Transcript Skin Disorders and Treatment

By: Joshua D. Sparling, M.D., F.A.A.D.
Franklin Health Dermatology
Franklin Memorial Hospital
February, 2010
1.
I have no financial incentive or conflict of interest from
anything which will be discussed in this presentation.
2.
This presentation’s purpose is purely to increase public
knowledge in skin issues and not for individual diagnosis
and treatment.
3.
If you have specific questions about your own health, please
see your primary care provider first and they may refer you to
me or another dermatologist. However, I would be happy to
answer general questions at the end of the presentation.
4.
Dermatology is by definition a visual field. Some photos may
be considered graphic in nature and may be shown without
warning.
5.
If I use words you don’t understand, please interrupt me!
•“ Skin Cancer” does NOT equal
“MELANOMA”!
• There are 3 main types of skin cancer:
•Basal Cell Carcinoma (BCC or BCCA)
•Squamous Cell Carcinoma (SCC or SCCA)
•Melanoma (Malignant Melanoma or MM)
“pearly” or translucent papule (raised growth) typically on
the face, ears, shoulders , neck, backs of hands
1.) The good news: BCCA almost never metastasizes!
2.) The bad news: BCCA is more common than ALL OTHER CANCERS COMBINED,
and they can be very destructive, as seen above. BCCA makes up about 75% of all
skin cancer.
3.) LESSON: HAVE ANY NEW GROWTHS CHECKED OUT AS SOON AS POSSIBLE.
•A new growth that bleeds easily or for no reason should
always be checked out immediately.
•The smaller and sooner a BCCA is diagnosed, the less of a
scar and cosmetic or even functional destruction (including
nerve damage) will result.
•Similar to BCCA but typically faster growing and does not have that “pearly”
appearance to it, more “hyperkeratotic” or hard and crusty.
•May bleed spontaneously or easily as with BCCA.
•Found in generally the same locations as BCCA, the head and neck, ears, and
back of the hands.
Unlike BCCA , SCCA can grow into “cutaneous horns.” They can get amazingly large!
Squamous Cell Carcinoma can be extremely destructive and lead to severe defects and even
amputations and infections.
Unlike BCCA, SCCA can metastasize and thereby lead to death!
There are approximately 250,000 cases of SCCA in the US each year . It accounts for about
20% of all skin cancers.
Animals can get skin cancers and SCCA on their noses and mouth
Smoking and chewing tobacco can lead to SCCA of the tongue,
mouth and throat, which can be devastating.
1.) Exposure to UV light (high
cumulative dose of sunshine
or tanning bed usage)
2.) Light skin; blonde or light brown hair;
green, blue eyes
3.) History of prior nonmelanoma skin
cancer
4.) Increasing age
5.) Chronic immunosuppression
6.) Chronic scarring conditions
7.) Human Papilloma Virus (or HPV)
infection (specific subtypes)
“But doctor I’ve been really good about wearing sunscreen
and staying out of the sun for the last decade. How can I
have skin cancer now?
Skin cancer takes DECADES to develop, which is why young children don’t get nonmelanoma skin cancer. It’s a classic case of PAST sins catching up with oneself.
What are they? Also referred to as simply “AKs.” They are pre-skin cancers and are
almost ubiquitous over the age of 70 in light skinned people.
A certain percentage can progress to become squamous cell carcinoma, which
as was mentioned before, can be lethal.
Treatment is relatively easy at this stage. Typically, the areas are frozen/treated
with liquid nitrogen.
Usually, this treatment is considered by most patients to only be slightly painful and
heals with little or no scar/discoloration.
Most common location is on the face and backs of the hands. However, they can be
anywhere that sun has touched the skin, i.e., shoulders, arms, back, legs, etc.
Must differentiate from dry skin.
1.) Mohs surgery: reserved for BCCA/SCCA on the ears, lips,
around the eyes, and nose and for very large skin cancers :
*covered by insurance but extremely expensive
*NOT necessary for most skin cancers
*only 2 Mohs surgeons in the state of Maine: Freeport and
Portland
* Cure rate 99%
2.) Excision: standard treatment for most skin cancers.
Cure rate 95%
3.) ED+C (Electrodessication and Curettage):
Cure rate 92%; only appropriate for BCCA and early SCCA not on
the face or scalp
5th most common cancer in men and 6th most common
cancer in women
Individuals with >100 moles on their body’s are 47 times
more likely to develop melanoma
Melanomas discovered by a dermatologist vs. the primary
care doctor are more likely to be thinner and hence more
survivable
Once melanoma metastasizes survivability is extremely low
(7% 5 year survival rate)
Most patients that come into my office and say they have been
diagnosed with “melanoma” are mistaken.
I want your pathology report – request a copy and please bring it
with you to your appointment!
A “dysplastic” or “atypical” nevus or mole is NOT the same thing
as a melanoma, nor is a “melanoma in situ” or pre-melanoma.
As we covered earlier, BCCA and SCCA are NOT the same thing
as melanoma and carry a far better prognosis.
If you have truly had melanoma, YOU are the one with the
disease, so LEARN about it and ask questions!! Know your
Breslow depth.
Don’t forget
the most
important
letter – E – for
Evolution or
change!
It’s simple.
Anyone can do it.
It could save your life!
Dermatologists’ most important job is to find and eradicate
skin cancer. It is for this reason that I offer all my patients
referred for a new/changing growth a full skin exam (all
clothes off for men and all but the lower underwear in
women – I have removed numerous skin cancers on the
breasts). Often, I find skin cancers that were not the reason
for initial referral. It is your choice to refuse, but a few
minutes of potential minor embarrassment could be life
saving.
There is no cure for psoriasis.
For mild psoriasis on small parts of the body, topical
steroids are the mainstay of treatment and are the most
appropriate. Daily topical moisturization is also critical.
For moderate to severe psoriasis where a significant portion
of the patient’s body surface area is affected, light therapy is
a great option.
It has been noted for 1000’s of years that sunlight can improve
psoriasis.
Psoriasis is one of the earliest known skin diseases.
“Leprosy” in the Bible was probably really psoriasis, according
to scholars.
However, a sun burn can severely
flare psoriasis:
So, a little sunlight is good, but a lot of sunlight is bad for
psoriasis. Why?
Scientists have determined that psoriasis is due to one’s
immune system overacting , too many T cells in the skin.
Small amounts of sunlight or Ultraviolet light downregulate or decrease the local immune system in the skin,
thereby improving psoriasis.
So, how about tanning?
Tanning is not safe. The tanning industry is poorly
regulated and the amount of ultraviolet light exposure is
widely variable. One can EASILY burn or get too much
exposure and worsen psoriasis. Tanning booth employees
are NOT trained to treat psoriasis, nor is the type of
ultraviolet light the best for psoriasis patients. It is also
much more likely to lead to skin cancer than the light
therapy used in a dermatologist’s office.
Light therapy or Narrow Band Ultraviolet Light B (NBUVB)
is not for every psoriasis patient.
It requires 2-3 times per week visits to use the booth.
It carries a small increased risk for long-term skin cancer.
Therefore, it should not be used for patients with localized
or mild psoriasis who “just don’t like having to apply topical
steroids.”
Many “rashes” are truly just dry skin. Most people NEED to
use a moisturizer EVERY DAY in the winter to prevent and
improve rashes/dry skin. I recommend Vanicream.
Many rashes that are not dry skin are due to allergic or
irritant contact reactions from over-the-counter products
and even prescriptions from well-meaning primary care
doctors.
Simplify, simplify, simplify. Use only Vanicream,
Aquaphor, Vaseline, or Cetaphil and you can’t go wrong.
Cetaphil should be used as a soap-substitute for all body
soap and face wash.
Shampoo: California Baby Shampoo (Target stores in the
baby section), next best is J+J Baby Shampoo.
If none of this works, consider a change in your
environment or situation. Consider seeing an allergist, if
you also have upper respiratory symptoms.
Contrary to popular belief, dermatologists cannot always
figure out what’s causing a rash. You need to play an active
role in figuring it out!
By far most hair loss is genetic
Your hair loss is most likely genetic if you have had gradual
hair loss, non-scarring hair loss, diffuse hair loss, no
redness of the scalp, on few/no oral medications, have a
healthy diet, are otherwise healthy (few chronic medical
issues) and have a family history of hair loss (male of female
).
However, there are many non-genetic causes of hair loss
which was treatable and reversible, so lab evaluation is
necessary, but don’t be surprised if the labs are normal and
the cause is ultimately found to be genetic.
Some of the non-genetic causes of hair loss that your doctor can
evaluate include the following:
*thyroid or liver disease
*protein deficiency and anemia (common with vegetarian diets)
*hepatic or renal failure
*anorexia or bulimia
*too much vitamin A or other extreme diets
*childbirth
*local fungal infection (ringworm)
*starting or stopping birth control pills
*stress or high fever
*some medications: chemotherapy, bromocriptine , beta
blockers, ACE inhibitors, amphetamines, anticholesterol agents
*lupus or other autoimmune disease
Alopecia areata -- focal smooth hair loss, no redness
Tinea capitis or ringworm – red, angry, tender hair loss
Diffuse hair loss from a metabolic disorder or medications –
The entire scalp hair is evenly affected
Males and females loose hair in different
places on the scalp. Males lose hair first
at the temples and frontal forehead and
have a receding hair-line. Then, the hair
is lost on the crown.
Females lose hair starting on the crown
and vertex of the scalp and typically
do not lose Hair in the front. They will
also eventually lose hair diffusely and the
hair will become thin throughout the
scalp.
Thank you!!