A new approach prevents skin cancer

A new approach prevents skin cancer

Cancer prevention and early detection techniques could eliminate as many as 100,000 cancer cases and 60,000 cancer deaths in the U.S. each year.

Cancer prevention and early detection techniques could eliminate as many as 100,000 cancer cases and 60,000 cancer deaths in the U.S. each year.

by Dr. William Nelson —

Every year there are more new cases of skin cancer than breast, prostate, lung and colon cancers combined. One in five Americans will contract skin cancer. Ninety percent of skin cancers are caused by excessive sun exposure, yet fewer than 33 percent of adults, adolescents and children routinely use sun protection.

Cancer prevention and early detection techniques could eliminate as many as 100,000 cancer cases and 60,000 cancer deaths in the U.S. each year. New technologies to evaluate and treat sun-damaged skin could have a positive impact on changing these statistics.

The same sunny weather that attracts so many tourists and new residents to the Sunbelt also increases the risk of skin cancer. The effects of chronic sun exposure result in visible, superficial sun spots as well as invisible changes under the skin’s surface. Ultraviolet photography and photodynamic therapy (PDT) are two recent developments that may help in the early detection and treatment of both types of pre-cancerous skin lesions.


Early detection with UV photography

Visual inspection can only detect changes on the skin’s surface, but damage due to sun exposure occurs beneath the outer layer of skin. Ultraviolet (UV) photography offers a very useful screening tool to help the skilled physician detect sun-damaged skin that may not be visible upon a routine examination.

The UV camera radiates ultraviolet light, which is able to penetrate 1.5 to 2.0 millimeters under the visible dead layer of skin and focus on the actual living portion where sun damage originates. This technology allows the advantage of much earlier detection of skin problems — before they develop into pre-cancers that are visible on the skin’s surface.

After finishing the treatment plan, the doctor should take another UV photo to verify the efficacy of the treatment. UV photography also helps evaluate other skin conditions including acne, oil balance, hydration, inflammation, growths, fungi, pH and thin skin due to reduced collagen, which makes it an ideal tool for evaluating all problem skin.


The importance of early detection

Following damage to the deeper skin layers, superficial signs of sun damage may eventually appear on the surface. The most common surface lesion is known as actinic keratoses (AK) which usually appears as rough or scaly patches. They may also flake or crust, and may temporarily disappear and then return.

An AK is most likely to appear on the face, ears, scalp, neck, back of the hand and forearms, shoulders and lips — the parts of the body most often exposed to sunshine. The scaly patch may be light or dark, tan, pink, red or a combination of these, or the same color as your skin.

It is estimated that 10 to 20 percent of untreated AKs will develop into squamous cell cancers. If treated early, almost all AKs can be eliminated before they become skin cancers. The existence of AKs indicates you have sustained sun damage and have a higher risk for developing all types of skin cancer, not just squamous cell carcinoma.

The more keratoses a person has, the greater the chance that one or more may turn into skin cancer. People with AKs may have up to 10 times as many subclinical (invisible) lesions as visible, surface lesions. These invisible lesions were undetectable until the development of the UV camera.


Treatment options

The most common treatment options for AKs have traditionally involved topical ointment 5-FU (Effudex), laser resurfacing or chemical peels. To avoid the prolonged recovery period and possible scarring associated with these techniques, photodynamic therapy has been developed.

Photodynamic therapy (PDT) is the treatment of choice for the invisible, deeper sun damage as well as the visible pre-cancerous AK lesions. PDT involves a two-step process proven effective in clinical testing. After one treatment, this treatment cleared 100 percent of the AKs in two-thirds of patients.

The first step is the application of a topical solution called Levulan. Abnormal cells have a much greater affinity for the solution and absorb it, while the healthy cells do not. The solution is left on for an incubation period lasting anywhere from 15 minutes to 18 hours.

The second step of PDT is to apply a concentrated light source to activate a chemical reaction which destroys the abnormal cells. Since the solution is absorbed only in the damaged cells, the healthy cells are not affected. This process can cause a mild burning sensation during the treatment. Usually, this improves immediately after treatment and ends within 24 hours.

Following the treatment, most patients experience mild swelling, redness and a peeling of the AK lesions and the surrounding tissue. Patients choosing a more aggressive treatment will experience more peeling and/or crusting of the damaged skin that resolves within one to two weeks. The doctor can easily control the severity of these reactions by limiting the incubation period and the amount of exposure to the light source.

Patients preferring not to experience a prolonged recovery time following the procedure may choose a more mild treatment and return to work after a day or two. The tradeoff is they will require more treatments to achieve the same clinical results.

In addition to eliminating AKs and subsurface skin damage, PDT has also been effective in improving the appearance of the skin by greatly reducing moderate to severe acne (including cystic acne), reducing color splotches, lessening fine lines and decreasing pore size.

Once a person has been successfully treated using this approach, it is recommended they return for a yearly follow-up to prevent future problems.


Dr. William Nelson is a naturopathic medical doctor and is a member of the American Academy of Aesthetic Medicine. He specializes in treating problem skin, reducing cellulite and obesity by combining the latest medical advances with safe, non-invasive natural therapies.

Reprinted from AzNetNews, Volume 23, Number 1, February/March 2005.

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