"Prompt action is your best protection. Treated early, almost all skin cancers can be effectively eliminated."
Skin cancer is the most prevalent of all cancers. Estimates vary on its occurrence but it is estimated that approximately 700,000 Americans develop skin cancer every year. Our clinicians are trained for the identification, removal of cancer, and reconstructive surgery.
Our facility is a Pennsylvania state-approved Surgical Center, adhering to the strict standards of an operating room environment. In addition to our clinicians, the staff includes Advanced Cardiac Life Support (ACLS)-certified nurses, operating room technicians, medical assistants.
Our professional staff and over 5,000 square-foot facility houses eight procedure rooms and two operating theaters. This allows our patients to feel at ease during their treatment.
ACTINIC KERATOSIS
An actinic keratosis (AK), also known as a solar keratosis, is a scaly or crusty bump that arises on the skin surface. The base may be light or dark, tan, pink, red, or a combination of these. . . or the same color as your skin. The scale or crust is horny, dry, and rough, and is often recognized by touch rather than sight. Occasionally it itches or produces a pricking or tender sensation. It can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.
An AK is most likely to appear on the face, ears, scalp, neck, backs of the hands and forearms, shoulders, and lips - the parts of the body most often exposed to sunshine. The growths may be flat and pink or raised and rough.
AK can be the first step in the development of skin cancer. It is thus a precursor of cancer or a precancer.
If treated early, almost all AKs can be eliminated without becoming skin cancers. But untreated, about thirty percent of these lesions may progress to squamous cell carcinomas. In fact, some scientists now believe that AK is the earliest form of SCC. These cancers are usually not life-threatening, provided they are detected and treated in the early stages. However, if this is not done, they can grow large and invade the surrounding tissues and, on rare occasions, metastasize or spread to the internal organs. Another form of AK, actinic cheilitis, develops on the lips and may evolve into a type of SCC that can spread rapidly to other parts of the body.
Question: What are the causes of AKs?
Chronic sun exposure is the cause of almost all AKs. Sun damage to the skin accumulates over time, so that even a brief exposure adds to the lifetime total. If you have AKs, it indicates that you have sustained sun damage and could develop any kind of skin cancer - not just squamous cell carcinoma. The more keratoses that you have, the greater the chance that one or more may turn into skin cancer. People may also have up to 10 times as many subclinical (invisible) lesions as visible, surface lesions.
Chronic sun exposure is the cause of almost all AKs. Sun damage to the skin accumulates over time, so that even a brief exposure adds to the lifetime total.
The likelihood of developing AK is highest in regions near the equator. However, regardless of climate, everyone is exposed to the sun. About 80 percent of solar UV rays can pass through clouds. These rays can also bounce off sand, snow, and other reflective surfaces, giving you extra exposure.
AKs can also appear on skin that has been frequently exposed to artificial sources of UV light (such as tanning devices). More rarely, they may be caused by extensive exposure to X-rays or specific industrial chemicals.
People who have fair skin, blonde or red hair, and/or blue, green, or gray eyes are at greatest risk. Because their skin has little protective pigment, they are most susceptible to sunburn. But even darker-skinned people can develop AKs if exposed to the sun without protection.
Individuals whose immune systems are weakened as a result of cancer chemotherapy, AIDS, or organ transplantation are also at higher risk.
AK is the most common type of precancerous skin lesion. Older people are more likely than younger ones to develop these lesions, because cumulative sun exposure increases with the years. Some experts believe that the majority of people who live to the age of 80 will have AK.
On average, however, more than half of our lifetime sun exposure occurs before age 20. Thus, AKs also appear in people in their early twenties who have spent too much time in the sun with little or no protection.
Question: What are the treatments for actinic keratoses?
There are many effective methods for eliminating AKs. All cause a certain amount of reddening, and some may cause scarring, while other approaches are less likely to do so. You and Dr. Vujevich should decide together the best course of treatment, based on the nature of the lesion and your age and health.
Cryosurgery
The most common treatment for AK, it is especially effective when a limited number of lesions exist. No cutting or anesthesia is required. Liquid nitrogen is applied to the growths with a spray device or cotton-tipped applicator to freeze them. They subsequently shrink or become crusted and fall off. Some temporary swelling may occur after treatment, and in dark-skinned patients, some pigment may be lost.
Topical Medications
Medicated creams and solutions are especially useful in removing both visible and invisible AKs when the lesions are numerous. The patient applies the medication according to a schedule worked out by Dr. Vujevich. During treatment, some discomfort may result.
5-fluorouracil (5-FU) cream or solution, in concentrations from 0.5 to 5 percent, is the most widely used topical treatment for AK. It works especially well on the face, ears, and neck. Some swelling and crusting may occur.
Another preparation, imiquimod cream is also being used by physicians for multiple keratoses. FDA-approved, it causes cells to produce interferon, a chemical that destroys cancerous and precancerous cells.
Preventative Steps
The best way to prevent actinic keratosis is to protect yourself from the sun. Here are some sun safety habits that can be part of everyone's daily health care.
1. Avoid unnecessary sun exposure, especially during the sun's peak hours (10 AM to 4 PM) and if possible seek the shade.
2. Cover up with clothing, including a broad-brimmed hat, long pants, a long-sleeved shirt, and UV-blocking sunglasses when you do go out into direct sunlight..
3. Wear a broad-spectrum sunscreen with a sun protection factor (SPF) of 30.
4. Keep newborns out of the sun. Sunscreens can be used on babies over the age of six months. Teach children good sun-protective practices.
5. Examine your skin from head to toe once every month and have a dermatologist examine your skin annually.
BASAL CELL CARCINOMA & SQUAMOUS CELL CARCINOMA
Basal cell carcinoma (BCC) is the most common form of skin cancer, affecting 800,000 Americans each year. In fact, it is the most common of all cancers. One out of every three new cancers is a skin cancer, and the vast majorities are BCCs. These cancers arise in the basal cells, which are at the bottom of the epidermis (outer skin layer). Until recently, those most often affected were older people, particularly men who had worked outdoors. Although the number of new cases has increased sharply each year in the last few decades, the average age of onset of the disease has steadily decreased. More women are getting BCCs than in the past; nonetheless, men still outnumber them greatly.
Chronic exposure to sunlight is the cause of almost all basal cell carcinomas, which occur most frequently on exposed parts of the body -- the face, ears, neck, scalp, shoulders, and back. Rarely, however, tumors develop on non-exposed areas. In a few cases, contact with arsenic, exposure to radiation, and complications of burns, scars, vaccinations, or even tattoos are contributing factors.
Anyone with a history of frequent sun exposure can develop basal cell carcinoma, often referred to as BCC. But people who have fair skin, light hair, and blue, green, or gray eyes are at highest risk. Those whose occupations require long hours outdoors or who spend extensive leisure time in the sun are in particular jeopardy. Dark-skinned individuals are far less likely than fair-skinned to develop skin cancer. More than two-thirds of the skin cancers that they do develop, however, are squamous cell carcinomas, usually arising on the sites of preexisting inflammatory skin conditions or burn injuries.
The five most typical characteristics of basal cell carcinoma are listed here. Frequently, two or more features are present in one tumor. In addition, basal cell carcinoma sometimes resembles non-cancerous skin conditions such as psoriasis or eczema. Only a trained physician, usually a specialist in diseases of the skin, can decide for sure. Learn the signs of basal cell carcinoma, and examine your skin regularly -- as often as once a month if you are at high risk. Be sure to include the scalp, backs of ears, neck, and other hard-to-see areas. (A full-length mirror and a hand-held mirror can be very useful). If you observe any of the warning signs or some other change in your skin, consult us immediately. We advise everyone to have a total body skin exam by a qualified skin specialist at regular intervals. We can suggest the correct time frame for follow-up visits, depending on your specific risk factors, such as skin type and history of sun exposure.
An Open Sore that bleeds, oozes, or crusts and remains open for three or more weeks. A persistent, non-healing sore is a very common sign of an early basal cell carcinoma.
A Reddish Patch or irritated area, frequently occurring on the chest, shoulders, arms, or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.
A Shiny Bump or nodule, that is pearly or translucent and is often pink, red, or white. The bump can also be tan, black, or brown, especially in dark-haired people, and can be confused with a mole.
A Pink Growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.
A Scar-like Area which is white, yellow or waxy, and often has poorly defined borders. The skin itself appears shiny and taut. Although a less frequent sign, it can indicate the presence of an aggressive tumor.
MELANOMA Melanoma is the most serious form of skin cancer. Even so, if diagnosed and removed while it is still thin and limited to the outermost skin layer, it is almost 100% curable. Once the cancer advances and metastasizes (spreads) to other parts of the body, it is hard to treat and can be deadly. During the past 10 years the number of cases of melanoma has increased more rapidly than that of any other cancer. Over 51,000 new cases are reported to the American Cancer Society each year, and it is probable that a great many more occur and are not reported.
Melanoma is the most serious form of skin cancer. To reach a more complete understanding, it is necessary to learn how the cells in the body become malignant.
Melanoma is a malignant tumor that originates in melanocytes, the cells which produce the pigment melanin that colors our skin, hair, and eyes and is heavily concentrated in most moles. The majority of melanomas, therefore, are black or brown. However, melanomas occasionally stop producing pigment. When that happens, the melanomas may no longer be dark, but are skin-colored, pink, red, or purple.
Melanomas fall into four basic categories. Three of them begin in situ and sometimes become invasive; the fourth is invasive from the start. It is helpful to recognize the names and be able to define the characteristics of each type.
Superficial Spreading Melanoma
This is by far the most common type, accounting for about 70 percent of all cases. As you might expect, this melanoma travels along the top layer of the skin for a fairly long time before penetrating more deeply.
The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat geometrical in form. The color varies, and you may see areas of tan, brown, black, red, blue, or white. Sometimes an older mole will change in these ways, or a new one will arise. The melanoma can be seen almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both. Most melanomas found in the young are of the superficial spreading type.
Lentigo Maligna
This is similar to the superficial spreading type, as it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown, or dark brown discoloration.
This type of in situ melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms, and upper trunk. Lentigo maligna is the most common form of melanoma in Hawaii. Lentigo maligna melanoma is the invasive form of this type of melanoma.
Acral Lentiginous
The third type of melanoma, acral lentiginous melanoma, also spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. This type of melanoma is sometimes found in dark-skinned people. It is the most common melanoma in African-Americans and Asians, and the least common among Caucasians.
Nodular Melanoma
Unlike the other three types, nodular melanoma is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. The color is most often black, but occasionally is blue, gray, white, brown, tan, red, or skin tone.
Malignant melanomas
Malignant melanomas are usually small brown-black or larger multicolored patches, plaques or nodules with irregular outline. They may crust on the surface or bleed. Many of them may arise in pre-existing moles.
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Actinic Keratosis
Typical Causes of AK
Treatment for Actinic Keratosis
Cryosurgery
Topical Medications
Preventative Steps
Basal Cell Carcinoma
Melanoma
Superficial Spreading Melanoma
Lentigo Maligna
Acral Lentiginous
Nodular Melanoma
Malignant melanomas |
