Dermatology: Where safety and beauty now meet

KAGEN

More than one million new cases of skin cancer will be diagnosed in the United States this year; and one in five Americans will develop skin cancer in their lifetime. Southwest Floridians fear the dangerous version - melanoma - and surprisingly, it reigns as the most prevalent form of cancer for adults 25-29 years old. Among adolescents and young adults 15-29, it is the second most common cancer.

"Parents are starting to bring kids in for annual exams, " says Dr. Mark Kagen of Riverchase Dermatology. "They say that melanoma is 'a cancer of young people'." It's not known why melanoma is so often found in those under 30, but it's not restricted to the younger set. "Anyone can get it," says Kagen. "They don't have to be older." This dangerous cancer is found in people of all ages, however.

Surprisingly, sun exposure is not a necessary factor for the affliction. "That's the scary part," says Dr. Kimberly Davidson, also of Riverchase, "because the deadliest form of melanoma can be on the bottom of your foot. You can get it in your eye, your mouth, anywhere," she explains. "That's why it's so frightening. Most people think you can only get melanoma where you've gotten sun, but that's a huge misconception."

DAVIDSON

Genetic pre-disposition plays a big part in who gets melanoma. What makes it deadly is its ability to metastasize, meaning it can spread to other organs. "It's very serious," says Dr. Davidson. "We might refer to a surgeon to remove it. It may require checking lymph nodes."

Warning and awareness

 

Melanoma warning signs should be heeded. "Look for any dark, irregular spot," says Davidson. "Anything that has irregular borders, dark brown to black, and usually bigger than a pencil eraser size." And remember, it can be anywhere on the body. Dr. Stanley Schwartz, of Associates in Dermatology, points out another misconception. "Flat moles can be a problem. With melanoma, it can start as a flat mole that's irregular in shape or color. So we want to keep track of the size and shape. More than two colors in a mole is a warning sign. Or if it's changing in size, or any way."

SCHWARTZ

Dr. Davidson says a typical scenario involves misdirected concern. "The lesions that most people are concerned about, we aren't concerned about at all. I see this time and time again. Someone comes in for a spot that they're concerned about," she explains, "and they don't want me to look for anything else, but we'll find something suspicious. That's very common."

Two good preventative measures are regular full-body exams, and establishing your own baseline. "People should get to know the location, size, shape, and color of their moles," says Dr. Schwartz.

Skin cancer 101

 

The most basic forms of skin cancer are basal cell and squamous cell carcinoma. Basal cell "can present as a red pimple-like lesion," explains Dr. Davidson, "or as kind of a pink, scaly patch that looks like psoriasis. Anything new on the skin that's itchy, bleeding, getting scaly or crusty and won't heal is suspicious, especially in sun-exposed areas," she says, "but it can happen anywhere. Those are very easily treated," she says. Squamous cell, also easily treated, "can start like a wart-like growth," explains Dr. Schwartz, "usually on sun-exposed areas." MOHS micrographic surgery is a

HARRIS

beneficial way to rid a body of basal and squamous cell carcinoma. "It's done right in the office," says Dr. Keith Harris, of Harris Dermatology. "MOHS is a specialized surgical technique where we remove the skin cancer in small layers and go right to a microscope. What it basically does is allow you to target where you're cutting, so you take out as little normal skin as possible, and patients have the smallest scars. It has the highest cure rate of any treatment that we have right now. My brother Brian is the one that does that in the office," Harris says.

Physicians must be certified in MOHS micrographic surgical training, so they can interpret what the microscope is telling them during each procedure. Dr. Andrew Jaffe, Medical Director at Riverchase, is also certified in MOHS.

"A lot of times, melanomas can stay in a non-aggressive stage for a long time," says Dr. Schwartz, but sadly, that's not always the case. "The earlier we catch a melanoma, the better a chance we have of curing it," he says. "We have up to a 99 percent cure rate in the early stages. The ways we're going to catch them in early stages is by having regular check-ups by a dermatologist, and regular skin exams at home."

Non-Invasive cure and control

 

Dermatologists are taking advantage of a new medicine on the market, Aldara cream, which is used for treating basal cell carcinoma. "It works by getting the body's immune system to recognize and fight off the skin cancer cells," says Dr. Schwartz, "but it's not always the best choice for everyone. The deeper ones respond better to surgery. But it does give us a non-surgical option that's relatively new. It takes six weeks and can cause a lot of inflammation," he explains, "but if the skin cancer was on your nose and you didn't want to have a scar. . . it depends on where it is. But it's nice to have these new things available."

Dr. Davidson and her colleagues at Riverchase are now using a light treatment that treats pre-cancers. "It's called photodynamic therapy," she says. "Patients come into the office, and we put medicine on their face, and then illuminate the medicine with a blue light which activates it, and it destroys the pre-cancers. We sometimes actually do hands, arms, and chest also. But it's more effective for face and scalp. We have a lot of balding men," she says, "who need it on their scalp."

Davidson finds the non-invasive procedures are appealing to both patients and doctors. "There's new things coming out all the time," she says. "It's exciting, because it doesn't always have to be surgery."

Cosmetic dermatology

 

The trend toward improving one's appearance without any down time has gathered so much steam that Riverchase and other dermatology practices have added medical spa components. SpaBlue, the adjunct to Riverchase, offers a full complement of enhancing treatments, including Thermage, injectable fillers, laser hair removal, facials, chemical peels, and laser treatments for brown spots, vessels, rosacea and redness. Many women stop in for free cosmetic consultations as well.

SpaBlue's newest laser, the Sciton, is an innovative, multi-function laser geared toward bringing back youth. "There are new lasers coming out all the time," says Dr. Davidson, "and this one's fantastic, because it can do anything and everything you want to do, whereas in the past you'd have 5 or 6 different lasers." The Sciton can treat brown spots and broken blood vessels on the face, it can be used for resurfacing the skin for better texture and skin tone, and it can address sun damage and wrinkles. It can even do hair removal. "A specific wavelength targets each thing. To resurface, the laser is targeting the water in the skin cells. It dissolves the skin cells, and peels away the top layer of skin," she says.

A real breakthrough

 

Sciton re-surfacing is mostly done to the face. "But what's great about this laser," says Davidson, "is you can adjust the depth of penetration. So this is one of the only lasers," she says, "where you can do the neck and the chest for women, and hands and arms. But you cannot do it as strongly - as high a wavelength - as you can on the face. Other areas of the body just don't heal as well, for several reasons.

Davidson explains that for years the "gold standard" in lasers was the CO2, "but you're healing for weeks, having a lot of down time and bandages on your face," she says. "Also, it cannot be used off the face."

The Sciton, because it imposes less down time, usually requires more than one treatment, but the trade-off is a no-brainer for today's consumers, who don't want to take time off. The Sciton does offer one efficient procedure combination, however. "We can treat the skin's texture and brown spots at the same time," says Davidson. "It's called the South Beach Peel - a micro-laser peel right over the brown spot treatment. We can do those right on top of each other."

Treatment with the Sciton laser costs anywhere from $1200-$1700, depending on how many problem areas a person is targeting. With the South Beach peel, "that includes two laser treatments in one," says Davidson, "so just one visit and you're done."

The line between cosmetic surgery and dermatology is blurring, specifically because of the trend towards non-invasive procedures, according to Davidson. "Cosmetic dermatology has been around a while," she explains. 'The plastic surgeons are actually starting to do more of what we do, because that's what people want: the non-invasive type of things. We're trained on the lasers and injectables. Plastic surgeons have no training in skin care, so they hire aestheticians to do their skin care," she says.

Patients ultimately have to weigh what type of doctor they need. A skin affliction is obviously the domain of a dermatologist. Enhancements may need the critical eye of a cosmetic surgeon who can fully contrast the options for a patient, but may also be best addressed by a cosmetic dermatologist who speaks the language of skin care and repair. One thing is for certain: quick fixes are a way of life for age-conscious baby boomers, and many of them are discovering the abundant choices at medical spas.

Be safe

 

Sun protection is key. "I recommend wearing an SPF 30 or higher," says Dr. Kagen. "Wear one that protects against UVA and UVB, because not every sunblock does both. And the ones that do, say it on the bottle." UVA and UVB refer to the wavelength of light: "UVA penetrates deeper, and burns less," he explains. "Either can cause skin cancer."

"And I recommend people reapply it every hour, to hour and a half," warns Kagen. "Not everyone knows to do that. That's important, for it to last all day long." "SPF 15 blocks about 93 percent of the burning rays," says Dr. Harris, "while SPF 30 blocks about 97 percent."

"Of course, no sunscreen is 100 percent effective," he counsels. "Clothing is first line of defense. There are a lot of sun-protection clothing lines you can find all over now." The tags and labels that denote UPF, or Ultraviolet Protection Factor, can be misleading, however. The clothing itself does not contain any added protection, such as sun-block in the fabric. "All it is," explains Harris, of the rating, "is the weave. The clothing has a weave that determines how good it's going to be at blocking the sun." The thicker the weave - denim, for example - the less sun penetrates the fabric.

Many would argue that UPF labels are a clever marketing ploy that replaces common sense. "These tags pop up, they're really big now," says Harris, of goods labeled UPF 50 and UPF 70, most often found in sporting goods stores and outfitters. "You'll see the shirts now," he says, with a smile.

screening

>> May is Skin Cancer Awareness Month: Riverchase Dermatology is offering free skin cancer screening at its Lee County offices.

>> Tues, May 6, 8:00-11:30 am 7331 Gladiolus Drive, Fort Myers Call 239-437-8810 for an appointment for your free screening

>> Wed, May 7, 8:00 am - 11:30 am 1425 Viscaya Pkwy Ste 102, Cape Coral Call 239-443-1500 for an appointment for your free screening