DR, WHAT IS IT? WHEN NEW GROWTHS APPEAR ON YOUR SKIN

DR, WHAT IS IT? WHEN NEW GROWTHS APPEAR ON YOUR SKIN
Leading dermatologist Dr. Joshua Fox explains benign growths

New Hyde Park, NY, February 2009 – The skin is the organ most exposed to the outside environment and it provides our first line of defense against a wide range of toxins, bacteria, viruses, foreign bodies, and diseases that could have serious and sometimes lethal impact. The many tumors and rashes that appear over time on different parts of the skin can be traced to more than 200 diseases, most of which are treatable, and most of which are completely benign. But it is the risk of malignancy or another life-threatening disorder, and the want to look beautiful, that makes it important to know when a growth or skin eruption requires medical assessment or can be treated simply.

Skin lesions may appear as pigment changes, such as a patch, as bumps, lumps, moles, warts, as flaky or crusty patches, or manifested in a wide number of other types of abnormalities. Joshua Fox, M.D., founder of Advanced Dermatology, P.C. in New York and on Long Island, and a spokesman for the American Academy of Dermatology and the American Society of Dermatologic Surgery, helps to clarify what we need to know about the changes we see on our skin.

MOLES: Most people are aware of the need to examine moles which appear benignly throughout life, and to check for new changes that occur, particularly in parts of the skin exposed to sunlight. Melanoma is the deadliest form of skin cancer taking about 41,000 lives worldwide, although it is far less common than the other skin carcinomas. The incidence of melanoma continues to grow at alarming rates among light-skinned people. According to the American Cancer Society, 60,000 people in the United States developed melanoma in 2007, and more than 8,000 died of the disease. The most suspicious moles are either congenital nevi, moles from birth, or dysplastic nevi, usually larger more irregular moles with irregular shape and or/color, which are found in an estimated ten percent of the American population.

WARTS: Warts are very common growths that occur on various parts of the body as a result of the human papilloma virus (HPV). “These are benign growths that affect all skin types and may go away without treatment, although if they persist, many people seek medical help to remove them due to irritation or just the unsightly appearance. The wart or virus also may promote certain skin cancers like some squamous cell carcinomas and cervical cancer,” Dr. Fox explains. They can be treated chemically, via cryotherapy, or with lasers, or surgically removed in a dermatologist’s office.

KERATOSIS PILARIS: Another type of common skin lesion is keratosis pilaris, in which the cells that normally flake off from the skin’s surface instead become trapped and plug hair follicles. They appear as hyperkeratotic, rough raised bumps based in hair follicles which can multiply in an area like the arms, thighs, buttocks, back and occasionally the face. “This is a common occurrence, particularly among teenagers,” Dr. Fox says, “and is not cause for serious concern.” Moisturizing is the first line of treatment for keratosis pilaris. He also suggests taking long baths and gently rubbing the skin surface with a course washcloth or buff puff. However, in some people this can cause irritation and/or discoloration. If the condition doesn’t go away, there are many effective topical treatments available with or without a prescription.

Seborrheic keratosis is a growth that appears usually over the age of 40, and can become irritating and itchy. It usually appears as brown keratotic stack on a lesion anywhere on the body. There are no particular topical or at-home treatments for this form. A dermatologist can treat areas with cryosurgery (freezing), dermatologic surgery or lasers to eliminate the discomfort and unsightliness.

SKIN TAGS: Skin tags are an annoying type of growth that about half of all people develop as they age. These are small pieces of hanging flesh that develop in areas that are prone to rubbing against clothing or other skin; or are moist areas such as the upper thighs, under arms, neck, and under women’s breasts from underwire bras. Another common site is the eyelid. “Most skin tags are small, but they continue to grow and often become painful or annoying because of their location,” according to Dr. Fox, who recommends a visit to dermatologist to have them removed if they are painful, irritating, bleeding, infected or get caught in clothing.

MELANOMA/SKIN CANCER: It is so important to be familiar with the moles on your body and to perform regular self-examinations of your skin. Melanoma often develops in a pre-existing mole that begins to change or in a completely new mole. Melanoma is a serious skin cancer and the mortality rate is remarkably high considering the fact that it is nearly always curable in its early stages; however, this high number can be attributed to the late diagnosis of the disease in which the cancer spreads to other parts of the body. Melanoma most often appears on the trunk of men and the lower legs and arms of women, although it can be found on the head, neck, scalp or elsewhere. Melanoma represents approximately 5% of all skin cancers in the USA, but accounts for about 75 % of all skin cancer deaths. The World Health Organization estimates that as many as 65,161 people a year worldwide die from malignant skin cancer, approximately 48,000 of whom are registered. The American Academy of Dermatology (AAD) estimates that in 2009, about 116,500 new melanoma cases will be diagnosed in the U.S. with 8,420 deaths (~1 death every hour). Incidence rates are at least 16 times greater in Caucasians than African Americans and 10 times greater than Hispanics. Moreover, even though skin cancers are not as prevalent in individuals with darker skin, they can have more morbidity and fatalities since they may go undiagnosed for longer. Researchers estimate that 1 out of 50 people in the U.S. in 2010 will be diagnosed with melanoma at some point in their lives. Specifically, among Caucasians, the rate of increase of melanoma incidence is 3-7% each year. Melanoma grows from pigment cells (melanocytes) in the outer layer of the skin (epidermis) and mucous membranes and tends to spread out within the epidermis before moving into the deeper layer of the skin (the dermis). In its advanced stages it can spread to other organs of the body. Frequent self-examination for the ABCDE (Asymmetry, Border Irregularity, Color, Diameter and Evolving) characteristics of abnormal moles is suggested.

These are the most common types of growths that may appear over time on the skin, and the majority are no cause for concern. Many other types of benign lesions are also possible such as dermatofibromas, cysts, freckles, fibromas, keloids, lipomas, and granulomas, as well as many more rare types. While an assessment of anything unusual or a mole that is irregular in shape or size is critical, many other skin lesions can still cause a discomfort, pain or embarrassment you don’t have to live with. Dr. Fox notes that there are a wide range of treatments available which you can discuss with your dermatologist. “Many patients don’t realize that most of the treatments can be performed at the time of the consultation visit so you go home without the problem you may have endured for months or years. Usually there is little to no mark left behind. It’s especially important to become educated to the changes that occur on your skin,” says Dr. Fox. “You need to recognize what you are prone to, how you can prevent it, and what options are available to treat it­, as well as which lesion can get you into trouble.”

DERMATOLOGY: BE ON ALERT FOR PRE-CANCER SKIN CONDITIONS.

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DERMATOLOGY: BE ON ALERT FOR PRE-CANCER SKIN CONDITIONS.

DR. JOSHUA FOX, dermatologist and founder of ADVANCED DERMATOLOGY and THE CENTER FOR LASER AND COSMETIC SURGERY in New York: “Actinic keratosis and seborrheic keratosis share the same name, despite the vast differences in their causes, their potential seriousness, their treatment regimens and even their prognoses. Both conditions have several features in common, including the growth of thick, raised bumps on the skin, and the increased incidence of both as we age. The actinic keratosis often looks innocuous enough, but it can be either a pre- cancer or the beginning stage of a serious skin cancer called squamous cell carcinoma. And, while the seborrheic keratosis is a completely benign growth, it may mimic or look similar to a melanoma — the deadliest skin cancer of all. It’s so important that patients understand the differences between these conditions, and that they know what to do when they suspect either one.”

BE ON ALERT FOR PRE-CANCER SKIN CONDITIONS.

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DERMATOLOGY:  BE ON ALERT FOR PRE-CANCER SKIN CONDITIONS.DR. JOSHUA FOX, dermatologist and founder of ADVANCED DERMATOLOGY and THE CENTER FOR LASER AND COSMETIC SURGERY in New York:

“Actinic keratosis and seborrheic keratosis share the same name, despite the vast differences in their causes, their potential seriousness, their treatment regimens and even their prognoses. Both conditions have several features in common, including the growth of thick, raised bumps on the skin, and the increased incidence of both as we age. The actinic keratosis often looks innocuous enough, but it can be either a pre-cancer or the beginning stage of a serious skin cancer called squamous cell carcinoma. And, while the seborrheic keratosis is a completely benign growth, it may mimic or look similar to a melanoma – the deadliest skin cancer of all. It’s so important that patients understand the differences between these conditions, and that they know what to do when they suspect either one.”

TWO SKIN CONDITIONS SHARE THE SAME NAME…BUT THE SIMILARITY ENDS THERE: Leading dermatologist Dr. Joshua Fox on critical differences between Actinic and Seborrheic Keratoses.

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TWO SKIN CONDITIONS SHARE THE SAME NAME…BUT THE SIMILARITY ENDS THERE: Leading dermatologist Dr. Joshua Fox on critical differences between Actinic and Seborrheic Keratoses.

New York, NY, May, 2007 – Merriam-Webster’s Medical Dictionary defines keratosis as “any disease of the skin marked by tough or calloused growths.” It’s this broad definition that allows Actinic Keratosis and Seborrheic Keratosis to share the same name, despite the vast differences in their causes, their potential seriousness, their treatment regimens and even their prognoses.

“While both conditions have several features in common including the growth of thick, raised bumps on the skin and are increased in the elderly and with commonality between Actinic Keratosis and Seborrheic Keratosis,” Joshua Fox, MD, founder of Advanced Dermatology and a spokesman for the American Academy of Dermatology. “Ironically, the Actinic Keratosis often looks innocuous enough, but it is now considered by some dermapathologists to be either a precancer for or an incipient squamous cell carcinoma – a serious skin cancer. While the Seborrheic Keratosis is a completely benign growth, it  may mimic or look similar to a melanoma – the deadliest skin cancers of all,” Dr. Fox adds. “It’s so important that patients understand the differences between these conditions, and that they know what to do when they suspect either one.”

Actinic Keratosis: The facts

Actinic Keratoses, called AK, usually appear on the skin as small, red, rough, scaly, raised bumps or patches. They were once thought of as a precancerous growth. However, numerous experts now believe that the AK particularly if hypertrophic is the earliest stage of squamous cell carcinoma – the second most serious skin cancer behind melanoma. In an article published in Clinics in Dermatology in 2004, researchers at Northwestern University School of Medicine confirm that AKs are indeed early cancers, and recommend speedy treatment to prevent them from developing into invasive squamous cell carcinoma.1

Dermatologists can remove Actinic Keratoses in a number of ways. Cryotherapy uses liquid nitrogen to freeze the growths and cause them to fall off, while topical agents such as the chemotherapy drug fluorouracil can destroy the growths. Laser therapy is often considered the least painful and most precise method of removing AKs, as local anesthesia is used to ensure the patient’s comfort and the laser can easily target only the growths themselves without harming surrounding tissue.

Fortunately, if one starts early in life then AKs are usually preventable, as the leading cause of this condition is sun exposure (hence their alternate name, Solar Keratosis). Dr. Fox advises the following three steps to minimize the risk of developing Actinic Keratoses:

  1. USE SUNSCREEN every day, particularly on areas of the skin that will be exposed to the sun, such as the neck, face and forearms. “Although the sun’s UV rays are strongest in summer, using sunscreen year-round is critical to skin health and can help reduce the signs of aging on the skin as well,” Dr. Fox notes.
  2. WEAR SUN-SMART CLOTHING to cover as much of the skin as possible, and shade the eyes and face with a hat. “While winter weather makes it easy to keep skin covered, dressing to stay cool and protected in the summer can be a challenge,” Dr. Fox says. “I recommend light-colored clothing that reflects the sun’s rays, and thinner fabrics for comfort.”
  3. STAY OUT OF THE SUN whenever possible. Seek shade or carry something with you in the form of a large umbrella, and schedule outdoor time before 10:00 a.m. and after 3:00 p.m., as between these hours the sun’s UVB rays are the strongest.

Seborrheic Keratosis: The facts

A Seborrheic Keratosis is a bit of a mystery, as no one knows what causes these waxy dark brown or black bumps to appear, usually around age 40, and often to multiply with age. They are not caused by sun exposure, and indeed they can develop anywhere on the body. They can appear as a single spot, as a cluster of spots or all over the body. They can be small, or large and disfiguring. They tend to run in families, but it is not uncommon for someone without a family history to develop them. Because they are benign, they do not require treatment unless they itch, bleed, become bothersome, inflamed or infected. The most common methods of SK removal include cryotherapy, curretage and/or electrocautery and laser.

Despite the disparity surrounding Seborrheic Keratosis, Dr. Fox points out, two facts are certain: “These are completely benign skin growths, and they to the novice eye be easily be mistaken for melanoma…and vice versa.” The danger, then, surrounding Seborrheic Keratosis is a misdiagnosis, particularly one that misidentifies a melanoma as an Seborrheic Keratosis.

“This leads to the most important advice for patients regarding their skin,” Dr. Fox concludes. “First, incorporating skin self-exams and a regular skin check-up by a board-certified dermatologist can ensure any new growths or changes to existing skin conditions are caught at their earliest stages. Of course, any skin changes or new growths should be evaluated immediately by a specialist. Lastly, patients should never hesitate to seek a second opinion when it comes to their skin health.