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Growths on our skin are very common. As our barrier to the environment, our skin comes up against numerous conditions that work to change it. Indeed, change is an ongoing process in the skin as it continually turns over and renews.
Genetics and age itself also bring change in the make-up of the skin. Often times patients of mine question whether or not to be concerned with a new or changing growth on the skin.
This blog will highlight some common and important skin findings.
What does Seborrheic Keratosis look like? Patients are often concerned about these growths because they come up fast, are dark and are raised. These skin lesions grow atop the underlying skin layers and do not replace the skin. Seborrheic keratoses are distinguished by their waxy "pegs," or white spots in the body of the growth.
What causes Seborrheic Keratosis? These lesions tend to run in families and have a genetic component.
How is Seborrheic Keratosis treated? In general, they are not removed unless they are bothersome or cosmetically undesirable.
What does Actinic Keratosis look like? Commonly, AK's are small, rough and raised areas found on the face, scalp or arms.
What causes Actinic Keratosis? These skin lesions are due to sun damage. Actinic keratosis (AK) is common, affecting one in six Americans.
How is Actinic Keratosis treated? While AK's are not skin cancer, they have a potential to turn into skin cancer. For this reason, they are generally treated. Treatment involves using liquid nitrogen or a prescription cream. Liquid nitrogen creates a predictable injury to the skin and recruits the body's immune system that, in turn, repairs the damage from the AK. Creams as treatment also work to accomplish the same goal recruiting the body's immune system.
What does Basal Cell Cancer look like? They are present on highly exposed areas of the skin. Basal cell lesions are characterized by appearing "dome-like" with a pearly sheen and neovascularization (new growth of blood vessels).
What causes Basal Cell Cancer? Basal cell skin cancers are caused from excessive sun exposure.
How is Basal Cell Cancer treated? It is highly unusual for basal cell skin cancers to metastasize so they are not considered life-threatening. They will, however, continue to grow and erode until they are removed completely. Once every cell of the basal cell lesion is removed, it is cured. If on an expansive area of the skin, a basal cell can be removed in an office with the cut-out specimen sent to pathology to determine that it was completely removed. If the lesion is on a tricky area like the nose or an ear, the Moh's microsurgical procedure will be performed. This procedure involves removing the growth methodically to get the abnormal tissue and preserve as much normal tissue as possible. More advanced suturing technique is used to bring the skin together for good effect.
What does Squamous Cell Skin Cancer look like? They are present on highly exposed areas of the skin. Squamous cell lesions appear as an excessive, focal irritation or as a sore that will not heal.
What causes Squamous Cell Skin Cancer? Squamous cell skin cancers are also caused from excessive sun exposure.
How is Squamous Cell Skin Cancer treated? Like basal cell cancers, it is highly unusual for squamous cell skin cancers to metastasize and they are not considered life-threatening. They are removed in total so that they do not spread and continue to cause damage. Squamous cell skin lesions are removed in the same way that basal cell lesions are removed.
Moles in general are focal discolorations and changes in the skin. The most worrisome mole is melanoma, a malignant transformation of the skin that afflicts around 60,000 Americans each year. Melanoma has the potential to metastasize to other areas of the body and is life threatening. Excessive sun exposure is the main cause of melanoma. Besides prevention with sunscreen and avoidance of the sun, early detection is important in minimizing harm.
The following is simple acronym tool to use in evaluating a mole:
The ABCD Skin Exam
Asymmetry - more concerning moles are not regular and symmetric (like a circle)
Border - more concerning moles have a jagged or irregular border
Color change - more concerning moles have more than one color and lack uniformity
Diameter - more concerning moles are greater than 5 mm (or the size of a pencil eraser)
Any level of concern for melanoma warrants a skin biopsy. If melanoma is discovered, a wide removal is performed and chemotherapy may be required as further therapy.
Remember, if there is any uncertainty or concern, see your doctor for further evaluation. While we cannot undo what has been done in the past to our skin, we can work to prevent further damage with sunscreen and sun avoidance.
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