Seborrheic Keratosis (SK)
Seborrheic Keratosis, often referred to as wisdom spots or barnacles, are benign lesions that appear on the skin as we age. Seborrheic keratoses can be flat or raised, of various sizes and shapes, smooth and waxy or rough and warty. They often range in color from skin colored to dark brown to black, and have a characteristic stuck on appearance, as if you could peel them off. Seborrheic keratoses can appear anywhere on the body except for the palms of the hands and soles of the feet. Seborrheic Keratoses are very common and can affect as many as 90% of adults 60 years and older.
What Causes Seborrheic Keratoses?
The cause is unknown. Sun exposure and genetics have been postulated as possible causes of their development.
Treating Seborrheic Keratosis
Seborrheic Keratoses are benign and do not need treatment. However, they are often removed for cosmetic purposes or biopsied if their appearance resembles that of a skin cancer. They can be removed via shave biopsy or with cryotherapy.
- Bolognia, JL., Jorizzo, JJ., Schaffer, JV., Callen, JP., Cerroni, L., Heymann, WR., … Schwarz, T. (2012). Dermatology, 3rd edition . London: Elsevier. James, WD., Berger, TG., Elston, DM. (2011). Andrews’ Diseases of the Skin, Eleventh Edition. Elsevier Seborrhoeic keratosis. (n.d.). Retrieved from https://dermnetnz.org/topics/seborrhoeic-keratosis/
Basal Cell Carcinoma
Basal cell carcinoma is the most common form of skin cancer. Basal cell carcinoma originates in the skin cells called keratinocytes, classifying it as a non-melanoma skin cancer. Basal cell carcinomas are locally invasive; metastasis is rare. Basal cell carcinomas can affect anyone, but most commonly affect older males and often, light eyed, fair skinned, blonde or red haired individuals. They are also common in those that have a history of repeated sunburns or long term UV exposure, either in tanning beds or outdoors. Basal cell carcinomas can present in many different ways. However, the classic appearance of a basal cell carcinoma is a skin colored to slightly pink smooth pearly papule often in sun exposed areas like the face, chest, back, or arms.
What Causes Basal Cell Carcinomas?
There are many factors contributing to the development of basal cell carcinomas. The most common cause is UV light exposure, either via sunlight or tanning beds. There are certain genetic mutations that can predispose one to a basal cell carcinoma and these mutations can be triggered by UV light exposure. Specific genes can also be inherited from a parent or other family member that can contribute to the development of a basal cell carcinoma. The best way to protect yourself against these skin cancers as well as many other skin cancers is to avoid overexposure to UV light. This can be done with sunscreen and sun protective clothing.
Treating Basal Cell Carcinoma
There are a wide variety of treatment options for basal cell carcinomas based upon location and subtype of the skin cancer. The most common procedures include standard excisions or Mohs surgeries for those that are located in more sensitive areas, like the face and hands, where skin sparing is most important. Other procedures include electrodessication and curettage, also known as ED&C or a scrape and burn procedure. Photodynamic therapy, topical chemotherapy drugs, and radiation therapy can also be utilized to treat basal cell carcinomas.
- Augustin, M., Wilsmann-Theis, D., Körber, A., Kerscher, M., Itschert, G., Dippel, M., & Staubach, P. (2019). Diagnosis and treatment of xerosis cutis – a position paper. JDDG: Journal Der Deutschen Dermatologischen Gesellschaft , 17 (S7), 3–33. doi: 10.1111/ddg.13906 Bolognia, JL., Jorizzo, JJ., Schaffer, JV., Callen, JP., Cerroni, L., Heymann, WR., … Schwarz, T. (2012). Dermatology, 3rd edition . London: Elsevier. Peris, K., Fargnoli, M. C., Garbe, C., Kaufmann, R., Bastholt, L., Seguin, N. B., … Grob, J. J. (2019, July 6). Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines. Retrieved from https://www.sciencedirect.com/science/article/pii/S0959804919303624
Squamous Cell Carcinoma
Squamous cell carcinoma is a common type of nonmelanoma skin cancer. Of the nonmelanoma skin cancers, about 20% are squamous cell carcinomas while the other 80% are basal cell carcinomas. A squamous cell carcinoma is most often locally invasive but has potential to metastasize and can become fatal. Squamous cell carcinomas most commonly affect elderly males but are common among many individuals. These skin cancers often present on the sun exposed areas of the skin and are scaly, often red, sometimes ulcerated lesions that can take weeks to months to grow. Some develop a warty or nodular appearance while others present with an abnormal growth resembling a horn. They tend to be more tender and painful than other skin cancers. The precursor to a squamous cell carcinoma is an actinic keratosis, which is a precancerous lesion that is often hard to see but feels like an unhealing gritty lesion on the skin.
What Causes Squamous Cell Carcinomas?
Squamous cell carcinomas are most commonly caused by genetic mutations. These mutations are most often triggered by UV exposure from sunlight or tanning beds. Other causes include smoking, HPV warts, and immunosuppression.
Treating Squamous Cell Carcinoma
Surgical removal including excision or Mohs surgery are the most common treatments for squamous cell carcinomas. Electrodessication and curettage is also done for this type of skin cancer. Prevention is important as well including decreasing UV radiation exposure including wearing sunscreen and sun protective clothing, staying indoors, and avoiding tanning beds. Treatment of actinic keratoses using cryotherapy is also essential in order to prevent these precancers from progressing to squamous cell carcinomas.
- Anil K.Rustgi3. (2016, May 9). Squamous Cell Cancers: A Unified Perspective on Biology and Genetics. Retrieved from https://reader.elsevier.com/reader/sd/pii/S1535610816301623?token=D7BEF71F2AD7DE073EC40531B24DFFDB9 B5A410721D01021E0A2740A1F023DA52FD7B0393A45148B8640606C46039FA5 Augustin, M., Wilsmann-Theis, D., Körber, A., Kerscher, M., Itschert, G., Dippel, M., & Staubach, P. (2019). Diagnosis and treatment of xerosis cutis – a position paper. JDDG: Journal Der Deutschen Dermatologischen Gesellschaft , 17 (S7), 3–33. doi: 10.1111/ddg.13906 Bolognia, JL., Jorizzo, JJ., Schaffer, JV., Callen, JP., Cerroni, L., Heymann, WR., … Schwarz, T. (2012). Dermatology, 3rd edition . London: Elsevier.
Xerosis, or dry skin, is a benign condition that affects many individuals, but especially individuals over the age of 60. Xerosis is characterized by dull appearing skin that is often rough and scaly. Severe xerosis can be itchy and can lead to fissuring, or cracking of the skin. Xerosis can affect skin anywhere on the body, the most common site being the shins.
What Causes Xerosis?
Xerosis is caused by loss of moisture in the outer layer of the skin, known as the stratum corneum. Often in older adults, xerosis can be attributed to loss of sweat and oil glands, many years of sun exposure, medications, smoking, or dehydration.
The goal of treating xerosis is to improve the skin barrier, to reduce inflammation and itchiness, and to decrease water loss through the skin. The most important treatment for xerosis is liberal application of thick emollients or moisturizers. The best time to apply them is within 3 minutes of exiting the shower or bath. Topical steroids or calcineurin inhibitors can help with severely dry skin that has become inflamed. Reducing bathing frequency, only using soaps on “hot spots” like the armpits, groin, and feet, and using humidifiers can also be helpful with maintaining skin moisture.
- Augustin, M., Wilsmann-Theis, D., Körber, A., Kerscher, M., Itschert, G., Dippel, M., & Staubach, P. (2019). Diagnosis and treatment of xerosis cutis – a position paper. JDDG: Journal Der Deutschen Dermatologischen Gesellschaft , 17 (S7), 3–33. doi: 10.1111/ddg.13906 Bolognia, JL., Jorizzo, JJ., Schaffer, JV., Callen, JP., Cerroni, L., Heymann, WR., … Schwarz, T. (2012). Dermatology, 3rd edition . London: Elsevier. Dry skin: Overview. (n.d.). Retrieved April 12, 2020, from https://www.aad.org/public/diseases/a-z/dry-skin-overview
Rhytides, or wrinkles, become very common as we age. Wrinkles are apparent with dynamic movements made by the face. However, as we age, these lines become present even when the facial muscles are not in motion. Common areas affected include the “crows feet,” or the areas lateral to the outer edge of the eye, above and below the lip, and at the corners of the mouth. Wrinkles affect both men and women. Fair skinned individuals tend to develop rhytides sooner than darker skinned individuals due to protective factors in the pigment producing cells.
What causes Rhytides?
Rhytides are caused by a number of factors. UV radiation exposure is a very common but preventable contributing factor. Also known as photoaging, UV exposure causes destruction of elastic fibers and collagen in the skin leading to wrinkles. Other less preventable factors include decreased elasticity of the skin, repeated facial muscle movements, reabsorption of bone and cartilage, changes in the volume and distribution of fat pads, and the inevitable gravity.
There are a number of treatments that have been successful in eliminating wrinkles. These treatments are almost always cosmetic. Topical retinoids and hyaluronic acid have been shown to be effective in preventing and improving fine lines. Procedures like botox and fillers are temporary but successful treatments for wrinkles. Other procedures include microneedling, chemical peels, and laser resurfacing can be done to improve the appearance of wrinkles. It is most important to take preventative measures in order to decrease the likelihood of developing wrinkles in the future. Moisturizing the skin regularly, wearing sunscreen daily, avoiding smoking, wearing sunglasses to avoid squinting, eating healthy, staying hydrated, and getting enough sleep are all ways to prevent wrinkles.
- Bolognia, JL., Jorizzo, JJ., Schaffer, JV., Callen, JP., Cerroni, L., Heymann, WR., … Schwarz, T. (2012). Dermatology, 3rd edition . London: Elsevier. Facial lines and wrinkles. (n.d.). Retrieved April 13, 2020, from https://dermnetnz.org/topics/facial-lines-and-wrinkles/ Lee, J. Y., Kim, Y. K., Seo, J. Y., Choi, C. W., Hwang, J. S., Lee, B. G., … Chung, J. H. (2008, January 16). Loss of elastic fibers causes skin wrinkles in sun-damaged human skin. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0923181107004082