The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.
HEALTH
With PAKs, the liquid nitrogen application must be applied both deeply and widely, and may need to be repeated. Local anesthesia may be required. If the lesions are resistant, more aggressive treatments, such as curettage and desiccation (scraping off the growth, then destroying residual tumor with an electrocautery needle), deeper cryotherapeutic freezing with wide margins around the growth, or Mohs micrographic surgery should be employed. For PAKs greater than 2.5 cm in diameter or with ulcerations suggesting deeper invasion and pos- sible evolution into SCC, Mohs surgery is often recommended as a first-line treatment, since these tumors have a high potential for further local spread- ing. In Mohs surgery, frozen sections of excised skin are examined during the operation, until all traces of the tumor are gone. Chemoprevention, using a treatment
to prevent further disease progression, may also be used on aggressive AKs. Photodynamic therapy (PDT), in which
Figure 1 1
non-UV light is applied to damaged skin that has been treated with a light- sensitizing agent, thus destroying the tumor, has successfully reduced the number of AKs present on individu- als and the number that would have developed in subsequent months. Other therapies, such as topical im- iquimod, 5-fluorouracil, and diclofenac 5 (a non-steroidal anti-inflammatory drug) have also been used for this pur- pose. Ongoing studies should clarify the effectiveness of chemoprevention for PAKs. The potential for serious damage
from aggressive AKs calls for prompt, effective treatment, close follow-up by a physician, and regular self-monitor- ing by the patient.
MICHAEL P. LOOSEMORE, MD, is a derma- tologist and fellow in the ACGME Procedural Dermatology fellowship of the Methodist Hospital in association with the Weill Cornell Medical College, Houston, under the direction of Dr. Leonard H. Goldberg. A published scien- tific author, he will begin practice as a full-time Mohs surgeon at the end of this academic year.
ADISBETH MORALES-BURGOS, MD, is a dermatologist and fellow in the ACGME Procedural Dermatology fellowship of the Methodist Hospital in association with the Weill Cornell Medical College, Houston, under the direction of Dr. Leonard H. Goldberg. An Assistant Professor in the Department of Dermatology at the University of Puerto Rico, she is a published scientific author, and will begin practice as a full-time Mohs surgeon at the end of this academic year.
LEONARD H. GOLDBERG, MD, is Clinical Professor of Dermatology at Weill Cornell Medical College in Houston and the University of Texas at Houston. He is currently in private practice and an active staff member of The Methodist Hospital. A Fellow of the Royal College of Physicians, he is also a Fellowship Director for the American College of Mohs Surgery and Past President of the Houston Dermatological Society. He is a member of numerous professional societies and com- mittees, including the American Academy of Dermatology, the American College of Mohs Surgery, and The Skin Cancer Foundation's Amonette Circle and Robins Fund for the Advancement of Mohs Surgery.
References available on p.97.
Epidermis Keratinocytes 2
Dermis Hair Folicle
Subcutaneous Layer
Sweat Gland 62 3
Figure 2: Clinical presentation of proliferative actinic keratosis (PAK). Figure 3: Histological appearance of proliferative actinic keratosis (PAK).
SK IN CANCER FOUNDAT ION JOURNA L