Skin Cancer Archive

Q. I recently had a basal cell carcinoma of the skin removed. Will it come back? Can I prevent a recurrence?

A. After being removed, basal cell carcinoma (BCC) of the skin does recur at some other spot on the body in about 40% of people. Routine skin examinations can find repeat cancers while they are still small. The exams should cover the entire body, including the top of your head, the backs of your ears, and the bottoms of your feet. BCC often appears as a waxy or pearly colored bump.

Sixteen million Americans struggle with rosacea, a skin condition characterized by flare-ups of reddened and sometimes bumpy facial skin. Over time, rosacea can reveal blood vessels under the skin's surface. But you don't have to suffer. Consider this advice from dermatologist Dr. Kenneth Arndt, a Harvard Medical School professor.

• Use topical treatments. "The most effective gels, creams, and lotions contain either metronidazole or azeleic acid. They should keep rosacea under control with continued use, which is safe for prolonged periods of time without side effects," says Dr. Arndt.

• Treat rosacea on the inside, too. "Very low doses of antibiotics, such as doxycycline, are effective in controlling rosacea's inflammation. The dosage is much lower than would be used for a bacterial infection, so the potential side effects are minimized or absent. Start with orals and topicals, then taper off to topical agents only"

• Eliminate dilated blood vessels with lasers. Effective treatments include the pulsed dye laser (yellow light), pulsed green-light laser, and intense pulsed light. Several treatments are usually required, spaced six to 12 months apart.

• Use diet to avoid flare-ups. "Do everything possible to avoid triggers such as spicy foods as well as thermally hot food and drink—it's the heat that causes flushing, not the coffee itself," says Dr. Arndt.

Aspirin may lower women's risk for melanoma. The longer women take aspirin, the lower their risk appears to be. However, because aspirin can cause gastrointestinal bleeding, women need to use it with caution.

Aspirin appears to be associated with a lowered risk of melanoma in postmenopausal women. It does not appear to cause melanoma risk to decrease. It is only associated with a decrease in risk.

With the unofficial start of summer just a few days away, many people will soon be stocking up on sunscreen. The products they’ll be seeing in stores look different than they have in the past. That’s because new rules for sunscreen labels are now in effect. The changes are good ones for consumers. The new rules, mandated by the FDA, are making sunscreen more informative with less misleading information. For example, the term “sunblock” is banned because none of these products can block all of the sun’s ultraviolet rays. “Waterproof” is also banned, replaced by “water-resistant”—which must be accompanied by a set time for reapplication. Another big change has to do with SPF, or sun protection factor. The best protection comes from a sunscreen that provides broad spectrum protection, meaning it filters out much of the UVA and UVB. Under the new FDA rules, if a label says “broad spectrum,” the product must pass tests proving that it truly protects against both UVA and UVB rays. Sunscreen products that don’t meet an SPF of 15 or higher for both UVA and UVB must now carry a warning.

Phone applications that monitor suspicious moles for the deadly skin cancer melanoma may not be reliable. In a study, three out of four applications incorrectly classified 30% or more melanomas as unconcerning.

Zeroing in on who might be eligible for this first-line treatment.

For the first time, dermatologists now have official guidelines for Mohs surgery, a procedure that removes skin cancer while minimizing damage to surrounding healthy tissue. The new Appropriate Use Criteria (AUC) for Mohs surgery, approved by a number of dermatologic associations, will help doctors better select patients for the procedure. "There can be a slight bias toward using it for almost all nonmelanoma skin cancers, since Mohs surgery offers the highest cure rate of any surgical procedure for skin cancer," says Dr. Tom Rohrer, a Mohs surgeon at Harvard-affiliated New England Baptist Hospital.

Q. My dermatologist is recommending Mohs surgery to remove a basal cell cancer on my nose. What does this involve?

A. Mohs micrographic surgery is named after Frederic Mohs, who developed the technique in the 1930s. It's a specialized surgical procedure used to eliminate skin cancers that spread locally (but do not spread through the body) and are likely to return unless all the cancer is cut out. The goal of Mohs surgery is to remove all of the cancer cells while preserving as much of the normal tissue as possible. To do this, the surgeon removes the cancerous tissue layer by layer, examining each layer under a microscope, until the outer edge of the removed layer (the margin) is free of cancer cells.

58 million of us have actinic keratoses. Now treatment is easier.

They look minor. They are usually pea-sized rough patches, often scaly and with surrounding redness, on sun-exposed skin. But actinic keratoses (AK), caused by too much sun exposure, are nothing to dismiss. "They can progress to skin cancer, or there can be so many that it's difficult to pick out lesions that are already skin cancers," says Dr. Suzanne Olbricht, associate professor of dermatology at Harvard Medical School.

How to spot potential problems and get peace of mind.

Skin cancer may be your last health worry under winter's gray skies. But skin cancer checks need to be a year-round maintenance effort. "About 50% of melanomas are identified by patients, and even more are discovered if the skin is examined with the help of a partner," says Dr. Kenneth Arndt, a Harvard Medical School professor.�