Tag Archives: Basal Cell Carcinoma

Basal Cell Carcinoma: Diagnosis And Treatment

The skin is The largest organ in the body. It certainly receives the largest amount of ionizing radiation from the sun, the most common cause of genetic mutation of cells of the skin. As you get older, these mutations build up, leading to an increasing number of skin cancers that need removal.

In my younger years, I had red hair and lots of freckles. Between the freckles I had a little pigmentation to protect me from the sun. The only sunscreen then available was a messy white paste called zinc oxide, and I resorted to it infrequently. I was out a lot playing tennis, hiking and camping, and even skied once or twice. I did wear hats a lot, especially as I got older and wiser, but still it is amazing I’m not having more trouble now.

I go to the dermatologist every 3 to 6 months to get my actinic keratoses frozen off. These are the little patchy,rough irregularities in the skin that can grow into basal cell, and sometimes squamous cell cancer. I have had just one skin cancer, a basal cell, which I discovered when there was a patch on my chin that kept bleeding when I shaved. One of my classmates in medical school was a plastic surgeon, and kindly removed this lesion with a minimum of scarring.

Lots of doctors, usually Dermatologists, currently specialize in Mohs surgery, in which the basal cell  cancer is gradually shaved off until its margins, the edge of the shaved biopsy, show no cancer.

The moral of the story is to avoid unnecessary ultraviolet exposure. Don’t go to tanning studios. If you must be in the sun, put on sunscreen, and wear a hat. Some would argue that if you stay out of the sun you will get vitamin D deficiency. It is true that vitamin D Is important, and I would recommend checking your blood vitamin D level every year or so. But would rather take my vitamin D in a capsule than get it from sun exposure.

—Dr. C.

Skin Cancer: The 3 Main Types (Cleveland Clinic)

Skin cancer is the most common form of cancer in the United States. The good news is, this disease is extremely treatable if caught early. Cleveland Clinic experts break down the 3 main types of skin cancer and how you can spot the signs of each.

Chapters: 0:00 Intro 0:24 What does skin cancer look like? 0:49 What are the signs of skin cancer? 0:59 What are the types of skin cancer? 1:06 What is basal cell carcinoma? 1:35 What is squamous cell carcinoma? 1:52 What is melanoma? 2:26 When should you talk to your doctor about skin cancer?

Melanoma: How To Catch Skin Cancer Early (Mayo)

TELEMEDICINE: THE RISE OF TELEDERMATOLOGY (AMA)

From AMA.org (June 12, 2020):

Teledermatology

“There’s an aging population, and there’s a lot of skin out there,” said Dr. Isaacs. “One in five people in the country develop skin cancer, but there is a plethora of benign skin conditions that also require the expertise of the dermatologist. So, you have increasing demand and a limited supply of dermatologists.”

A basic example of how the TPMG teledermatology program works involves a patient who is concerned about a suspicious lesion or mole on their body. The patient can take a picture of the location in question and send it to their primary care physician for review. The physician can request the patient come in for a more thorough evaluation, or if the physician determines that a dermatologist should be involved, they can send the photo to an on-call dermatologist to review.

If the patient does an in-person evaluation, the physician can also take a higher-quality image and forward that to a dermatologist. The dermatologist can then decide whether there is a problem, if a prescription is needed, or if there should be an in-person evaluation and potential biopsy.

A study in the Journal of the American Academy of Dermatology in 2019 found that when TPMG dermatologists had the chance to look at well-photographed skin lesions, they were able to identify nearly 10% more cancers with almost 40% fewer referrals to the dermatology department.

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COMMENTARY

A high quality I-phone picture of a skin lesion can provide the dermatologist with 90% of the information needed for a diagnosis.

Melanoma diagnosis depends even more on the visual. In fact, Artificial  Intelligence evaluation of Melanoma may be  overtaking dermatologist expertise.

Size can be indicated by including a dime in the photo.

It is true that the roughness, softness or hardness may be important in diagnosis, but perhaps these characteristics could be described by the Patient.

This week, I started worrying about an itchy, rapidly growing lesion on my back. I sent a picture of this to my dermatologist, hoping he would call it a wart and reassure me. It was very regular, soft, and had a rough surface like warts I have had in the past.

However, he saw some redness and had me come in for removal. We will see what the pathology shows.

Dermatologists are in short supply, and making more efficient use of their expertise attractive.

Calling the Doctor’s office, arranging for e-mail Photo transmission, and a talk with the Doctor on the phone could save a visit. The Primary Doctor could send you directly to the dermatologist, or might be comfortable with watching and waiting.

Dermatology is indeed a field ripe for Telemedicine.

—Dr. C.