Services

• Acne
  • ClearLight
  • Photo Dynamic Therapy
• Eczema
• Psoriasis
• Pigmentation Abnormalities
  • Vitiligo
  • Melasma
• Skin Cancer
  • Types of Skin Cancer
  • Treatment Options
    • Photo Dynamic Therapy
    • 5-Fluorouracil-Efudex, Carac
    • Aldara
    • Cryosurgery
• Skin Cancer Surgery / Mohs

Skin Cancer

Skin cancer is the most prevalent of all cancers, affecting more than 1 million Americans every year. While heredity and environment contribute to its causes, sunburn and UV light inflict most of the damage that leads to skin cancer. And since most people receive between 50 and 80 percent of their lifetime exposure to the sun by the age of 18, sun protection has become more important now than ever before.

People with a family history of skin cancer face a higher risk of developing the disease, and those most susceptible appear to have fair skin and a northern European heritage. Environmental factors also strengthen the risk. A reduction of the earth’s ozone has increased the level of UV light exposure above what we experienced 100 or even 50 years ago.

Types of Skin Cancer

Actinic keratoses (AK) patches or lesions mark the earliest stage of skin cancer development. These small, scaly spots typically occur on the face, ears, neck, scalp, hands, arms and legs of people who have experienced significant sun exposure. AKs can form above or below the skin’s surface, are only a few millimeters in size, and can be flat or raised. They are typically harmless, but 20 percent of them may become cancerous, and patients can have up to 10 times as many undetected AKs under the skin’s surface as visible ones.

Basal cell carcinoma (BCC) is the most common type of skin cancer and appears frequently on the head, neck and hands as a small, fleshy bump, nodule or red patch. These slow-growing tumors do not spread to other areas of the body, but if left untreated they often begin to bleed, crust over, heal and repeat the cycle. Basal cell carcinoma can also extend below the skin to bones and nerves, causing considerable local damage.

Squamous cell carcinoma (SCC) is the second most common skin cancer and typically appears as a bump or red, scaly patch on the face, lips, mouth or rim of the ear. Squamous cell carcinoma can invasively develop into large masses, then spread to other parts of the body. Therefore, it’s very important to seek early treatment.

Malignant melanoma is the most deadly of all skin cancers, but is completely curable when treated early. Melanoma tumors grow from melanocytes—cells that make pigment in the skin—and are typically tan, brown, black, white or even red. Melanoma may appear suddenly or begin in or near a mole or other dark spot in the skin. It’s important to know the location and appearance of moles on the body to detect changes as early as possible. A dermatologist should examine any mole that changes, since early melanoma can be removed while still in its curable stage.

Recognizing Skin Cancer

Some skin cancers are quite obvious while others are subtle. Visit a dermatologist if you notice new growth that does not look like other moles: a mole that changes in size, texture or color; or a mole that bleeds, itches or is painful. People with a personal history of skin cancer or precancerous growth, a family history of melanoma, or more than 50 moles should have a full skin exam annually.

Prevention of Skin Cancer

Overexposure to ultraviolet light, whether from sunlight or tanning lamps, is the most preventable risk factor for skin cancer. Since between 50 and 80 percent of sun exposure occurs during the first 18 years of life, routine sun protection is critical. Wear sunscreen with an SPF of 15 or higher daily and reapply after swimming or sweating.

Treatment of Skin Cancer

When a patient’s skin biopsy reveals cancer, Raleigh Dermatology considers an array of medical and surgical treatment procedures, depending on the type of cancer, its location and the patient’s needs. Surgical treatments include electrodessication and curettage (ED&C), which involves alternately scraping or burning the tumor in combination with low levels of electricity; cryosurgery, which involves freezing the tumor using liquid nitrogen; and laser surgery. Mohs micrographic surgery is a special procedure that removes the entire tumor while sparing as much normal skin as possible.

Treatment Options for Actinic Keratoses (AK) Lesions

Photo Dynamic Therapy (PDT) offers a non-invasive, two-step treatment for AK lesions that have not yet expanded or thickened on the face or scalp. PDT combines light and a clear, topical, light-activated solution called Levulan that targets and destroys AKs. Raleigh Dermatology applies Levulan to the lesion and leaves it on for 60 minutes. BLU-U, a specific wavelength of light, activates the Levulan for 20 minutes. Targeted AK cells absorb the Levulan and become sensitive to the light. We then remove the Levulan and administer the light treatment, which successfully destroys the AKs.

Solaraze is a clear, colorless to pale yellow non-greasy gel containing the drug diclofenac sodium, a non-steroidal anti-inflammatory drug. Patients typically smooth a small amount of the gel onto the affected skin twice a day. Diclofenac inhibits production of a substance called cyclo-oxygenase, which is involved in the production of prostaglandins and other chemicals in the body. This inhibiting action reduces prostaglandin production. Solaraze gel is thought to reduce a specific prostaglandin called PGE2.

Solaraze gel should not be applied to open skin wounds, infections or inflamed, scaly skin. Patients should wash their hands thoroughly after using Solaraze gel, and stay out of the sun or cover skin while outdoors during the treatment period, which typically lasts 60 to 90 days.

Fluorouracil safely and effectively targets and eliminates abnormal AK cells above and below the skin’s surface before they progress into a more aggressive AK or squamous cell carcinoma. Raleigh Dermatology prescribes several fluorouracil creams to treat AK cells, including Efudex®, Fluoroplex® and Carac®. Patients should apply just enough fluorouracil to cover the lesion and avoid the corners of the eyes, eyelids and corners of the nose and mouth unless directed otherwise. Most dermatologists prescribe that patients apply the cream twice a day for two to four weeks.

Patients experience four phases of symptoms during treatment. Mild inflammation occurs during the early inflammatory phase. Next, during the more intense inflammation phase, redness and swelling with some crusting and burning occurs. During the tumor disintegration phase, lesions resolve as the skin exfoliates. Finally, new skin grows into the treatment area over a two-week healing phase. Complete healing occurs within two months after the treatment ends and patients experience healthy skin again.

Cryosurgery (freezing) using liquid nitrogen can also remove AK lesions. Often, Fluorouracil is used prior to or following cryosurgery as interval therapy in patients with severe AK lesions.

Raleigh Dermatology may prescribe Aldara (Imiquimod) cream for patients with AK cells. Aldara works by activating immune cells to travel to targeted AK cells and eliminate them before they progress into a more aggressive AK or squamous cell carcinoma. Aldara cream should be applied in 2-by-2-inch patches to the treatment area once a day for two days a week, three to four days apart. Patients should wash off the Aldara cream after eight hours, and treatment typically continues for 16 weeks. Patients may experience some reddening, peeling, swelling, burning or itching at the targeted area.