Skin Cancer Screening and exams
- Here at Pure Dermatology & Cosmetic Center, we recommend annual full-body skin evaluation in order to detect skin cancer or skin pre-cancers in all patients starting in the late teenage years. During these full-body skin exams, we discuss and look for the 3 main forms of skin cancer – Basal Cell Carcinoma, Squamous Cell Carcinoma, or Malignant Melanoma – the most lethal of the three. While Basal cells and Squamous cell skin cancers are common on chronically sun-exposed areas of the skin, Melanomas are related to “holiday burns” and tend to have a genetic predisposition. Since melanoma can be deadly, and the is the #1 cancer killer in women in their 20s, the key is early detection. Melanomas caught in the early stages (before spreading to lymph nodes) have an excellent survival of 95% after 5 years. In contrast, late detection can be catastrophic for both patients and their families.
- During your annual full-body skin examination, our providers will discuss the “ABCDEs” of melanoma and discuss how to detect them, safe sun-protective measures, and monthly self-skin assessments at home – All of which are recommended by the American Academy of Dermatology.
- Actinic keratosis (AKs), or skin precancers, are scaly growths that are typically pink dry and flaky on sun-exposed skin. They generally come and go with sun-exposure, and tend to affect people who are fair-skinned and live in sunny environments (like ours in Newport Beach California!). Most patients who develop AKs have a history of chronic sun exposure or frequent sunburns. These scaly DNA-damaged growths typically occur on areas repeatedly exposed to the sun, such as the face, tops of hands, V of chest and the balding scalp.
- The main concern over these spots is that they predispose affected patients to squamous cell carcinoma (SCC), a skin cancer that if left untreated, may spread. Approximately 10% of AKs progress into a SCC, in particular with chronic sun exposure, specifically from UV B radiation. Because patients with AKs are sun damaged, they have a higher rate of developing not only SCCs, but Basal Cell Carcinomas (BCC), Melanomas, & other more rare forms of skin cancer such as Merkel cell carcinomas.
- We tend to use liquid nitrogen (LN2) to “freeze” the thick skin pre-cancers (AKs), but also know that the sun did not shine one UV ray to the skin cells of the AK, but also to the surrounding skin cells. That is why we often opt to treat our patients preventatively for their “background” non-hypertrophic AKs with “field treatment”, either in the form of a chemotherapy cream we prescribe to their pharmacy OR (and sometimes in addition) with an in-office light treatment called “PhotoDynamic Therapy” or PDT.
Skin tags are a common growth that develop in both men and women as they grow older. Skin tags typically are flesh colored or sometimes darker and can range in size. The most common areas of skin tags are in areas where there is more friction such as: groin, neck, armpits. Skin tags are most common in people who have obesity or type 2 diabetes. The common care for skin tags is the removal of them by Liquid Nitrogen or Cauterization, or simply cutting them off by a trained physician.
Squamous Cell Carcinoma (SCC)
Squamous Cell Carcinoma is a more aggressive type of skin cancer than a Basal Cell Carcinoma (BCC), as it occasionally spreads to lymph nodes
SCC usually has a precursor lesion which is called: Actinic Keratosis. We treat AK’s a few different ways:
- Liquid Nitrogen to the lesions
- Chemotherapy Creams
- Salicylic Chemical Peels
- PDT (Photodynamic Therapy)
If the AK has turned into an SCC, we perform either Mohs surgery or an excision based on the area of the skin cancer.
Basal Cell Carcinoma (BCC)
Basal Cell Carcinoma is a slow growing form of skin cancer that needs to be treated, not because it causes death (rare for BCCs) but because they can go down to bone and be damaging over a long period of time.
Usually treated with Mohs surgery by Dr. Nguyen in our office if on face, neck, tops of hands, pretibial (ie shins/lower legs) or in areas of severe sun damaged skin or if the spot is recurrent (previously treated and came back)
BCC’s are also treated with cutting it out (excision) by the provider who initially biopsied the spot or ED&C (electrodessication and curettage) by our PA if indicated.
Some cases can be treated with chemo creams (imiquimod or Efudex)
Melanoma is one of the most aggressive and life threatening types of skin cancers. Melanomas are mostly superficial and can be taken out by surgery as long as it’s treated in the early stages.
Melanomas typically have a precursor to them that can arise from otherwise normal-appearing skin. Some freckles or moles that start to change can be a sign of Melanoma.
ABCDE’s of Dermatology
These are the indicators to look out for if you have a suspicious mole or lesion on the body. If you fall into any of these categories, give our office a call so we can further examine the mole/lesion or perform a full body skin examination.
A: Asymmetry of shape and color
B: Border irregularity including smudgy or ill-defined margin
C: Color variation and Change
D: Different (formerly diameter)
E: Evolving (enlarging, changing)
Photodynamic Therapy (PDT) for Actinic Keratosis (AKs)
- The most popular option that we recommend to most of our patients with Aks is Photodynamic Therapy (PDT) is a treatment used mainly for the treatment of skin pre-cancers (called Actinic Keratosis) and has FDA approval for the treatment of these rapidly dividing skin pre-cancers. It is also commonly used off-label for facial skin rejuvenation, as well as the treatment of mild to moderate acne.
- PDT utilizes Levulan (Aminolevulinic acid), a naturally occurring photosensitizing compound, to create a photochemical reaction that selectively destroys cancer cells. Levulan is applied to the skin and is subsequently “activated” by specific wavelengths of light.
- The treatment of wide-spread skin pre-cancers with PDT occurs in three main stages. First, the Levulan medication is applied to the treatment area and is left on the skin anywhere from 10 minutes to 1 hour. This allows for the medication to penetrate into the pre-cancer cells. The next step is placing the light over the treatment area to ‘activate’ the medication. The light shines on the area from either 10-30 minutes depending on your incubation time. Lastly, a topical steroid and sunscreen is applied to help calm the skin. Typically patients treat the same area twice spaced one month apart to get the optimal treatment.
PDT Home Care Instructions
Day of Treatment
- You may apply an ice pack or cool water to the treated areas if needed. This will help keep the area cool and alleviate any discomfort as well as help keep swelling down.
- Use Advil or Tylenol for discomfort if needed.
- Protect yourself from the sun! Use a wide brimmed hat and sunscreen with an SPF of 30 or greater. Your skin will be VERY sensitive to the light for 48 hours. Stay indoors with as little light exposure as possible. You may leave the house after 48 hours. Make sure you are applying sunscreen frequently during your healing process.
- You may shower the day after your treatment. Continue with steps above. The discomfort usually subsides between 48-72 hours following the treatment.
- If blisters form, you should soak the areas with a solution of 1 teaspoon of white vinegar and 1 cup of cold water. Ice should be applied directly over vinegar soaks. Soak for 20 min. Pat the area dry and apply the Calming Cream from our office, (or Aquaphor and Hydrocortisone). Follow this step every 4-6 hours during the hours you are awake.
- Re-apply Aquaphor or Calming Cream as needed. The treated area will be dry and tight. Keep using moisturizer to help hydrate your skin.
- You may begin using make-up or shaving once the crusting, if any, has healed. This usually occurs 5-10 days following the treatment.
- Avoid getting any sun 2 weeks after the treatment. The treated area will be very photosensitive to sun exposure and pigment changes may occur. Re-apply your sunscreen at least 2 times a day.
- Your skin may be red for up to 2 weeks. Please call our office if.
Rashes may be due to skin allergies, eczema, psoriasis, fungal infections or other less common causes of skin rashes. Call Pure Dermatology & Cosmetic Center for your consultation and treatment based on the specific condition leading to your rash.
Warts & Molluscum Contagiosum
Warts & Molluscum can be cumbersome viral skin infections that can persist for years without treatment. The Professional Healthcare providers at Pure Dermatology & Cosmetic Center can treat your wart with liquid nitrogen, Cantharadin (“blistering beetle juice”), injections of immunotherapy (“Candida Antigen”), topical imiquimod or retinol creams, or shave excisions.
Acne is caused by enlargement of the oil gland (which is stimulated by genes, stress, diet & hormones), which leads to oil gland overproduction. When oil is overproduced, the channel that delivers the oil, the skin pore, becomes enlarged. This leads to natural bacteria on our skin to “fall” into the open pore and cause an inflammation/infection. The excessive oil overproduction also causes the top epidermal cells to get clogged, leading to the skin pore to trap dead skin and bacteria in the oil gland. When the pressure is too much, the oil gland and pore can rupture, leading to big cystic acne and lead to severe scarring. So the treatment should be directed at the cause of the acne:
- Enlarged oil gland (with topical tretinoin aka “retinol”)
- Sterilizing the natural bacteria on the skin (with topical antibacterial ie: benzoyl peroxide or topical antibiotic)
- Exfoliating off the top layer of clogged skin cells (with monthly peels/Hydrafacials & at home “peel pads”)