DR, WHAT IS IT? WHEN NEW GROWTHS APPEAR ON YOUR SKIN
Leading dermatologist Dr. Joshua Fox explains benign growths
New Hyde Park, NY, February 2009 – The skin is the organ most exposed to the outside environment and it provides our first line of defense against a wide range of toxins, bacteria, viruses, foreign bodies, and diseases that could have serious and sometimes lethal impact. The many tumors and rashes that appear over time on different parts of the skin can be traced to more than 200 diseases, most of which are treatable, and most of which are completely benign. But it is the risk of malignancy or another life-threatening disorder, and the want to look beautiful, that makes it important to know when a growth or skin eruption requires medical assessment or can be treated simply.
Skin lesions may appear as pigment changes, such as a patch, as bumps, lumps, moles, warts, as flaky or crusty patches, or manifested in a wide number of other types of abnormalities. Joshua Fox, M.D., founder of Advanced Dermatology, P.C. in New York and on Long Island, and a spokesman for the American Academy of Dermatology and the American Society of Dermatologic Surgery, helps to clarify what we need to know about the changes we see on our skin.
MOLES: Most people are aware of the need to examine moles which appear benignly throughout life, and to check for new changes that occur, particularly in parts of the skin exposed to sunlight. Melanoma is the deadliest form of skin cancer taking about 41,000 lives worldwide, although it is far less common than the other skin carcinomas. The incidence of melanoma continues to grow at alarming rates among light-skinned people. According to the American Cancer Society, 60,000 people in the United States developed melanoma in 2007, and more than 8,000 died of the disease. The most suspicious moles are either congenital nevi, moles from birth, or dysplastic nevi, usually larger more irregular moles with irregular shape and or/color, which are found in an estimated ten percent of the American population.
WARTS: Warts are very common growths that occur on various parts of the body as a result of the human papilloma virus (HPV). “These are benign growths that affect all skin types and may go away without treatment, although if they persist, many people seek medical help to remove them due to irritation or just the unsightly appearance. The wart or virus also may promote certain skin cancers like some squamous cell carcinomas and cervical cancer,” Dr. Fox explains. They can be treated chemically, via cryotherapy, or with lasers, or surgically removed in a dermatologist’s office.
KERATOSIS PILARIS: Another type of common skin lesion is keratosis pilaris, in which the cells that normally flake off from the skin’s surface instead become trapped and plug hair follicles. They appear as hyperkeratotic, rough raised bumps based in hair follicles which can multiply in an area like the arms, thighs, buttocks, back and occasionally the face. “This is a common occurrence, particularly among teenagers,” Dr. Fox says, “and is not cause for serious concern.” Moisturizing is the first line of treatment for keratosis pilaris. He also suggests taking long baths and gently rubbing the skin surface with a course washcloth or buff puff. However, in some people this can cause irritation and/or discoloration. If the condition doesn’t go away, there are many effective topical treatments available with or without a prescription.
Seborrheic keratosis is a growth that appears usually over the age of 40, and can become irritating and itchy. It usually appears as brown keratotic stack on a lesion anywhere on the body. There are no particular topical or at-home treatments for this form. A dermatologist can treat areas with cryosurgery (freezing), dermatologic surgery or lasers to eliminate the discomfort and unsightliness.
SKIN TAGS: Skin tags are an annoying type of growth that about half of all people develop as they age. These are small pieces of hanging flesh that develop in areas that are prone to rubbing against clothing or other skin; or are moist areas such as the upper thighs, under arms, neck, and under women’s breasts from underwire bras. Another common site is the eyelid. “Most skin tags are small, but they continue to grow and often become painful or annoying because of their location,” according to Dr. Fox, who recommends a visit to dermatologist to have them removed if they are painful, irritating, bleeding, infected or get caught in clothing.
MELANOMA/SKIN CANCER: It is so important to be familiar with the moles on your body and to perform regular self-examinations of your skin. Melanoma often develops in a pre-existing mole that begins to change or in a completely new mole. Melanoma is a serious skin cancer and the mortality rate is remarkably high considering the fact that it is nearly always curable in its early stages; however, this high number can be attributed to the late diagnosis of the disease in which the cancer spreads to other parts of the body. Melanoma most often appears on the trunk of men and the lower legs and arms of women, although it can be found on the head, neck, scalp or elsewhere. Melanoma represents approximately 5% of all skin cancers in the USA, but accounts for about 75 % of all skin cancer deaths. The World Health Organization estimates that as many as 65,161 people a year worldwide die from malignant skin cancer, approximately 48,000 of whom are registered. The American Academy of Dermatology (AAD) estimates that in 2009, about 116,500 new melanoma cases will be diagnosed in the U.S. with 8,420 deaths (~1 death every hour). Incidence rates are at least 16 times greater in Caucasians than African Americans and 10 times greater than Hispanics. Moreover, even though skin cancers are not as prevalent in individuals with darker skin, they can have more morbidity and fatalities since they may go undiagnosed for longer. Researchers estimate that 1 out of 50 people in the U.S. in 2010 will be diagnosed with melanoma at some point in their lives. Specifically, among Caucasians, the rate of increase of melanoma incidence is 3-7% each year. Melanoma grows from pigment cells (melanocytes) in the outer layer of the skin (epidermis) and mucous membranes and tends to spread out within the epidermis before moving into the deeper layer of the skin (the dermis). In its advanced stages it can spread to other organs of the body. Frequent self-examination for the ABCDE (Asymmetry, Border Irregularity, Color, Diameter and Evolving) characteristics of abnormal moles is suggested.
These are the most common types of growths that may appear over time on the skin, and the majority are no cause for concern. Many other types of benign lesions are also possible such as dermatofibromas, cysts, freckles, fibromas, keloids, lipomas, and granulomas, as well as many more rare types. While an assessment of anything unusual or a mole that is irregular in shape or size is critical, many other skin lesions can still cause a discomfort, pain or embarrassment you don’t have to live with. Dr. Fox notes that there are a wide range of treatments available which you can discuss with your dermatologist. “Many patients don’t realize that most of the treatments can be performed at the time of the consultation visit so you go home without the problem you may have endured for months or years. Usually there is little to no mark left behind. It’s especially important to become educated to the changes that occur on your skin,” says Dr. Fox. “You need to recognize what you are prone to, how you can prevent it, and what options are available to treat it, as well as which lesion can get you into trouble.”