Skin Cancer Screening

Submitted by Robert Lajvardi MD

Blocking UV rays will save your skin from the need for many cosmetic procedures and skin cancer treatments. Prevention is golden and nothing is as important as sun-blocking as a life style.

Sun damaged skin often leads to lesions know as Actinic Keratosis. These are known as “pre-cancerous” lesions and multiple treatments exists to correct, reverse and treat these lesions or abnormalities. The goal is to treat these lesions as early as possible to avoid progression to skin cancer such as Basal Cell Carcinoma or squamous Cell Carcinoma.

Early treatments of pre-cancerous lesions is cheaper and more effective and often can leave less scarring and better cosmetic outcome.

Current Treatment Options For Actinic Keratosis

Photodynamic Treatment With IPL

FDA has approved the use of topical aminolevulinic acid (ALA–Levulan kerastick) in the treatment of Actinic Keratosis. We use a non-laser light source known as IPL to activate this photosensitizer ALA followed by exposure to a specific wavelength of light which causes cellular destruction. The wavelength of light used activates ALA which then selectively goes after damaged skin epithelium and abnormal cells within the dermis. Studies of patients with multiple AKs on the face and scalp have shown close to 90 percent of the lesions completely clearing up after eight weeks of treatments compared with 6 percent with the control group.

Advantages

Ability to treat a large number and/or area of damaged skin without the need of multiple treatments of chemotherapy agents or cryogenic freezing. Cosmetic outcome are far superior to other alternative treatments of Actinic Keratosis. Minimal risk of pigmentary changes.

Disadvantages

Downtime for 2 days- patients can not go out and be exposes to the sun. Most common complaint is slight burning/stinging within the first 48 hr.

Glycolic Acid Peel

Glycolic Acid Peel at higher strengths of 70% has been shown to be effective in treating Actinic Keratosis in a series of 5 treatments.

Chemical Peels

A chemical peel is a procedure in which a topically applied wounding agent creates smooth, rejuvenated skin by way of an organized repair process and exfoliation.

Patients with a history of HSV infection, previous radiation exposure, immunosuppression, post-inflammatory hyper-pigmentation, keloids, recent facial surgery, or taking photosensitizing medications may experience higher rates of complications.

Cryotherapy

Cryotherapy uses liquid nitrogen as the freezing agent to effectively destroy the top layer of skin know as epidermis and with deeper freeze, some penetration to deeper skin can be achieved. The idea is “selective tissue destruction”. Such selective tissue destruction will lead to removal of the damaged tissue and allowing for healing to take place in the next 4-12 weeks.

Advantages

Inexpensive and ideal for isolated and few lesions in a given area. Relatively painless.

Disadvantages

Not ideal for treating larger extensive area treatments. May leave some pigmentary changes.

Efudex

Advantages

It can work.

Disadvantages

Chemotherapy agent with much longer downtime and more side effects. Dermatitis, rash, alopecia (hair loss), Heartburn, nausea, vomiting, anorexia, stomatitis, esophagitis, anorexia, stomatitis, diarrhea. Cardiac enzyme abnormalities, chest pain, coagulopathy, dyspnea, ECG changes similar to ischemic changes, hepatotoxicity; hyper-pigmentation of nail beds, face, hands, and veins used in infusion; hypotension, palmar-plantar syndrome (hand-foot syndrome), photosensitization, Cerebellar ataxia, headache, somnolence, ataxia are seen primarily in intra carotid arterial infusions for head and neck tumors.