ABCD’s of Skin Cancer
Asymmetry: One half unlike the other half
Border: Irregular, scalloped or poorly defined border
Color: Varied from one area to another; shades of tan and brown or black; sometimes white, red or blue
Diameter: While melanomas are usually greater than 6mm in diameter when diagnosed (the size of a pencil eraser), they can be smaller. If you notice a mole different from others or which changes, itches, or bleeds (even if it is small) you should see your dermatologist.
Acne is a skin condition which causes clogged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, back, chest, neck, shoulders and upper arms. It is most common in adolescents but oftentimes adults in their 20’s, 30’s, 40’s and even older adults can develop acne. Untreated acne can leave permanent scars. Topical and/or oral antibiotics are often prescribed to treat acne. Chemical peels, laser treatments, injections of corticosteroids, birth control pills, and microdermabrasion are other common treatments for acne.
Actinic Keratosis (AK’s) are common skin lesions caused by years of sun exposure and are considered the earliest stage in the development of skin cancer. AK’s are also called “solar keratosis” or “sun spots.” Fair-skinned individuals are more susceptible, and AK’s tend to appear on skin that receives the most sun: the forehead, ears, neck, arms, hands, lower lip, bald scalp, and lower legs of women. Common treatments include cryosurgery, topical chemotherapy, topical immunotherapy, topical NSAID, and photodynamic therapy (PDT).
Allergic Contact Dermatitis
Allergic contact dermatitis is caused by a reaction to substances called allergens that come into contact with your skin. In susceptible people, these contact allergens can cause itching, redness, and blisters. Common allergens include: nickel, rubber, detergents, some skin care products, poison ivy and its relatives, chromates, hair dyes, and neomycin. Treatments available include topical steroid creams and/or oral antihistamines.
Athlete’s Foot (tinea pedis) is a fungal infection like a tiny plant-like “germ,” that can grow and multiply on human skin, especially the feet. It grows best in a dark, moist, and warm environment. A foot inside a shoe is the perfect place for the fungus. The same fungus may also cause “jock itch” in the groin. It is more frequent among teenage and adult males, but may occur in women and in children under the age of 12.
An atypical or dysplastic nevus (mole) is a benign growth that may share some of the features of a melanoma, but is NOT a melanoma or any other form of cancer. The presence of an atypical nevus, however, may increase the risk of developing melanoma, or be a marker for it. Since an atypical nevus is not the same as melanoma, it does not need to be treated aggressively but should be observed for any changes, biopsied, or conservatively excised.
Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is the most common form of skin cancer worldwide. In the majority of cases, it is thought to be caused by exposure to the harmful ultraviolet (UV) rays of the sun. BCC does not usually metastasize; rather, it infiltrates the surrounding area destroying tissue. The most common appearance of BCC is a small, dome-shaped, pimple-like growth that has a pearly color. Blood vessels may be seen on the surface. It can also appear as a sore that seems to heal but repeatedly recurs. There are various treatment options available for BCC and will be determined by your dermatologist. They include: excision, electrodesiccation and curettage, cryosurgery, radiation therapy and laser surgery, topical therapy, and Mohs micrographic surgery.
The hallmark of any bullous disease is the formation of blisters. The type of disease depends upon what level of the skin the blisters form and where they are located on the body. Many of these diseases are also categorized as autoimmune diseases. Bullous diseases of the skin include bullous pemphigoid, pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceous, paraneoplastic pemphigus, mucous membrane pemphigoid, linear IgA bullous disease, dermatitis herpetiformis, and epidermolysis bullosa acquisita. Treatment usually involves one of the following: Oral corticosteroids (prednisone), immunosuppressant drugs, tetracycline, or sulfa drugs.
Common Skin Growths
Many common growths develop on the skin. While the cause is often poorly understood, it is known that some are associated with aging, and others are inherited. Benign lesions are not life threatening, but people often have these lesions removed for cosmetic reasons. Examples include:
- Prurigo Nodularis
- Pyogenic Granuloma
- Epidermoid and Pilar Cysts (Sebaceous Cysts)
- Sebaceous Gland Hyperplasia
- Digital Mucinous Pseudocyst
- Hemangioma (Cherry Angioma)
- Seborrheic Keratoses and Verrucous Acanthoma
- Nevi (moles)
- For diagnosis and treatment for any of these lesions, please see your dermatologist.
Eczema describes certain kinds of inflamed skin conditions including redness, blistering, oozing, scaly, itchiness or thickening. Atopic dermatitis often translates to excess inflammation in the skin and the linings of the nose and lungs. Most common in childhood, these conditions can continue into adulthood. With regular treatment, patients often find much relief and reduction in the severity and duration of the disease.
Fungal Infections of the Skin
Fungal infections of the skin or nails, also referred to as tinea, are quite common. Fungal infections are contagious and thrive in warm, moist areas. A comb, clothing, shower surface, or pool area can harbor tinea. Common fungal infections include: athlete’s foot (tinea pedis), jock itch (tinea cruris), ringworm (tinea corporis), scalp ringworm (tinea capitis), and nail fungus (onychomycosis, tinea unguium).
Genital warts, also knows as venereal warts, or condylomata acuminata, are caused by the human papilloma virus (HPV). More than 100 types of HPV are known to exist. Genital warts are usually sexually transmitted and all partners should be checked thoroughly. They can also be seen in infants who have been delivered vaginally to mothers with HPV in their genital tracts. The treatment depends on the number of warts, their specific location, and other factors. Recurrences are always possible. Transmission can be prevented by the proper use of condoms. Your dermatologist may provide treatment via both surgical and non-surgical (chemical) options.
Granuloma annulare is a raised skin lesion that may be pearly white, skin-colored, red, or purple. It is most often in an isolated area, but may appear as several “bumps” spread over the body. It appears most often on the tops of the hands and feet, elbows and knees. It is more common in children and young adults, although it may affect people of all ages. As most people do not have symptoms, treatment is not necessary. The spots on the skin generally disappear on their own without leaving scars. For diagnosis and treatment, consult your dermatologist.
Hair Loss & Hair Restoration
People who notice hair that is falling out, thinning or appearing in large amounts on their comb or brush should consult a dermatologist. With correct diagnosis, many people with hair loss can be helped. Your dermatologist will evaluate the hair-loss problem to find the cause so they can determine whether the problem will resolve on its own or if medical treatment is needed.
A hand rash, also called hand dermatitis or hand eczema, is very common and may be caused by many things. Most cases start with dry, chapped hands that later become patchy, red, scaly, and inflamed. Numerous items can irritate the skin on the hands including: overexposure to water, too much dry air, soaps, detergents, solvents, cleansing agents, chemicals, rubber gloves, and even ingredients in some skin and personal care products.
There are two types of herpes simplex virus:
The Type 1 virus causes cold sores which are tiny, clear, fluid-filled blisters. Most people get Type 1 infections during infancy or childhood. It can be transmitted by kissing, sharing eating utensils, or by sharing towels. The sores most commonly affect the lips, mouth, nose, chin, or cheeks and occur shortly after exposures.
The Type 2 virus causes genital sores. Most people get Type 2 infections following any sexual contact with an infected person.
Herpes Zoster (Shingles)
Herpes Zoster, also known as shingles or zoster, is a viral infection caused by the same virus that causes chicken pox. Anyone who has had chicken pox can develop herpes zoster. The virus remains dormant in certain nerve cells of the body, and when it reactivates it causes zoster. Beginning symptoms are burning, itching, tingling, or extreme sensitivity in one area of the skin, usually limited to one side of the body. Between one to three days a red rash will appear at the site and may eventually turn into blisters. There may also be a fever or headache associated with other symptoms.
Hyperhidrosis is an excessive sweating condition. There are three types:
- Primary focal hyperhidrosis is a true medical condition not caused by medication or another medical problem. It occurs on specific areas of the body usually appearing on both sides equally, such as; hands, feet, underarms, head and face. Treatment options include iontophoresis, Botulinum toxin type A (BOTOX®), oral medication, sympathectomy, and surgical intervention.
- Generalized idiopathic hyperhidrosis is a true medical condition in which large areas of the body sweat. This is usually treated with oral medication.
- Secondary generalized hyperhidrosis may be caused by a medical condition such as menopause, overactive thyroid, diabetes, or stroke. Medications, exercise and heat can also cause secondary generalized hyperhidrosis. This condition must be investigated by a dermatologist for proper diagnosis and treatment.
Lichen planus (LP) is a common inflammatory disease of the skin and mouth. It affects about one to two percent of the general population. The cause of LP is not known. LP of the skin is characterized by reddish-purple, flat-topped bumps that may be very itchy. This can occur anywhere on the body but seems to favor the insides of the wrists and ankles.
Melanoma is a cancer of the pigment producing cells in the skin known as melanocytes. If given time to grow, melanoma can grow down into the skin ultimately reaching the blood and lymphatic vessels, and spread around the body (metastasize) causing a life-threatening illness. It is curable when detected early, but can be fatal if allowed to progress and spread. Consistently check your moles using the ABCD’s of skin cancer and see your dermatologist yearly for a full body skin exam.
Moles (nevi) are extremely common. Research has shown that certain moles have a higher-than-average risk of becoming cancerous.
Congenital Mole – When a person is born with a mole (ranging from small to large/giant) it is called a congenital mole (nevus). The large/giant congenital mole has been shown to carry a higher risk of developing melanoma.
Atypical Mole – Also called dysplastic nevi, these moles are generally larger than average (bigger than a pencil eraser) and irregular in shape. They tend to have uneven color with mixtures of tan, brown, red, and pink. People with atypical moles have a greater chance to develop melanoma.
Acquired Mole – moles that appear after birth are called acquired moles and generally not cause for concern. People who have more than 50 to 100 acquired moles, however, have a greater risk for developing melanoma than those with fewer moles.
Molluscum contagiosum is a common skin disease caused by a virus which affects the top layers of the skin. Molluscum appears as small flesh-colored or pink dome-shaped growths that are shiny and have a small indentation in the center. They often become red or inflamed and can spread by skin-to-skin contact. It does not affect any internal organs. Many dermatologists choose to treat molluscum because the growths are easily spread from one area to another; however, they will go away on their own within 6 months to 5 years.
Nail Fungus & Common Disorders
While uncommon in children, nail disorders affect a large number of older adults. As we age, nails thicken and become more susceptible to fungal nail infections. Circulatory problems and use of medications, which also tend to increase as we age, raise the risk of developing a nail condition. Common nail fungi and disorders include: white spots, splinter hemorrhages, ingrown toenails, fungal infections (onychomycosis), bacterial infections, tumors and warts, mucinous cysts, dark spots.
Perioral dermatitis is a common skin problem that affects young women and occasionally, men or children. “Perioral” refers to the area around the mouth, and “dermatitis” indicates a rash or irritation of the skin. Small red bumps, mild peeling, mild itching, and sometimes burning are present with perioral dermatitis. Oral antibiotics and topical creams are often used to cure this condition.
Pityriasis rosea is a rash that can occur at any age but is most common from age 10 to 35 years and can last from several weeks to several months. The condition often begins as a large single pink patch on the chest or back. This patch may be scaly and is called a “herald” or “mother” patch. It is often mistaken for ringworm. Within weeks more pink patches, sometimes hundreds, will appear and are smaller than the “mother” patch. The primary cause is unknown; however, it is not caused by a fungus.
Poison Ivy, Oak & Sumac
A poison plant rash is an allergic contact dermatitis caused by contact with oil called urushiol. Urushiol is found in the sap of poison plants like poison ivy, oak, and sumac. Contact with urushiol can occur in three ways; direct contact (touching the sap), indirect contact (touching something on which urushiol is present), and airborne contact (burning poison plants puts urushiol particles into the air). A reaction appears within 12-48 hours. There is severe itching, redness, and swelling followed by blisters. It is important to know what these poison plants look like so you can avoid them.
Pruritus is an itch or a sensation that makes a person want to scratch. Pruritus can be a part of skin diseases, internal disorders, or due to faulty processing of the itch sensation within the nervous system. Skin diseases like urticaria (hives), varicella (chicken pox), and eczema which may have itching associated with a rash. Some parasitic infestations such as scabies and lice may be very itchy. Pruritus may also be a manifestation of an internal condition the most common being kidney failure. Some types of liver disease like hepatitis, thyroid disease, blood disorders, anemia, and neurologic conditions can cause itch. Lastly, infectious diseases like HIV can cause severe itching.
Psoriasis is a persistent skin disorder that occurs in two out of every hundred people in the U.S., detectable by red, thickened areas with silvery scales. Often found on the scalp, elbows, knees, and lower back, it can also occur in other areas such as the nails. There are many types of treatments including, but not limited to: steroids, Anthralin, vitamin D, light therapy, retinoids, and biologic agents.
Rosacea is a common skin disease that causes redness, flushing, acne, and swelling. It mostly affects the cheeks, forehead, chin, and nose. Small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads. Rosacea can be treated with various oral and/or topical medications, laser treatment, as well as products specifically designed for patients with rosacea.
Scabies is caused by a tiny mite that has infested humans for more than 2,500 years. It is often hard to detect, and causes a fiercely, itchy skin condition. Scabies is almost always caught from another person by close contact. The earliest and most common symptom of scabies is itching, especially at night. Little red bumps like hives, tiny bites, or pimples appear. Visit your dermatologist as soon as possible to begin treatment. An important note to remember if experiencing scabies is that it is not a reflection of your personal hygiene and cleanliness.
Seborrheic Dermatitis is a skin disorder that causes a red, scaly, itchy rash. This condition most commonly develops on the scalp, sides of the nose, eyebrows, ears, eyelids, and the middle of the chest. Three age groups are most commonly affected: infancy (“cradle cap”), middle-aged, and seniors. Seborrheic dermatitis tends to come and go and is most common in people with oily skin or hair and may be seen with acne or psoriasis. For people living in northern climates, winter can worsen seborrheic dermatitis.
Seborrheic keratoses (SK’s) are benign skin growths that can occur anywhere on the skin. Usually beginning as small, rough bumps, SK’s tend to eventually thicken and develop a warty surface. Most are brown, but these growths can range in color from light tan to black. Some SK’s can become as large as a half-dollar. What often distinguishes these growths from other lesions is a waxy, stuck-on appearance, similar to a drop of brown candle wax. Cryosurgery is a common treatment option for SK’s.
Skin cancer is the most prevalent of all types of cancers. Fair-skinned individuals who sunburn easily have the greatest risk to develop skin cancer. Other important risk factors include use of tanning devices, family history, repeated medical and industrial x-ray exposure, immunosuppression, scarring from diseases or burns, and occupational exposure to compounds such as coal, tar and arsenic. You should develop a regular routine to inspect your entire body for any skin changes. If a growth, mole, sore, or skin discoloration appears suddenly or begins to change, see your dermatologist.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is a tumor that arises in the outer layer of the skin. Middle-aged and elderly people, especially those with fair complexions and frequent sun exposure, are most likely to be affected. If treated in a timely manner, it is uncommon for skin SCC to spread to other areas of the body. They often arise from small sandpaper-like growths called actinic keratoses (AK’s) and appear as a crusted or scaly area of the skin with a red, inflamed base. SCC can be present as a growing tumor, a non-healing ulcer or just as a crust. Any worrisome skin lesions, especially those that are not healing and are growing, bleeding, or changing should be promptly evaluated by your dermatologist.
Tinea versicolor is a skin condition caused by an overgrowth of yeast on the skin’s surface. The yeast normally lives in the pores of the skin and can thrive in oily areas such as the neck, upper chest, and back. An overgrowth results in a fungal infection that causes uneven skin color, scaling, and sometimes itching. Treatments include topical cleansers, shampoos, creams or lotions, oral medications, and medicated cleansers.
Urticaria (hives) are localized, pale, itchy, pink wheals (swellings) that can burn or sting. They may occur singularly or in groups on any part of the skin. They are part of an allergic reaction and are very common. Allergic reactions, chemicals in foods, or medications may cause hives; sometimes it is impossible to find out the cause. Antihistamines are prescribed to provide relief and work best if taken on a regular schedule to prevent hives from forming.
Vitiligo is a medical condition that causes the skin to lose color, or pigment. Some people develop a few spots that may lighten or turn completely white while others can have widespread loss of skin color. Vitiligo develops when cells called melanocytes die or are destroyed by the body’s immune system. As the cells die, an area of skin or hair turns white because the cells no longer make pigment. Treatment options include light therapy & medications, narrow band ultraviolet B, or PUVA (UVA light).
Warts are non-cancerous skin growths caused by a viral infection in the top layers of skin. The virus that causes warts is called the human papilloma virus, or HPV. There are several different kinds of warts including: Common Warts (verruca vulgaris), Plantar/Palmar Warts (verruca plantaris/palmaris), Flat Warts (verruca-plana), and Genital Warts (condylomata acuminata). Cryotherapy (freezing) and laser treatments are common therapies used to treat the various types of warts.