Ask the Doctor

The following are FAQ's from patients that are intended for general information only and are not intended to be a directive for specific medical care. They are provided in the spirit that a well-informed patient is a wiser healthcare consumer. Click on a topic to view responses.

If you have a question or topic you would like to have addressed in "Ask The Doctor", please E-mail Dr. Beeson. Then revisit "Ask The Doctor" for the response. Thank you.


Botox
    Botox

Cheek
    Cheek Implants

Facial Scars
     Acne Scars
     Topical Silastic Sheeting

Hair
    Hair Transplantation

Hyperpigmentation
     "Age Spots" or "Liver Spots"
     Hyperpigmentation following laser resurfacing

Nasal
    Nasal Labial Folds

Neck
    Necklift
    Laxity in neck

Osteoma
    Osteoma (bruising of periosteum)

Skin Cancers
     Melanoma
     Basal Cell Carcinoma
     Squamous Cell Carcinoma

Botox

What is Botox Cosmetic?
A natural, purified protein that relaxes wrinkle-causing muscles, creating a smooth, rejuvenated, and more youthful appearance. It is used as a non-surgical medical treatment to reduce unwanted wrinkles and frown lines.

How does Botox Cosmetic work?
Botox Cosmetic is administered in a few tiny injections of purified protein that relaxes muscles by temporarily blocking nerve impulses that trigger the wrinkle-causing muscle contraction.

What is Botox Cosmetic used for?
Botox Cosmetic is FDA approved for the treatment of unwanted glabellar frown lines. These are the wrinkle or frown lines located between the eyebrows, that are commonly referred to as the "furrows" or "frown lines". Botox Cosmetic can also be used by Dr. Beeson to medically treat wrinkles in the forehead, the crow's feet area, and in some cases, fine wrinkles around the eyes, mouth, and other areas. These are termed "off-label" uses. This is similar to the way that doctors use Renova. Renova, or Retin-A , is FDA approved for the treatment of acne; however, a licensed doctor can use it to treat fine wrinkles. This is an off-label use. Dr. Beeson has been using Botox Cosmetic for many years as a non-surgical, medical alternative to treat unwanted frown and wrinkle lines in these areas. However, the FDA will only allow advertising regarding treatment of the "glabellar frown lines".

How long has Botox Cosmetic been used?
Botox Cosmetic has been used in medical treatment for almost 20 years in the various parts of the world. Botox Cosmetic has been FDA approved for injecting into the eye muscles of children to eliminate the need for eye muscle surgery to treat the lazy eye, for treatment of spasms of the eyelid, and for treatment of certain types of neck spasms. For approximately 10 years, doctors have been using Botox as a non-surgical treatment for facial wrinkles. Now the FDA has approved Botox Cosmetic for the treatment of glabellar wrinkles. Botox is the only product of its kind with a proven 10-year safety record and effective use in hundreds of patients worldwide.

Are Botox Cosmetic treatments comfortable?
No. An anesthetic cream can be applied to the skin prior to treatment, which virtually eliminates or markedly reduces the mild skin prick sensation of the injections. Usually, patients are able to return to their normal activities the same day.

How long does Botox Cosmetic last?
Some patients see the effects within the first 1-2 days. Studies have shown, and our experience has been, that most patients continue to show gradual improvement within the first several days, which is maximized at one week. However, there are some people who can continue to show improvement for an entire month. Our patients have shown that Botox Cosmetic can last between 3-7 months on average. However, the effect varies from individual to individual based upon their body's metabolism and other factors. In general, we would recommend a patient return every four months for a Botox Cosmetic treatment. However, studies do show, and our experience has indicated, that with each injection, the results tend to last longer.

What are the potential side effects of Botox Cosmetic?
There is a potential downside associated with any medical treatment or procedure. WIth Botox Cosmetic, that downside is very shallow and appears to be confined almost entirely to temporary sagging of the eyelid muscle when Botox Cosmetic is injected very close, or into, the eyelid. Today, techniques have been perfected that make that very, very rare. FDA studies have shown that some patients can experience temporary headache, nausea, respiratory-like infections, or mild bruising and discomfort at the site of the injection. However, these were very infrequent and occurred in roughly the same number of patients who were not treated with Botox Cosmetic in their studies (placebo group).

What are the contraindications to Botox Cosmetic?
Botox Cosmetic has not been evaluated in pregnant or breastfeeding individuals. Therefore, if you are pregnant or breastfeeding, or anticipate either, we would not recommend Botox Cosmetic treatment for you at this time. In addition, if you are taking aminoglycosides or any other drugs that interfere with neuromuscular transmission, there is a theoretical potential contraindication to botox cosmetic treatment. Patients with neuromuscular diseases such as myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, etc., are not recommended for Botox Cosmetic treatment.

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Cheek Implants

Cheek implants are used to provide more fullness over the cheekbones. They are usually done from inside the mouth where an incision is made and tissue is elevated from the bone. Medical grade implants are then placed over the bony contours to provide more prominence of the cheekbones. This oftentimes provides more of an "almond" shaped face and oftentimes can be used to decrease the depth of the buccolabial folds (the groove between the nose and the corner of the mouth). There is a nerve which runs underneath the eye and supplies sensation to the cheek and upper lip. It is not uncommon for this to be bruised or affected by the swelling following this surgery. This is usually only temporary. There are also small muscles and nerves which provide movement to the face and help to elevate the mouth which results in our smile. If there is considerable swelling or stretching of the tissues when the implant is placed, this can provide swelling or bruising of the nerves and muscles which affects the facial movement (the seventh cranial nerve or facial nerve) which can result in some dysfunction. This is less common than the numbness previously described. Both are usually temporary.

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Facial - Acne Scars

It is important to realize that some scars cannot be removed but only improved. Scars in the top layer of skin [papillary dermis] can be completely removed. However, scars that extend into the deeper layers of skin [reticular dermis] cannot be removed but only improved. Sometimes acne scars penetrate deep into this area. Scars from trauma that require suturing usually extend into this area and are permanent. For that reason, we cannot totally remove them, but only cosmetically improve them and make them less apparent. Laser resurfacing helps to smooth the appearance of the scars compared to surrounding tissue. In addition, some studies seem to indicate that laser resurfacing may actually stimulate growth factors which result in more collagen being produced. In some cases, this can result in elevating depressed scars. We have found this to occur in scars which have been as much as 10-15 years old.

Studies have also shown that doing dermabrasion or laser resurfacing at 1-2 months after an initial surgery, such as a facial laceration, may actually stimulate wound healing and improve the aesthetic appearance of the scar. While laser resurfacing is not a cure for traumatic or acne scars, in many cases it can add some improvement. However, patients need to be realistic and realize that they can never have scars totally removed, only improve upon.

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Facial - Topical Silastic Sheeting

There are a variety of treatments available to improve scars. However, it is important to note that we can never totally remove scars; we can only improve them. The top layer of the skin, called the papillary dermis, does not scar. However, the lower layer, called the reticular dermis, does scar. If injuries penetrate into the deeper layer (those commonly requiring stitches do), there will always be a scar. In facial plastic surgery, we try to make that scar less noticeable by hiding it in skin lines, making it less wide, or breaking up the longer scar into smaller scars. In some cases, medical treatments such as topical silastic sheeting or injecting steroids into the wound can soften it and make it cosmetically more appealing. In other cases, dermabrasion or laser resurfacing can provide improvement. In still other cases, the old scar actually has to be excised or removed and a new scar created. Hopefully, this new scar is smaller, less prominent, and more "camouflaged" than the previous scar. It is important to remember that it takes 12-18 months for an area to completely heal. Scars often look their worst in the first 3-4 months and then oftentimes improve remarkably. For that reason, one usually needs to wait until a scar has fully matured or is approximately 12-18 months old before one considers scar revision surgery.

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Hair Transplantation (FAQ's)

What do we mean by hair transplanting?
Hair transplantation is a surgical procedure in which hair from normal areas of the scalp, such as back and sides, is moved to the bald area.

Does it really work - has it been proven?
Yes. For over 40 years, work has been done on this procedure. In properly skilled hands, it has been most successful.

In what types of baldness is the procedure helpful?
Hair transplantation is helpful in dealing with male pattern baldness. It is also successful in treating baldness as a result of scars from burns, accidents, operations, and in some cases, radiation.

How long will the transplanted hair last?
Transplanted hair should last a lifetime or at least as long as the hair remains in the region from which the transplants were taken. This conclusion is based on the continued growth of hair examined 40 years after the first hair transplants were performed.

How is this procedure performed?
The donor area, or back of the scalp, and the bald areas are anesthetized by the use of a local anesthetic similar to that used by a dentist. Strips of hair-bearing tissue are then removed with a special instrument. Next, small plugs are removed from the bald areas and discarded. Hair transplants are properly prepared and carefully placed into the previously prepared regions over the bald area. A protective bandage is then applied.

Is this a painful procedure?

As a number of patients have said, "The discomfort is no more than going to the dentist". The use of a local anesthetic permits painless removal of the small transplants. Momentarily, the local anesthetic produces a mild discomfort. Seldom is there any pain after the procedure. However, any discomfort that may occur after the procedure is generally very mild and readily relieved by analgesics. Because "twilight" anesthesia is used in many cases, most patients have amnesia to their surgery and complain of no discomfort.

How has this procedure been accepted by patients who have it?
Acceptance has been excellent, especially by those who have pursued hair transplantation to its conclusion. This usually requires multiple sessions.

How many visits to the doctor will be necessary?
This varies with the individual patient, depending mainly upon the size of the bald area and the number of transplants performed at each visit. The number of transplants can be reasonably well established at the initial consultation.

Can the transplanting procedure be accomplished at intervals of 3-6 months apart?
Yes, it can be done in stages to suit the patient. Again, this depends upon the individual's desire and the amount of transplantation necessary. Some patients may require a small number of transplants where the longer intervals may be satisfactory. However, in the larger areas of baldness, suitable cosmetic results are best accomplished in as rapid, continuous, and carefully planned series of procedures as possible. We usually recommend staged procedures at 3-4 month intervals.

How much time is required for each session of hair transplant?
This varies with the amount of transplantation done, but usually takes approximately one hour or so.

Where should the hairline be placed?
This is a matter of individual preference, but based upon our experience, we make suggestions, depending upon each patient's degree of baldness, their age, facial shape, and the amount of hair available at the donor site.

Shall I have a haircut immediately before the procedure?
No, the longer the hair, especially in the donor site, the less conspicuous the area of treatment will be.

How should a patient prepare himself for the procedure?
Very little preparation is necessary. We suggest to our patients that they shampoo their hair the evening and morning before the procedure, eat a light breakfast (toast, coffee, and juice), but avoid over-indulgence of food or drink before coming to the Center. If they are having a twilight anesthetic, the anesthesiologist may give them more specific instructions regarding oral intake, which might differ.

What should the patient do when he leaves the Center?
Patients usually resume their normal activities, unless this involves strenuous physical exertion, within three days. Usually bandages remain in place until the following morning. Combing, brushing, or any disturbance of the site should be avoided except as directed by the doctor for the first several days following surgery. General shampooing with baby shampoo is permissible at two days following surgery.

Will my insurance cover this procedure?
If hair loss is a result of an accident or disease, insurance may cover. However, in the great majority of cases, hair restoration surgery is considered cosmetic and is not covered by insurance. It is always best to consult with your insurance company concerning this matter.

How much does hair restoration surgery cost?
This again varies with the individual depending upon the extent of hair loss. Generally speaking, this procedure is no more expensive than a good hairpiece, which would cover the same area. Transplants are usually billed on a per-graft basis.

Can the patient be put to sleep and the transplantation done in the hospital?
For most patients, the procedure is done in our Cosmetic Surgery Center and has proven to be much less expensive, more convenient, and without some of the risks or complications that can be associated with a general anesthetic.

What disorders or medical conditions of the patient should a physician know about?
The patient should tell the surgeon about any disorder or physical condition he has; especially heart problems, high blood pressure, anemia, bleeding abnormalities, epilepsy, drug reactions, or allergies of any type. It is important for the patient to realize that this is a procedure for those in good health. We recommend that you see your personal physician for a checkup prior to surgery.

Are there any complications from this procedure?
In our experience, this has been infrequent and minor. However, as with any operative procedure, complications are always possible. Complications can include anesthetic risks, bleeding, infection, wound healing, scar formation, pigmentation changes, injury to muscles and nerves, lack of hair growth, or the need for additional surgery. Fortunately, these complications are very rare; however, they always need to be considered.

Can a toupee or hairpiece be worn after the procedure?
Yes. This often serves as a protective shield and an excellent cosmetic screen. In extensive cases of baldness where there is inadequate donor hair to cover the area, transplanted hair may be used as a frontal hairline to enhance the natural appearance of the hairpiece for a more acceptable cosmetic result. However, one needs to be careful that the hairpiece does not rub or irritate the newly transplanted grafts.

Will there be visible scaring over the front of the scalp?
As with any cosmetic surgical procedure, if the patient is closely examined, one may be able to detect scar lines. In our experience, this has not been a problem or a cause to deter a hair replacement procedure.

What about the donor site from which the transplants were taken?
After the transplants are removed, the individual donor sites shrink and usually results in a small linear scar that is camouflaged by the surrounding hair.

What causes baldness?
The most common baldness is hereditary male pattern baldness. Relatively few cases of hair loss are caused by scalp disease or tumors. Hereditary male pattern baldness results from an inherited tendency to lose scalp hair at a certain age, providing the male hormones are present in the bloodstream. Hair around the sides of the head ordinarily remains for a lifetime and, if the hair is relocated, it usually continues to grow in its new location.

Is there any good, non-surgical treatment for male pattern baldness?
No adequate treatment now exists, but medical researchers are actively investigating this area. While certain topical and oral medications are available, they are not uniformly effective, and the results they provide may vary widely.

Will I continue to lose hair?
It is difficult to predict, but since the transplanted hair comes from the areas where hair would ordinarily continue to grow through one's lifetime, you should not lose a transplanted hair. Hair loss generally continues throughout life and hair restoration procedures do not prevent ongoing hair loss from occurring.

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Hyperpigmentation - "Age Spots" or "Liver Spots"

The color of our skin is due to the thickness of the top layer of the skin (the stratum corium) as well as to the amount of pigment or melanin in our skin. Increased exposure to the sun or elements can cause a stimulation of both. Sometimes this can result in "blotchy" areas or areas on the arms, legs, or face that are commonly referred to as "liver spots".

A variety of agents can be used to treat this condition. Topical creams and lotions, which can be purchased over-the-counter that contain glycolic acid, may gradually help to soften and remove these areas. This process may be slow and take several weeks to months. Stronger creams and ointments can be obtained from a physician. These may range from stronger concentrations of glycolic acid to topical exfoliates such as Retin-A’s, including the newer Renova cream. These help to strip away the dead cell layers of the skin and gradually remove the photo damaged skin. More advanced cases can be treated with topical chemical peels such as trichloroacetic acid or, in some cases, laser resurfacing. When the condition is due to increased concentration of pigment, topical creams and lotions are less effective. A classification of creams called hydroquinones can oftentimes be used to help "bleach" the skin. These are prescribed by the doctor and should be applied on a daily basis. When used in combination with Renova, they may be more effective. In very advanced or severe cases, phenol-based chemical peels can be used to remove the pigmented areas. This oftentimes results in exchanging a darkened spot for a lighter one which needs to be covered with makeup.

It is important to realize that a form of skin cancer [melanoma] can appear as a dark spot on the skin. Any questionable areas should be evaluated by your doctor.

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Hyperpigmentation - Following Laser Resurfacing

Laser resurfacing can provide improvement in skin texture and tone. However, when one has more darkly pigmented skin, there can be some color changes. Usually these are transient. When they do occur, various topical creams and lotions can be utilized to expedite their resolution. However, close follow-up is often necessary. Many physicians feel that "pre-treating" with various types of creams and lotions such as Retin-A and hydroquinones can help to decrease what is termed post-inflammatory hyperpigmentation.

The cost for full-face laser resurfacing runs approximately $3,000 to $5,000. When we do the surgery, we usually request that our patients apply Vaseline to the face as a moist dressing technique and shower three to four times a day for the first seven days. For the next one or two months, they need to be careful regarding sun exposure. Increased sun exposure at this time can result in an increased chance for pigmentation changes. For that reason, the use of sunscreen is very important. When the pigmentation changes do occur, makeup can usually easily cover these areas. However, it is always best to minimize their occurrence with appropriate postoperative care.

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Nasal - Nasal Labial Folds

The problem with prominent nasal labial folds or significant problems to the groove in between the nose and the corner of the mouth is a frequent problem with both males and females. This is due not only to the laxity in the skin but is also accentuated by one’s bone structure. It tends to be more common in people who have less prominent cheekbones. In other people, it is sagging of what we term the malar (or cheek prominence) fat pad. A facelift procedure is usually utilized to deal with this problem. By removing some of the fatty tissue in the area as well as re-supporting fatty tissues in other areas, supporting muscle, and redraping the skin, we usually provide a satisfactory improvement to this problem. In some cases, cheekbone implants can be a benefit. In extremely severe cases, material can be used to "fill in" the fold. This can range from the use of injectable collagen, your own fatty tissue, or synthetic implants such as Goretex It is important for a doctor to physically evaluate a person to help determine what would be the best treatment. However, it is equally important for patients to realize that the aging process is complicated and individualized.

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Neck - Laxity in Neck

Often with aging, one develops deep bands or cords in the neck. This is due to laxity of the platysma muscle. Surgically re-supporting this muscle can provide a more pleasing contour.

Often, people develop a significant laxity in fullness in the neck area — the so-called turkey gobbler neck. This is due to laxity in the skin, muscle, and often, the collection of fatty tissue under the chin. This to can be surgically improved by using incisions in small creases underneath the chin and behind the ear. Endoscopic techniques using small telescopes attached to TV cameras allow doctors to use much smaller incisions than were used in previous years. Liposuction is used to remove the fatty tissue and surgical techniques are used to re-support the muscle and to remove the excess skin. Incisions are usually camouflaged under the chin, behind the ears, and in the posterior hairline. Recovery time can vary but usually takes approximately four to five days.

It should be remembered that the necklift only treats the neck and does not affect laxity in the jaw area. A facelift improves the neck, the cheek, and the lateral temporal area. A necklift can be used in people who have more advanced aging in the neck area or are aging more quickly in that area. A facelift can be performed at a later time when laxity develops in these other areas. The necklift is usually done under IV or "twilight" sedation on an outpatient basis.

The costs of these procedures vary depending upon the complexity and extent of the procedure. It is usually necessary to have an evaluation by the physician to determine this as well as the costs.

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Neck - Necklift

A necklift is designed to remove tissue laxity in the neck. In many people, fatty tissue collects in the area beneath the chin, which adds more fullness. In some people, weight reduction will improve this area. However, in many others, it needs to be surgically removed. In a necklift procedure, small incisions approximately 1/4 inch to 1/2 inch are made under the chin and behind the ear. Through these areas, small telescopes with TV cameras attached are used to remove the fatty tissue and to reposition the muscles. If extra skin needs to be removed, the incisions behind the ear are sometimes carried and hidden in the hairline so that extra skin can be removed. The recovery time is approximately 5-7 days.

These procedures are done under IV sedation. We call this "twilight" anesthesia. The cost for surgery is approximately $3,500 for the doctor’s fee. There is a facility fee whether the surgery is performed in our surgery center, the hospital, or other locations. This runs approximately $1,500. The anesthesiologist is a physician who administers the anesthesia. Their charges are approximately $500. Pre-operative laboratory tests and prescription medications vary in cost but could add an additional $100–$200.

The advantage is that the incisions are hidden and that the recovery time is very quick. The disadvantages are that only the neck area is treated. Obviously, it does not treat sagging in the cheek or forehead area.

Our suggestion would be to obtain a consultation with several doctors. The doctor would evaluate your medical history, perform a physical exam, and determine if a necklift would be a procedure which would address your concerns.

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Osteoma

An osteoma is a condition where the lining over the skull, called the periosteum, is severely bruised. It can stimulate a bony deposit to form deep in the skin. While it does not usually grow, it can cause an unsightly protrusion and oftentimes results in irritation of the overlying skin because of pressure from clothing, irritation, etc. Oftentimes, an x-ray can help to determine if this is a bony deposit or some other type of growth. If it is an osteoma, this can be surgically removed. New endoscopic surgery techniques allow one to make small incisions behind the hairline and use small telescopes to get underneath the skin. Special sanding instruments can be utilized to microscopically "sand down" the bony protuberance. Osteomas are benign or "non-cancerous". However, one cannot fully determine if something is a malignancy without a biopsy. If an individual has an area that increases in size, is painful, bleeding, or frequently irritated, they should seek medical evaluation to be sure of the condition. This is especially true if the individual is experiencing significant weight loss.

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Skin Cancers - Melanoma

What is it?
Last year in the United States, more than 38,000 people were diagnosed with malignant melanoma. Each year 7,000 people die from this form of cancer. Malignant melanoma is less common than other skin cancers (basal cell and squamous cell carcinomas), but it is potentially more lethal. The incidence of this tumor has climbed 4% per year since 1973 and the lifetime risk for developing melanoma is rising as well; 1 in 75 change by the year 2000. However, survival rates have also increased over the years which is attributed to an increased awareness of the public and medical communities with earlier recognition and subsequent treatment.

What causes it?
Trouble begins in cells called melanocytes when an unknown collaboration between defective genes and undefined environmental factors spurs the growth of cancerous cells. Although sunlight has been implicated in the development of this growth, the cause is less certain than that of other skin cancers.

What to look for?
Any pigmented lesion that changes color, diameter or size, shape or consistency, demonstrates change in the surrounding skin, or is symptomatic (tender, itchy, infected or bleeding) must be viewed as suspicious and needs to be evaluated by a physician.

Look for the warning signs in pigmented [colored] lesions of the skin:
ABCD
Asymmetry (one half unlike the other half)
Border irregularity (scalloped or poorly circumscribed border)
Color (varied from one week to another; shades of tan/brown; black; sometimes white, red or blue)
Diameter (larger than 6mm, the diameter of a pencil eraser)

It is recommended to examine your body regularly, as often as once a month. Be sure to include the scalp, back of the ears and neck, and other hard-to-see areas. (A full-length mirror and hand-held mirror can be very helpful.) If you observe any one of these warning signs or other changes in your skin, or unusual growth, consult your physician immediately.

Treatment
After the physician’s exam, the diagnosis is confirmed with a biopsy ; a small piece of tissue removed and examined in the laboratory under a microscope. If tumor cells are present, treatment (usually surgery) is required. In the case of melanoma, the biopsy not only reveals the diagnosis but also allows the physician to evaluate how deep the growth extends into tissue. This has very important implications as far as prognosis for survival and treatment options. Surgery remains the treatment of choice for malignant melanoma. Radiation, chemotherapy, and immunotherapy are generally reserved for patients with distant spreading [metastatic] malignant melanoma or those with a poor prognosis, as an adjuvant to surgery.

The only way to cure a primary melanoma is to excise it entirely before it has an opportunity to spread. In fact, patients with minimum and low-risk melanomas (based on depth or thickness of involvement) generally do well without any further treatment. Once the tumor spreads beyond the skin, care focuses on keeping patients as comfortable as possible for as long as possible. Treatment should always be guided by an expert in melanoma.

Long–Term Follow-up
Any patient who’s had melanoma needs to be seen regularly for a skin check and physical examination. Appointments should be scheduled every 3 months in the first year after an occurrence, and every six months thereafter. Patients who have had very thin melanomas can probably be examined on a yearly basis after several uneventful years. Again, the objective is to make sure there are no signs of distant spread [metastatic] and no new tumors.

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Skin Cancers - Basal Cell Carcinoma

What is it?
Basal cell carcinoma is the most common form of skin cancer, affecting nearly 1 million Americans each year. In fact, it is the most common of all cancers. Traditionally, elderly males with outdoor exposure were most affected. People now are developing basal cell carcinomas at earlier ages and women are now equally affected.

What causes it?
Chronic exposure to sunlight is the cause 95% of the time. Parts of the body exposed to the sun are most involved; the face, ears, neck, scalp, shoulders, and back. Rarely do tumors develop on non-exposed skin surfaces. In a few cases, contact with arsenic, exposure to radiation, complications from burns, scars, or vaccinations are contributing factors.

Who gets it?
While anyone with excessive sun exposure is at risk, people with fair skin, light hair, and blue/green eyes are more apt to develop the tumor. Outdoor occupations and leisure activities increase susceptibility. Skin cancers occur more often in people living in sunny areas like Texas, Arizona, and California than in areas receiving less sunshine, such as New England.

What to look for?
Basal cell carcinoma sometimes resembles non-cancerous skin conditions such as psoriasis or eczema — only a trained physician can decide for sure. It is recommended to examine your body regularly, as often as once a month, if you are at high risk. Be sure to include the scalp, back of ears, and neck as well as other hard-to-see areas. (A full-length mirror and hand-held mirror can be very helpful.)

The five warning signs of basal cell carcinoma are:
1) An open sore that bleeds or crusts for 3 or more weeks
2) A reddish patch or irritation which does not resolve
3) A smooth growth with an elevated, rolled border and an indentation in the center (tiny blood vessels may develop in surface of lesion).
4) A shiny bump or nodule which is pearly or translucent
5) A scar-like area with poorly defined borders and taut, shiny skin (although a less frequent sign, it can indicate an aggressive tumor).

If you observe any one of these warning signs or other changes in your skin, or unusual growth, consult your physician immediately.

Treatment
After the physician’s exam, the diagnosis is confirmed with a biopsy — a small piece of tissue removed and examined in the laboratory under a microscope. If tumor cells are present, treatment – usually surgery– is required. Treatment can almost always be performed on an outpatient basis in the physician’s office or clinic. A local anesthetic is used; pain/discomfort during and after the procedure is minimal. Because all surgery involves cutting the skin, scarring is inevitable. When small skin cancers are removed, the result is usually cosmetically acceptable. Larger tumors may require more complex reconstruction involving a skin graft or flap.

Types of treatment
Excisional surgery — growth is cut out and wound closed with stitches
Electrosurgery — (cuttage and electrodesiccation) growth is scraped away and burned.
Cryosurgery — growth is destroyed by freezing with liquid nitrogen. This is the treatment of choice for patients who have bleeding problems or anesthetic allergies.
Radiation therapy — X-ray beams are directed at the malignant cells.
Moh’s surgery — (microscopically controlled surgery) very thin layers of the growth are removed, checking each layer under a microscope until the site is tumor-free.
Laser surgery — laser beam is used to either excise or vaporize the tumor.
Enter Geram — investigational genetically engineered product of the human immune system which may be of value in some basal cell carcinomas.

Prevention
The skin-damaging effects of sunlight are permanent and build up slowly over time. Ordinary sun exposure and sunbathing produce gradual skin damage even if sunburn is avoided. As many as 10, 20, or more years can pass between the time of sun exposure and the time skin shows signs of sun damage. You can prevent further skin injury by using sun-protective measures.

With the passage of time, skin-cancer patients are likely to develop additional skin cancers. If you notice a new growth, or a sore that doesn’t heal or recurs, be sure to have it examined by a physician.

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Skin Cancers - Squamous Cell Carcinoma

What is it
Squamous cell carcinoma is the second most common form of skin cancer after basal cell carcinoma
It affects more than 100,000 Americans each year. It arises from cells (squamous cells) that make up the upper layers of skin and can occur anywhere on the body but are most common in sun-exposed areas. Although these tumors originate in the superficial layers of skin, they eventually penetrate deeper tissue if not treated — in a small percentage of cases, they spread (metastasize) to distant tissues and can be fatal.

What causes it?
Chronic exposure to sunlight (most cases. This is why tumors appear most frequently on sun-exposed areas: face, neck, bald scalp, hands, shoulders, arms, and back. The rim of the ear and lower lip are especially vulnerable areas. It may occur in areas of previous injury: burns, scars, long-standing sores, sites exposed to x-rays or chemicals. It can also occur with conditions that suppress the immune system or cause chronic skin inflammation
Occasionally it can arise spontaneously on what appears to be normal, healthy, undamaged skin; researchers believe inheritance may play a role.

Who gets it?
· Anyone with a long history of sun exposure
· Fair skin, light hair blue/green eyes are at highest risk. African Americans are far less likely to develop any form of skin cancer.
· Anyone with an outdoor occupation or who spends the majority of their leisure time outdoors.

What to look for?
· A persistent, scaly-red patch with irregular borders that sometimes crusts or bleeds
· An elevated growth with a central depression that occasionally bleeds
· Rapid growth and increase in size.
· A wart-like growth that crusts and occasionally bleeds
· An open sore that bleeds, crusts, and persist for weeks.
· Regardless of appearance, any change in a pre-existing skin growth, or the development of a new growth or open sore that fails to heal, needs to be evaluated by a physician.

Treatment
After a physician’s examination, a biopsy will be performed to confirm the diagnosis. This involves removing a piece of the affected tissue and examining it under a microscope. If tumor is presents, treatment (usually surgery) is required. Treatment can almost always be performed on an outpatient basis in a physician’s office or clinic. A local anesthetic is used and pain/discomfort is usually minimal.

Types of Treatment
  • Excisional surgery: the entire growth is removed by a scalpel and sent to the laboratory where it is examined microscopically to ensure all tumor cells have been removed.
  • Curettage and Electrodesiccation: the growth is scraped away, then burned until no tumor remains.
  • Cryosurgery: liquid nitrogen freezes the tumor. No cutting is included in this bloodless procedure.
  • Moh’s surgery: (microscopically controlled surgery) successive thin layers of tumor are removed and examined under the microscope. This is repeated until the site is tumor-free. This procedure saves the greatest amount of healthy tissue and reduces recurrence.
  • Radiation: x-ray beams are directed to the tumor. Total tumor destruction requires a series of treatments, usually several times a week for one to four weeks.
  • Laser surgery: A laser beam is used to excise or vaporize the tumor.
  • Follow Up
    · Anyone who has had a squamous cell carcinoma has an increased chance of developing another because of excessive previous sun exposure which cannot be reversed or undone.
    · Although the tumor has been carefully removed, another may arise in the same place or nearby.
    · Squamous cell carcinomas on the nose, ears, and lips are especially prone to recurrence.
    · It is important to periodically examine the entire body for warning signs of squamous cell carcinoma, paying particular attention to any previously treated site.
    · Any changes should be reported to a physician.

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