Ron Shelton MD Newsletter - Skin Cancer Has Many Appearances

Skin Cancer Has Many Appearances
Please your sunscreen wisely this Summer.

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July 2017 Newsletter

Skin Cancer Has Many Appearances Please use your sunscreen wisely this Summer.

BASAL CELL CARCINOMA (Skin Cancer) of the Right Nostril. Somewhat translucent at the edge with fine capillary blood vessels and a central indentation.

This is the most common form of skin cancer. It can appear pink and flat or white and flat. It can become raised and have an ulcer in the center. Anything that changes size, color, border becoming irregular, bleeding (if you note blood after rubbing with a towel don’t shrug it off!), different colors, a lack of homogeneity, or a lack of symmetry should be shown to your dermatologist.
Despite basal cell carcinoma not tending to metastasize (spread to distant areas) the skin cancer will continue to grow widely and deeply causing an eventual ulceration (hole) that doesn’t heal. It can spread inwards to important areas by direct growth.

Non-healing wound found to be a basal cell carcinoma as shown in the photograph below:

Some basal cell carcinomas have brown pigment in them such as seen on the eyelid in the photograph below:

Some basal cell carcinomas are treated with a prescription cream, a scraping and cauterizing (burning) procedure done with local anesthetic, excisional removal, radiation therapy and others which need tissue conservation or those at higher chance of recurrence can be treated by Mohs micrographic surgery.

Other skin cancers are called SQUAMOUS CELL CARCINOMAS. When they are diagnosed early they are fully curable but larger, deeper and recurrent squamous cell skin cancers can metastasize. They may start in normal sun exposed skin or they may develop from an actinic (solar) keratosis. These keratoses are small rough spots, usually slightly red at the base and are often more readily felt than seen.

Actinic (solar) keratosis on the top of the hand near the base of the index finger. A thicker form of the same is seen on the side of the index finger. A biopsy was done and no invasive squamous cell carcinoma was found fortunately.

SQUAMOUS CELL CARCINOMA. These skin cancers are usually very hard or rough. They may even be tender to the touch. A pink or red color is usually seen at the surrounding base..

Some squamous cell skin cancers are very flat but rough and others can get quite thick.

MELANOMA SKIN CANCER grows at different rates depending on many different factors. Early diagnosed melanomas can be fully curable, but neglected tumors can spread to different organs. This metastasis can occur faster than with other skin cancers. Melanomas usually have some different shades of brown in their clinical appearance, but blue, grey, white and red can be seen as well. Any enlarging mole, brown spot, or any colored mark that changes should be checked.

Above, MELANOMA-in-situ (prior to becoming spreadable). Tan and dark brown. The lighter color around it is where a prior doctor had done a chemical peel twenty years before to lighten a dark spot.

Not all melanomas are dark brown. Below is an invasive melanoma on the back of the arm of a female golfer who always wore short sleeves and was unaware of this growth.

The following photos are of different melanomas.

Invasive Melanoma of the right cheek

The below is a disturbing history of a patient that was seeing a doctor who repeatedly, over some years, kept freezing what was thought to be a benign sunspot. He hadn’t seen his doctor for a while and saw me for the first time. When I told him it would need a biopsy, he didn’t believe me and just wanted it to be frozen again. My biopsy revealed it was a deeply invasive melanoma.

As melanomas become deeper their chance of spreading increases. At early stages the disease can be fully curable, but once diagnosed even with a “pre” melanoma (melanoma-in-situ) one is never “out of the woods.” Careful surveillance with skin checks is advisable,multiple times per year, and please observe safe sun, use of sunscreen, and perform self skin exams. Reporting to your dermatologist any changes of pre-existing lesions if you notice a change in shape, color, border becoming irregular, height, itching, soreness or bleeding could be life-saving.

DON’T START TO PANIC. NOT EVERYTHING THAT LOOKS LIKE THE ABOVE PHOTOS ARE DIAGNOSED AS CANCER.

You may start to look at your own spots and see that there are growths that may look very alarming to you but they may be benign as shown in the following photos:

A biopsy-proven benign (non-cancerous) seborrheic keratosis

An inflamed benign seborrheic keratosis (biopsy-proven)

A benign blue nevus of the scalp.

ACTINIC KERATOSIS (AK) : An actinic keratosis is a precancerous rough lesion that can be so small that it is more readily felt than seen. While others can be quite evident small in diameter but thick and others An be very wide but thin. A minority of AKs that are left untreated do develop into more serious squamous cell carcinomas.

Please see your dermatologist for a full body examination and annual follow-up. Wear your sunscreen (greater than SPF 15, and preferably with a Ultraviolet A blocker as well), avoid sunbathing and suntan parlors, try to avoid mid day sun, wide-brimmed hats and cover your skin when you are exposed to intense sun, and see your dermatologist in between examinations should you see a new spot develop that doesn’t go away in three to four weeks, or if a preexisting growth changes in size, color, symmetry, border, persistently itches, hurts or bleeds.

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I would like to remind my patients that I do not practice general dermatology, nor do I perform total body examinations.
Please continue to see your referring general dermatologist for these checks.

Remember to use your sunscreen and take at least 1000mg of Vitamin D3 per day by mouth, as your skin will lose the ability to make vitamin D without ultraviolet exposure.

Please call to schedule a consultation with Dr. Shelton if you’re interested in discussing the advances in technology that are now available. As a prior patient of Dr. Shelton, there will be no consultation fee for the visit.

Phone: (212) 593-1818

www.Thenyac.Com