Know Your Spots

Even if you have carefully practiced sun safety all summer, it’s important to continue being vigilant about your skin in fall, winter, and beyond.

Throughout the year, you should examine your skin head to toe once a month, looking for any suspicious lesions. Self-exams can help you identify potential skin cancers early, when they can almost always be completely cured.

First, for a successful self-exam, you obviously need to know what you’re looking for.  As a general rule, to spot either melanomas or non-melanoma skin cancers (such as basal cell carcinoma and squamous cell carcinoma), take note of any new moles or growths, and any existing growths that begin to grow or change significantly in any other way.  Lesions that change, itch, bleed, or don’t heal are also alarm signals.

It is so vital to catch melanoma, the deadliest form of skin cancer, early that physicians have developed two specific strategies for early recognition of the disease: the ABCDEs (see: Indentify Your Spots) and the Ugly Duckling sign.

Actinic Keratosis (AK)

Actinic keratosis (AK), also known as solar keratosis, is a precancerous lesion of the epidermis (outer layer of skin) that is caused by long-term exposure to sunlight. Chronic sunlight exposure alters the keratinocytes (cells that make up the majority of the epidermis) and causes areas of your skin to become scaly, rough, discolored and sometimes tender to the touch.

AKs are most commonly found on sun-exposed areas such as the face, lips, ears, neck, scalp, forearms and backs of hands. People who have fair skin and light- colored hair and eyes are at the greatest risk of developing AKs. Individuals who are immunosuppressed, either by cancer chemotherapy treatments or organ transplants, and who have an immuno-deficiency disorder, are also considered high risk for developing AKs.

AKs are not life threatening as long as they are diagnosed and treated in the early stages. If left untreated, aggressive AKs have the potential to progress into squamous cell carcinoma, a serious type of skin cancer. Therefore, it is important to report any suspicious skin lesions to Dr. Bradley.

Treatment Options

Dermatologists often diagnose and treat AKs based on clinical appearance alone, but sometimes a skin biopsy is needed. After a dermatopathologist assesses your skin tissue under a microscope and determines the lesion is an AK, Dr. Bradley will discuss several treatment options with you. Your treatment may vary based on the location, size of the lesion and the amount of AKs you have developed. Your age and general health will also be taken into consideration. Common treatment options are cryosurgery (freezing lesion with liquid nitrogen), topical chemotherapy creams, photodynamic therapy, chemical peels and laser resurfacing therapy.

How Can We Protect Ourselves?

Because chronic overexposure to sunlight is the leading cause of actinic keratosis, sun avoidance, especially during peak sunlight hours of 10 a.m. to 4 p.m., is an important preventive measure to help reduce the risk of developing this precancerous lesion.

Limit skin exposure to the sun’s harmful ultraviolet rays by wearing broad-brimmed hats and protective, tightly woven clothing. Furthermore, use a broad-spectrum sunscreen, rated SPF-30 or higher, on all exposed skin, including the lips, even on cloudy days. Reapply sunscreen frequently. Additionally, avoid tanning salons and artificial tanning devices.

Inspect your entire body regularly for any skin changes, especially those already mentioned, and routinely visit Dr. Bradley for a skin examination.

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

Source: Skin Cancer Foundation

Atypical Nevus

Atypical nevi, also known as atypical moles, are benign lesions that have irregular and indistinct borders, are darker in color, and often larger than normal moles. An Atypical nevus occurs when melanocytic cells that represent your skin color grow in organized clusters instead of being evenly distributed throughout your skin. These atypical nevi generally first appear during adolescence, although they can develop during any period of your life. Family history, overexposure to the sun’s ultraviolet rays, and extreme hormonal changes during puberty and pregnancy are also contributing factors in the development of atypical nevi. Atypical nevi can be found anywhere on the body but are most commonly found in sun-exposed areas such as the back, chest, face, abdomen and extremities.

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Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer. It occurs most frequently on sun-exposed regions of the body. Although this skin cancer rarely spreads (metastasizes) to other organs of the body, it can cause destruction of surrounding tissue. Thus early detection and treatment are needed.

Most basal cell carcinomas are caused by chronic sun exposure, especially in people with fair skin, light hair and blue, green or grey eyes. In a few instances, there are other contributing factors such as burns, exposure to radiation, arsenical intoxication or chronic dermatitis.

Treatment Options

After sections of tissue from a biopsy of your skin are assessed under a microscope by a dermatopathologist and determined to be basal cell carcinoma, Dr. Bradley will discuss several treatment options with you. Dr. Bradley’s choice of therapy depends on the size, location and subtype of basal cell carcinoma. Your age and general health are also taken into consideration. The more common treatment options include excisional surgery, electrosurgery, radiation therapy and Mohs Micrographic Surgery.

How Can We Protect Ourselves?

Because chronic overexposure to sunlight is the leading cause of basal cell carcinoma, sun avoidance, especially during peak sunlight hours of 10 a.m. to 4 p.m., is an important preventive measure to help reduce the risk of developing this skin cancer.

Limit skin exposure to the sun’s harmful ultraviolet rays by wearing sunglasses, broad-brimmed hats and protective, tightly woven clothing. Furthermore, use a broad-spectrum sunscreen, rated SPF-30 or higher, on all exposed skin, including the lips, even on cloudy days. Reapply sunscreen frequently. Additionally, avoid tanning parlors and artificial tanning devices.

Inspect your entire body regularly for any skin changes, especially those already mentioned, and routinely visit Dr. Bradley for a skin examination.

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Identify Your Spots

Do You Know Your A B C D E’s?

Spotting changes in current moles and/or developing lesions early on can help prevent the development and spread of skin cancer. It is important to know what to look for and how to look for it when dealing with early skin cancer detection.

Every month, inspect your entire body for any skin changes and routinely visit your dermatologist for a complete skin examination. Early detection of melanoma can be lifesaving because this cancer may be curable in its early stages. Any irregularity in an existing or newly developed pigmented skin lesion could be a sign of melanoma and should be examined immediately by your dermatologist. These irregularities may include asymmetry, an uneven border, color variations, diameter of more than 6mm or evolving changes of the lesion – all of these irregularities are covered in the ABCDEs of melanoma. If you notice any of the following irregularities in current skin lesions, see Dr. Bradley immediately.

[A] Asymmetry

If you draw a line through this mole, the two halves will not match.

[B] Border

The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.

[C] 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.

[D] 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.

[E] Evolving

Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger.

Melanoma

Melanoma is a serious form of skin cancer of the melanocytes, the cells that produce the dark, protective pigment called melanin. Individual lesions may appear as a dark brown, black or multi-colored growth with irregular borders that can become crusted and bleed. Melanoma may affect anyone at any age and can occur anywhere on the body.

An increased risk of developing this disease is seen in people who have fair skin, light hair and eye color, a family history of melanoma or who have had melanoma in the past. These tumors can arise in or near a preexisting mole or may appear without warning. Melanoma may spread to other organs, making it essential to treat this skin cancer early.

Treatment Options

After sections of tissue from a biopsy of your skin are assessed under a microscope by a dermatopathologist and determined to be melanoma, your dermatologist will discuss several treatment options.

Treatment of melanoma is designed according to several variables including location, extent of spread and aggressiveness of the tumor as well as your general health. Forms of treatment for melanoma include surgical excision, Mohs Micrographic Surgery, chemotherapy, and radiation. Sometimes lymph nodes are removed. Dr. Bradley will help you to better understand these treatment options.

How Can We Protect Ourselves?

Overexposure to sunlight, especially when it results in sunburn and blistering, is a major cause of melanoma. Thus, an important preventive measure to help reduce the risk of melanoma is sun avoidance, especially during peak sunlight hours of 10 a.m. to 4 p.m.

Limit skin exposure to the sun’s harmful ultraviolet rays by wearing sunglasses, broad-brimmed hats and protective, tightly woven clothing. Furthermore, use a broad-spectrum sunscreen rated SPF-30 or higher on all exposed skin, including the lips, even on cloudy days. Reapply sunscreen frequently. Additionally, avoid tanning parlors and artificial tanning devices.

Inspect your entire body for any skin changes and routinely visit your dermatologist for a skin examination. Detecting melanoma early can be lifesaving, since this cancer may be curable in its early stages. Any irregularity in an existing or newly developed pigment skin lesion (asymmetry, uneven border, color variability, diameter of more than 6mm, elevation or bleeding) could be a sign of melanoma and should be examined immediately by a dermatologist.

People with dark complexions can also develop melanoma, especially on the palms of the hands, soles of the feet, under nails and in the mouth. Therefore, these areas of the body should be examined closely on a regular basis.

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Seborrheic Keratoses (SK)

Seborrheic Keratoses (SKs) are common, noncancerous lesions that grow on the epidermis (outer layer of the skin) and can develop on any part of the body. SKs usually begin as rough, itchy bumps and can thicken and darken to a brown or black color over time. They are usually roundor oval-shaped growths with an elevated, rough surface and sometimes seem to be glued to the skin or dropped on like candle wax. Though they may appear to spread, SKs are not contagious.

There is no known cause of SKs to date, but the lesions become more common with age. They are not believed to be caused by the sun’s ultraviolet rays and do not have a higher chance of turning into skin cancer, including melanoma. SKs are not a sign of serious health issues except in very rare instances, when they can develop suddenly in very large numbers and can be associated with internal malignancies.

Although harmless, SKs should be observed regularly, like the rest of your skin, for any changes in size, shape or color. Any growth that bleeds, itches or becomes irritated should be checked by Dr. Bradley.

SK Can Resemble Other Skin Disorders

Warts – Warts are caused by a virus. They are usually not as dark and do not appear to have been pasted on as SKs do.

Actinic Keratoses (AKs) – AKs represent a very early stage of skin cancer and develop on sun-exposed parts of the body. AKs are usually flatter, redder and rougher than SKs.

Moles – Moles (also known as nevi) can be similar in color but are more commonly developed during childhood. Most people develop 20-30 moles during their lifetime.

Melanomas – Melanomas can sometimes be confused with SKs because they can both be dark in color and have irregular shapes.

Treatment Options

Seborrheic keratoses cannot be prevented or cured by medications or creams. Dermatologists often diagnose and treat SKs based on clinical appearance, but sometimes a skin biopsy is needed. After a dermatopathologist assesses your skin tissue under a microscope and determines the lesion is an SK, Dr. Bradley will discuss several treatment options with you. Your treatment may vary based on the location and size of the lesions, taking your age and general health into consideration. Common treatment options include shave removal (cutting off the lesion with a small, flat blade under local anesthesia), cryosurgery (freezing the lesion with liquid nitrogen), curettage (scraping the lesion from the skin) and/or electrosurgery (burning the lesion off with electric current). Since SKs are superficial lesions, their removal causes minimal scarring. Dr. Bradley will help you decide which option is best for you.

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Squamous Cell Carcinoma

Squamous cell carcinoma is a major type of cancer that arises from the outer epidermal layer of the skin and mucous membranes and occurs most commonly on areas exposed to the sun. If untreated, squamous cell carcinoma may penetrate and destroy underlying tissue. In a small percentage of cases, this tumor can spread (metastasize) to distant organs and may be fatal.

Chronic sun exposure is the leading cause of squamous cell carcinoma, especially in people with fair skin, light hair and blue, green or grey eyes. Other factors that may contribute to the development of this cancer include burns, scars, exposure to radiation or chemicals, chronic inflammatory conditions and immunosuppression.

Although more likely to develop in fair-skinned individuals, squamous cell carcinoma may occur in dark-skinned people, especially at sites of preexisting inflammatory conditions or burns.

Signs that may indicate the presence of squamous cell carcinoma include scaly red patches, elevated growth with a central depression, wart-like growths, nodules and open sores. All of these types of lesions may develop a crusted surface or bleed.

Treatment Options

After sections of tissue from a biopsy of your skin are assessed under a microscope by a dermatopathologist and determined to be squamous cell carcinoma, Dr. Bradley will recommend several treatment options. Her recommendation for therapy depends on the size, location and subtype of squamous cell carcinoma. Your age and general health are also taken into consideration. The more common treatment options include excisional surgery, electrosurgery, radiation therapy and Mohs Micrographic Surgery.

How Can We Protect Ourselves?

Because chronic overexposure to sunlight is the leading cause of squamous cell carcinoma, sun avoidance, especially during peak sunlight hours of 10 a.m. to 4 p.m., is an important preventive measure to help reduce the risk of developing this skin cancer.

Limit skin exposure to the sun’s harmful ultraviolet rays by wearing sunglasses, broad-brimmed hats and protective, tightly woven clothing. Furthermore, use a broad-spectrum sunscreen, rated SPF-30 or higher, on all exposed skin, including the lips, even on cloudy days. Reapply sunscreen frequently. Additionally, avoid tanning parlors and artificial tanning devices.

Inspect your entire body regularly for any skin changes, especially those already mentioned, and routinely visit Dr. Bradley for a skin examination.

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Sunscreen Explained

Sun protection at any age is important to prevent the short-term as well as long-term damaging effects of sunlight. Sunscreen plays a major part and should be used in conjunction with other sun-safety steps for optimal sun protection.

A single overexposure to sunlight can result in painful, red, sunburned skin. A bad burn when young can have serious consequences such as skin cancer later in life. Long-term overexposure can cause skin cancer, wrinkles, freckles, age spots, dilated blood vessels, and changes in the texture of the skin that make skin look older.

The sun produces both visible and invisible rays. The invisible rays, known as ultraviolet A (UVA) and ultraviolet B (UVB), cause most of the problems, including suntan, sunburn, and sun damage. There is no “safe” ultraviolet (UV) light, and there is no such thing as a safe tan.

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Common Myths

“Wearing sunscreen can cause vitamin D deficiency.”

There is some controversy regarding this issue, but few dermatologists believe (and no studies have shown) that sunscreens cause vitamin D deficiency. Also, vitamin D is available in dietary supplements and foods such as salmon and eggs, as well as enriched milk and orange juice.

“If it’s cold or cloudy outside, you don’t need sunscreen.”
This is not true. Up to 40 percent of the sun’s ultraviolet radiation reaches the earth on a completely cloudy day. This misperception often leads to the most serious sunburns, because people spend all day outdoors with no protection from the sun.

“80 percent of your sun exposure comes as a child, so it’s too late to do anything now.”
It appears that this universally promoted idea was based largely on a misinterpretation. A recent multi-center study showed that we get less than 25 percent of our total sun exposure by age 18. In fact, it is men over the age of 40 who spend the most time outdoors, and get the highest annual doses of UV rays. And since adult Americans are living longer and spending more leisure time outdoors, preventing ongoing skin damage will continue to be an important part of a healthy lifestyle.

Buy a high-quality product with an SPF of 30 or higher; check its ingredients to make sure it offers broad-spectrum protection; and decide whether it works better for everyday incidental use or extended outdoor use. Finally, look for The Skin Cancer Foundation’s Seal of Recommendation, which guarantees that a sunscreen product meets the highest standards for safety and effectiveness. Once you choose the right sunscreen, use it the right way. But remember, you should not rely on sunscreen alone to protect your skin against UV rays. By following our guidelines, you can lower your risk of developing skin cancer, while helping your skin look younger, longer.

Changing South Florida One Patient at a Time

We are here to help, and as experts in our field we’re confident we can do the best job for you. Call (954) 634-1595 to schedule a consultation with us today and let us help improve your quality of life.