in sequence. This approach can both improve the cure rate and reduce side effects. One to two weeks of 5-FU followed by cryosurgery can reduce the healing time for 5-FU and decrease the likelihood of white spots following cryosurgery.

CHEMICAL PEELING

This method, best known for reversing the signs of photoaging, is also used to remove some actinic keratoses on the face. Trichloroacetic acid (TCA) and/or similar chemicals are applied directly to the skin. The top skin layers slough off and are usually replaced within seven days. This technique requires local anesthesia and can cause temporary discoloration and irritation.

LASER SURGERY

A carbon dioxide or erbium YAG laser is focused onto the lesion, and the beam cuts through tissue without causing bleeding. This is a good option for lesions in small or narrow areas, and, therefore, can be particularly effective for keratoses on the face and scalp, as well as actinic cheilitis on the lips.

However, local anesthesia may be necessary, and some pigment loss can occur. Lasers are useful for people taking blood thinners or as a secondarytreatment when others have not succeeded.

PHOTODYNAMIC THERAPY (PDT)

PDT can be especially useful for lesions on the face and scalp. Topical 5-aminolevulinic acid (5-ALA), a photosensitizing agent, is applied to thelesions. Subsequently, the medicated area is exposed to strong light that activates 5-ALA. The treatment selectively destroys actinic keratoses, causing little damage to surrounding normal skin, although some swelling and redness often occur.

How to Prevent Actinic Keratosis

The best way to prevent actinic keratosis is to protect yourself from the sun. Here are some sun-safety habits that really work.

* Seek the shade, especially between 10 A.M. and 4 P.M.
* Do not burn.
* Use a 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 or immediately after  swimming or excessive sweating.
* Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
* Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
* Examine your skin head-to-toe every month.
* See your doctor every year for a professional skin exam.
* Avoid tanning and UV tanning salons.

Medical Reviewers:
Rex A. Amonette, MD
David J. Leffell, MD
Perry Robins, MD

A PUBLICATION OF THE SKIN CANCER FOUNDATION
For more information or to order this article as a brochure, please contact:
The Skin Cancer Foundation
149 Madison Ave., Suite 901,
New York, NY 10016
© 2008

Photos courtesy of:
Pearon G. Lang, Jr., MD, and
MSKCC Dept. of Dermatology
Photos courtesy of:
Pearon G. Lang, Jr., MD, and
Memorial Sloan Kettering Cancer Center
Deptartment of Dermatology

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

What is 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. In 1992, the NIH recommended that the term “dysplastic nevus” be avoided in favor of more descriptive language.

Cancer

According to the National Cancer Institute, doctors believe that dysplastic nevi are more likely than ordinary moles to develop into a type of skin cancer called melanoma. However, currently, most dermatologists do not believe that dysplastic nevi develop into melanomas. But individuals with multiple dysplastic nevi are at much higher risk for developing melanomas. Because of this, moles should be checked regularly by a doctor or nurse specialist, especially if they look unusual; grow larger; or change in color, or outline; or if any changes occur.

The controversy over the malignant potential of dysplastic nevi is highlighted by the publications and opinions of Dr. Clark and Dr. Ackerman. Essentially, Dr. Clark proposed that the melanocytic nevus evolve into a melanoma in stages - benign to dysplastic, then dysplastic to melanoma. Dr. Ackerman refuted this theory, by proposing that you either have a benign nevus, or a melanoma. There is no transition stage; and the melanoma is a melanoma on day one of its development. Today, most dermatologists believe that an individual with multiple dysplastic nevi do not need to have them all removed. The patient and doctor simply need to be exceedingly careful in identifying a melanoma growing among the dysplastic but benign lesions.

Self skin exam monthly is very important. Some dermatologist recommend that an individual with either histologic diagnosis of dysplastic nevus, or clinically apparent dysplastic nevi should be examined by an experienced dermatologist with dermatoscopy once a year (or more frequently).

To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see “ABCDE” mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy^.

A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”:

• Asymmetrical skin lesion.
• Border of the lesion is irregular.
• Color: melanomas usually have multiple colors.
• Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
• Evolution: The evolution (ie change) of a mole or lesion may be a hint that the lesion is becoming malignant.

The E is sometimes omitted, as in the ABCD guideline. A weakness in this system is the D. Many melanomas present themselves as lesions smaller than 6 mm in diameter; and likely all melanomas were melanomas on day 1 of growth, which is merely a dot a millimeter in size. An astute physician will examine all abnormal moles, including ones less than 6 mm in diameter. Unfortunately for the average person, many seborrheic keratosis, some lentigo senilis, and even warts breaks most if not all of the ABCD rules, and can not be distinguished from a melanoma without a trained eye or dermatoscopy.

A recent and novel method of melanoma detection is the “Ugly Duckling Sign” It is simple, easy to teach, and highly effective in detecting melanoma. Simply, correlation of common characteristics of a person’s skin lesion is made. Lesions which greatly deviate from the common characteristics are labeled as an “Ugly Duckling”, and further professional exam is required. The “Little Red Riding Hood” sign, suggests that individual with fair skin and light colored hair might have difficult to diagnose melanomas. Extra care and caution should be rendered when examining such individuals as they might have multiple melanomas and severely dysplastic nevi. A dermatoscope must be used to detect “ugly ducklings”, as many melanomas in these individuals resemble non-melanomas or are considered to be “wolves in sheep clothing”. These fair skinned individuals often have lightly pigmented or amelanotic melanomas which will not present with easy to observe color changes and variation in colors. The borders of these amelanotic melanomas are often indistinct, making visual identification without a dermatoscope (dermatoscopy) very difficult.

People with a personal or family history of skin cancer or of dysplastic nevus syndrome (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma.

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