Skin Cancer Treatments at Cosmetic Vein & Laser Center

Skin Cancer

Skin cancer is the most common form of cancer In the United States. It accounts for more than 50% of all malignancies, with 60,000 new cases of melanoma and over 1 million new cases of basal cell carcinoma diagnosed every year.

Each year there are more new cases of skin cancer than breast, prostate, lung and colon cancer combined. One in five Americans will develop skin cancer in the course of their lifetime.

Early detection and treatment are paramount for prevention, cure, and acceptable cosmetic outcome. The Cosmetic Vein and Laser Center offers advanced skin cancer detection and prevention strategies. Our surgical and non-surgical treatment options for non-melanoma skin cancers and pre-cancerous lesions provide optimal cosmetic outcome with essentially no scarring. Photodynamic Therapy (PDT) has recently become the non-surgical treatment of choice for treating pre-cancerous skin lesions and many early non-melanoma skin cancers.

What Causes Skin cancer?

The sun emits an invisible form of radiation called ultraviolet radiation which damages the skin, causing premature aging and skin cancer.
All forms of skin cancer have been associated with exposure to ultraviolet light as their primary causative factor. About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun. At a time when most cancers are on the decline, all types of skin cancers are steeply rising. Furthermore, skin cancers that historically cursed people over the age of 50, are now afflicting people in their 20’s, 30’s, and 40’s. The effects of the sun are cumulative over a lifetime and it is estimated that at least one in five Americans will develop some form of skin cancer.

The sun’s rays (including tanning salons), also cause photoaging, the premature wrinkles, age spots, broken capillaries, and skin roughness that make us look older than we are.

Two types of UV radiation mainly damage our skin, UVA rays (the “aging” rays) penetrate deeper and cause premature aging and the more dangerous melanoma skin cancers. UVA rays are tricky because they cause serious damage without the visible signs of sunburn. UVB (the “burning” rays), cause sunburn and non-melanoma skin cancers.

What are “Pre-cancers” or Actinic Keratosis?

Actinic keratoses are rough or scaly brown or reddish patches that occur on sun-exposed areas such as the face, ears, scalp, neck, backs of the hands and forearms, shoulders, and lips. They may flake or crust, and they may temporarily disappear and then return.

Left untreated, actinic keratoses (AKs) can evolve into dangerous squamous cell carcinomas. It is estimated that 10-20% of untreated AKs will develop into squamous cell cancers. If treated early, almost all AKs can be eliminated without becoming skin cancers. If you have AKs, it indicates that you have sustained sun damage and have a higher risk for developing all types of skin cancer - not just squamous cell carcinoma. Because of its malignant potential, early detection and treatment of AKs is imperative.

For every actinic keratosis that is visible on the skin’s surface, there are dozens of sub-clinical (invisible) lesions growing underneath. Innovative non-surgical treatment like PDT (Photodynamic Therapy) takes this into consideration by destroying precancerous lesions even before they are visible.

How do we Treat Actinic Keratosis and other Non-melanoma Skin Cancers?

New technology known as Photodynamic Therapy (PDT) allows us to treat pre-cancerous lesions and many early skin cancers non-surgically by precisely destroying all of the cancer cells even before they are visible on the skin’s surface.

Traditionally, actinic keratosis lesions required freezing (cryotherapy), scraping (curettage), or surgical procedures that result in scarring or loss of pigment. Although effective, traditional treatments rely on the lesions being visible on the skin’s surface. Every small cancer contains millions of abnormal cells and it is difficult to estimate exactly how much to cut or freeze off. If you freeze or cut deeply enough to remove all of the cancer cells, you risk leaving unsightly white scars. If you minimize the treatment diameter or freeze too shallow, you risk leaving cancer cells behind.

Newer therapies involve topical chemotherapy creams such as Aldara and Efudex that are applied twice daily for several weeks to months. These creams are very effective when used correctly, but patient compliance is difficult because during treatment, and for several weeks thereafter, your face becomes extremely red, scaly, and crusted. During this period, the treated skin feels burned, irritated, and sun-sensitive. For these reasons it is difficult and painful to treat large areas at one time.

To avoid the prolonged recovery period and possible scarring associated with these techniques, photodynamic therapy has been developed. PDT (Photodynamic Therapy)/ALA is non-surgical, requires only one to two treatments, and can be applied to diffuse areas like the entire face, chest or arms in one visit.

What is Photodynamic Therapy (PDT)?

Photodynamic Therapy (PDT) is a non-surgical treatment that relies on the use of a naturally occurring substance known as 5-aminolevulinic acid (5-ALA). When applied directly to sun-damaged skin, concentrated ALA (Levulan) is selectively absorbed by rapidly growing cells such as cancer, pre-cancers, and sun spots. Within these cells, ALA reacts with oxygen and becomes highly excitable when exposed to specific wavelengths of light energy. In this excitable state, ALA destroys the unhealthy cells that make up skin cancers, pre-cancers (actinic keratosis), and sun damage.

Photodynamic Therapy (PDT) is ideal for treating larger areas and finally allows us to treat pre-cancerous lesions non-surgically by precisely destroying the cancer cells even before they are visible on the skin’s surface.

Studies report between 85-100% clearance for actinic keratosis, superficial basal cell and early squamous cell cancers with one to two treatments.

PDT Treatments are virtually painless and you leave the office feeling like you have a mild to medium sunburn. Over the next several days, the unhealthy cells rapidly crust and peel off, leaving healthy new skin behind. These FDA- approved treatments are non-invasive, non-scarring, and less painful than surgery, freezing, or topical chemotherapy creams such as 5-FU and Imiquimod.

In addition to being both curative and preventative for most early skin cancers, patients achieve amazing cosmetic benefits from one to two treatments. Research shows that 94% of patients have significant reduction in fine lines, deep wrinkles, sun-spots, dilated facial veins, redness, pore size, skin texture, and rosacea.

PDT has also become a leading treatment for moderate to severe acne and sebaceous hyperplasia. Typically, one to four treatments reduces acne breakouts and scarring in more than 85% of patients.

Photodynamic Therapy (PDT) is rapidly gaining popularity over many of the “old school” treatments for sun damage, acne, and skin cancer. It has become one of the most exciting and versatile therapeutic modalities for dermatologists, laser specialists, and patients in all decades of life. It allows us to wipe the slate clean, leaving skin healthy, younger, and cancer-free.

What does a Photodynamic Therapy Treatment involve?

Photodynamic therapy involves

Pre-treating the skin with a light microdermabrasion to help remove the top layer of skin cells and allow the process to work more effectively
5-ALA, aka Levulan, a clear painless solution, is then applied to the treatment area and allowed to incubate for 15 – 60 minutes.
ALA is then activated by a specific wavelength of light called a BLU-U for 10-15 minutes. This destroys the abnormal cells. Additional Light sources may be used to drive the solution deeper into the skin for even better cosmetic results.
PDT Treatments are virtually painless and you leave the office feeling like you have a mild to medium sunburn. Over the next several days, the unhealthy cells rapidly crust and peel off, leaving healthy new skin behind.
Patients choosing a more aggressive treatment will experience more peeling and/or crusting of the damaged skin that resolves within in one or two weeks. The doctor can easily control the severity of these reactions by limiting the incubation period and the amount of exposure to the light source. Patients not willing to experience a prolonged recovery time after the procedure may choose a more mild treatment and return to work after a day or two. The tradeoff is that they will require more treatments to achieve the same clinical results.
These FDA- approved treatments are non-invasive, non-scarring, and less painful than surgery, freezing, or topical chemotherapy creams such as 5-FU and Imiquimod.

What are the Advantages of ALA/PDT Treatments over Traditional Therapies?

For Early Non-Melanoma Skin Cancers and Pre-cancers:

Easier for patients than repeated liquid nitrogen (freezing), Efudex, or Aldara because the side effects are minimal, rapid healing, and only 1-3 treatments.
ALA/PDT treatments are less painful than liquid nitrogen or surgical removal
Reduced scarring and improved cosmetic results than liquid nitrogen, surgery, and topical creams
ALA/PDT improves the entire skin surface treated (i.e. face, or arms), creating even tone and texture, rather than spot treating with liquid nitrogen or surgery.
PDT is also effective in improving the appearance of the skin by greatly reducing moderate to severe acne (including cystic acne), reducing sun and age spots, reducing fine lines, and decreasing pore size.

Anyone who currently has, had, or wants to prevent AKs or pre-cancerous skin lesions should be evaluated for photodynamic therapy (PDT). Once a person has been successfully treated using this approach, it is recommended they return for a yearly follow up to prevent future problems.

More on PDT

Are There Different Types of Skin Cancer?

Yes, there are three main types of skin cancer:

Basal cell carcinoma (BCC) is the most common type of cancer in humans and the most common skin cancer. About one million of the skin cancer cases diagnosed annually are BCCs. BCCs are rarely fatal, but can be highly disfiguring.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer. Squamous cell carcinoma is also primarily caused by repeated and prolonged exposure to ultraviolet rays of the sun. More than 250,000 cases are diagnosed each year, resulting in approximately 2,500 deaths. BCC and SCC are the two major forms of non-melanoma skin cancer. Between 40 and 50 percent of Americans who live to age 65 will develop at least one of these two forms of skin cancer.

Melanoma The incidence of many common cancers is falling, but the incidence of melanoma continues to rise significantly, at a rate faster than that of any of the seven most common cancers.

Malignant melanoma has multiple possible causes but the two most important risks factors are sun exposure and genetics. About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun. It has been proposed recently that melanoma is influenced mainly by the UVA rays more than the UVB rays.

Melanoma is more common in fair-skinned individuals with red hair and blue eyes as well as areas of the world closer the equator.

Melanoma is the deadliest of the skin cancers. Although it accounts for only about three percent of skin cancer cases, it causes more than 80 percent of skin cancer deaths. Death from melanoma in the US occurs at the rate of approximately one life per hour or more than 8,000 deaths annually. The survival rate for patients whose melanoma is detected early, before the tumor has penetrated the epidermis, is about 99 percent. The survival rate falls to 15 percent for those with advanced disease. Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.

Each type of skin cancer has important sub-types and stages. To learn more about these sub-types and stages, you can visit the National Cancer Institute at www.cancer.gov

What are basal cell carcinoma and superficial basal cell carcinoma?

A basal cell carcinoma typically begins as a painless “pimple-like” bump that can be pink or skin-colored. This lesion will typically grow very slowly over time until but may reach a point when it suddenly grows more quickly. Often the lesion will be very fragile and will bleed easily. It may appear to heal, but never entirely resolves. Basal cell carcinoma can arise in all skin types, although is most common in fair-skinned individuals who have had a great amount of sun / ultraviolet exposure throughout their lifetime. Although basal cell carcinoma rarely spreads to lymph nodes or other areas of the body, it can spread locally and destroy soft tissue and cartilage, resulting in significant disfigurement and possible infection. Very few cases of death due to basal carcinoma are reported.

What do basal cell carcinoma and superficial basal cell carcinoma look like?

Basal cell carcinomas may take on a number of forms. They may appear as bleeding, oozing, open sores that persistently crust and remain unhealed for several weeks to months. Superficial basal cell carcinomas may appear as red patches on the arms, legs, shoulders, or chest, which may itch or burn. Nodular basal cell carcinoma appears as pearly, shiny bumps or nodules of white, tan, black, or brown coloration. Sometimes basal cell carcinoma may appear as a pinkish growth with raised outer borders and depressed crusted or eroded centers. These may grow larger and begin to show tiny blood vessels just underneath the pearly surface. Finally, a less common form of basal cell carcinoma may appear as a whitish scar-like growth with undefined borders.

Any growth resembling a basal cell carcinoma should be evaluated by a skin care specialist to determine its identity and determine the best treatment plan. If left unchecked, basal cell carcinomas that arise near the eyes, nose, or ears are capable of invading deeply and causing significant damage, even extending into important blood vessels and tissues of the brain.

How can my basal cell carcinoma and superficial basal cell carcinoma be treated?

Superficial basal cell carcinomas may resolve with topical chemotherapy creams, PDT (Photodynamic Therapy) or scraping and electrocautery. Specialized type of surgery called Mohs Micrographic Surgery is often used to treat larger skin cancers, including basal cell carcinoma.

Do Indoor Tanning Salons cause skin cancer?

Ultraviolet radiation (UVR) is a proven human carcinogen, according to the U.S. Department of Health and Human Services.

The link between Ultraviolet radiation from natural and artificial sources and skin cancer is becoming much like the link between cigarettes and lung cancer. Despite the estimated annual revenue of indoor tanning industry of $5 billion, evidence shows an undeniable link between tanning bed use and development of both melanoma and non-melanoma skin cancers.

The total doses of UVR from tanning beds are as much as five times that achieved by natural sunlight. As such, 20 minutes in a tanning bed may be equal to as much as 3 hours in the mid-day sun. Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.

People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.

How do I prevent skin cancer?

The prevention of skin cancer is based on sun protection, sun avoidance, and regular evaluation by a physician that specializes in skin. Sun avoidance is obviously the most important step in skin cancer prevention. 90% of skin cancers are caused by excessive sun exposure, yet fewer than 33 percent of adults, adolescents, and children routinely use sun protection.

Cancer prevention and early detection techniques could eliminate up to 100,000 cancer cases and 60,000 US cancer deaths each year. New technologies in the evaluation and treatment of sun damaged skin could have a positive impact on changing these statistics.

Although many dermatologists continue to misinform their patients by telling them that the majority of sun-damage occurs before the age of 18, recent studies indicate that this is likely not the case. While it is important to use sunscreen at all ages, reports suggest that Americans get less than 25% of their lifetime UV dose by 18.

The single most important skincare product available to prevent wrinkles and skin cancer is a sun block that protects against both UVA and UVB rays. Choose sun blocks, which physically prevent sunlight from reaching the skin’s surface, over sunscreens, which chemically denature the light. If you are confused by the bewildering array of products, simplify your search by selecting products that contain Zinc Oxide or Titanium Dioxide. These are currently the only physical blocking agents that protect against both UVA and UVB rays. My personal favorite sunscreens for the face are Skin medica’s Environmental protection SPF 30 and IS Clinical’s Treatment Sunscreen SPF 25. You rarely need a sun block with an SPF (Sun Protection Factor) greater than 30 if you choose the right ingredients and apply it correctly. Whether it’s waterproof or water resistant, it should be applied liberally enough to form a film (one ounce for the whole body) and it should be reapplied every 2 hours or after swimming/sweating.

There are several reputable clothing companies that make FDA approved fabric for UV protection. Also, wearing wide brimmed hats in addition to sunscreen is helpful in protecting your face from sun exposure.