Skin Cancer and Basal Cell Carcinoma

Medical Skin Care Advice: Skin cancer is the most common form of human cancer. It is estimated that over 1 million new cases occur annually. The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. It has also been estimated that nearly half of all Americans who live to age 65 will develop skin cancer at least once.

The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal.

The term “skin cancer” refers to three different conditions. From the least to the most dangerous, they are:

* basal cell carcinoma (or basal cell carcinoma epithelioma)
* squamous cell carcinoma (the first stage of which is called actinic keratosis)
* melanoma

The two most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma. Together, these two are also referred to as nonmelanoma skin cancer. Melanoma is generally the most serious form of skin cancer because it tends to spread (metastasize) throughout the body quickly. Skin cancer is also known as skin neoplasia.
Basal cell carcinoma

What is basal cell carcinoma?

Basal cell carcinoma is the most common form of skin cancer and accounts for more than 90% of all skin cancer in the U.S. These cancers almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue.
Image of Skin Cancer
Skin Cancer

What are risk factors for developing basal cell carcinoma?

Light-colored skin, sun exposure, and age are all important factors in the development of basal cell carcinomas. People who have fair skin and are older have higher rates of basal cell carcinoma. About 20% of these skin cancers, however, occur in areas that are not sun-exposed, such as the chest, back, arms, legs, and scalp. The face, however, remains the most common location for basal cell lesions. Weakening of the immune system, whether by disease or medication, can also promote the risk of developing basal cell carcinoma. Other risk factors include

* exposure to sun. There is evidence that, in contrast to squamous cell carcinoma, basal cell carcinoma is promoted not by accumulated sun exposure but by intermittent sun exposure like that received during vacations, especially early in life. According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, which are areas that receive high amounts of UV radiation.

* age. Most skin cancers appear after age 50, but the sun’s damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.

* exposure to ultraviolet radiation in tanning booths. Tanning booths are very popular, especially among adolescents, and they even let people who live in cold climates radiate their skin year-round.

* therapeutic radiation, such as that given for treating other forms of cancer.

Image of Basal Cell Carcinoma
Basal Cell

What does basal cell carcinoma look like?

A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangiectases. The texture of such a spot is often shiny and translucent, sometimes referred to as “pearly.” It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain melanin pigment, making them look dark rather than shiny.

Superficial basal cell carcinomas often appear on the chest or back and look more like patches of raw, dry skin. They grow slowly over the course of months or years.

Basal cell carcinomas grow slowly, taking months or even years to become sizable. Although spread to other parts of the body (metastasis) is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.

How is basal cell carcinoma diagnosed?

To make a proper diagnosis, doctors usually remove all or part of the growth by performing a biopsy. This usually involves taking a sample by injecting a local anesthesia and scraping a small piece of skin. This method is referred to as a shave biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.

How is basal cell carcinoma treated?

There are many ways to successfully treat a basal cell carcinoma with a good chance of success of 90% or more. The doctor’s main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person’s age, general health, and medical history.

Methods used to treat basal cell carcinomas include:

* Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.

* Surgical excision: The tumor is cut out and stitched up.

* Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.

* Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.

* Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed “microscopically controlled excision.” The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.

* Medical therapy using creams that attack cancer cells (5-Fluorouracil–5-FU, Efudex, Fluoroplex) or stimulate the immune system (imiquimod [Aldara]). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.

How is basal cell carcinoma prevented?

Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

Common sense preventive techniques include

* limiting recreational sun exposure;

* avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);

* wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;

* regularly using a waterproof or water resistant sunscreen with UVA protection and SPF 30 or higher;

* undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor; and

* avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light.). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a “base coat” to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as “waterproof.”

Facts on Vitamin C Products and C Serum

Here are 9 facts on Vitamin C Serum from Dr Joanne Turner and her Blog - Skin Revision.

Facts on Vitamin C Products and C Serum - Is it all hype?

I recommend everyone put Vitamin C and E onto their face daily because they protect against UV induced cell damage. It is this sun damage that not only causes premature aging but also skin cancers. However Vitamin C has other properties including being one of the few ingredients that has a science base to show that it reverses signs of aging to the skin.

Vitamin C was originally used in skin care products in the form of ascorbic acid. At a 10% concentration and low ph, ascorbic acid has been shown to stimulate collagen, decrease wrinkle depth and have lightening effects on pigmentation. It was thought that a minimum 10% concentration was required but newer information indicate that lower concentration (5%) may have benefit. It is best to stay with products that have this concentration or above.

9 Facts about vitamin C serums

1. Consumer beware - not all products contain sufficient vitamin C to be of benefit Most products on the market do not have sufficient concentration to be of benefit to the skin. Many companies, keen to cash in on the market trends for antioxidants in skin care, put only miniscule amounts in and consumers unknowingly will buy a product that will be of no benefit. Unfortunately you cannot judge from the prestige or price of the product you buy, you need to look at the concentrations.

2. Vitamin C does not work in everyone For reasons that are not yet known, Ascorbic Acid at a good concentration does not work in everyone. It may only be 60% of the population who get the age reversing benefits of vitamin C. Some people who do not respond to Ascorbic Acid however still get anti-aging benefits from the newer vitamin C derivatives. (Discussed later). Vitamin C, however is a potent antioxidant and you still should get the benefits of protection from UV induced cell damage even if it does not keep you looking younger.

3. Vitamin C in the form of Ascorbic Acid is very expensive. Vitamin C is very unstable and difficult to get into a formulation this in part explains why ascorbic acid skin products tend to be very expensive.

4. Your Vitamin C may oxidise before you get to put it on your skin The biggest problem with Ascorbic Acid creams and serums is that because they are unstable, they are oxidised very quickly and once it is oxidised it does not provide any benefit to the skin at all. Even in stabilised formulations there is a risk that before you get your precious vitamin C cream or serum home, it will already be useless and worse may even because more damage to your skin than good.

5. Watch for yellowing of your serum- it indicates oxidation As it undergoes oxidation the ascorbic acid takes on a yellowish tinge, so it is important to check your creams or serums before you put them on your face, and if there is any yellow discolouration, DISCARD.

There is a problem with the colour check as the first stage of oxidation is colourless, so prior to going yellow it can be in an oxidised state that cannot be detected.

6. Do not buy vitamin C preparations that are tinted yellow or orange The second problem with using a colour test is that many vitamin C serums are tinted and you will not be not be able to detect if it is oxidised by visual checking. Why a company would do this is beyond me, when they know the difficulties of instability of vitamin C formulations oxidising. If you didn’t trust them you would think they are deliberately trying to mislead. Do not buy tinted formulations of vitamin C.

7. Vitamin C derivatives are more stable, less expensive and effective at lower concentrations There are newer derivatives of Vitamin C: Ascorbyl palmitate, Tetrahexyldecyl ascorbate and Magnesium ascorbyl phosphate, and some of these are proving as effective as ascorbic acid in collagen stimulation. Refer Smartskincare an excellent science based skin care site. These derivatives are effective in lower concentrations, are more stable and less expensive and as such may be a better choice. There is a battle among some of the big cosmetic houses as to which is most effective but the newest Tetrahexyldecyl ascorbate if particularly promising, and seems to work in some people who are resistant to Ascorbic Acid.

8. There is nothing special about the base cream or serum that the vitamin C (or any other active product) is delivered in Thinking about it logically, if a product has 10% ascorbic acid in stabilised form, or 2% Tetrahexyldecyl Ascorbate (the active ingredient) then no matter what the cost it will be equally effective, as there is no base serum or cream that has properties that make it effective in anti-aging-and that is the truth.

This is illustrated with my recent comment on Boots no 7 perfect and protect - where a chain store anti-aging cream is matching up to more expensive prestige brands and winning. The reason: it is the active ingredients that has the effect, no matter what advertising trys to seduce you - REMEMBER THIS FACT.

9. You can make your own Vitamin C Serum There is however some ingredients that are now considered state of the art in modern skin care. Among these is a group of base ingredients that help protect the skin and maintain the intercellular network. Refer Cosmetic Cop - Paula Begoun cosmetic ingredients dictionary on natural moisturising factors. These do not have anti—aging benefit but protect the skin and assist in repair. Glycerin is one of these, other very good protectants and natural moisturisers are ceramides and silicones.