Tag: clinicalphoto

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Skin Blemishes of Breast

Skin Blemish of Breast
(click to enlarge)

Skin lesions and blemishes are very common. Most of them are benign and have no malignant potential. But some can be malignant or potentially malignant. Some areas of the body are easy to examine but other parts of the body are not clearly visible. One such area is lower part of a woman’s breast.

Many women are very particular in doing breast self-examination but forget to do visual inspection of the nipples, areola and under surface of the breasts where moles can be missed.

Moles that are of medical concern are those that look different than other existing moles or those that first appear after age 20. If you notice changes in a mole’s colour, height, size or shape, you should have these moles checked. If the moles bleed, ooze, itch, appear scaly or become tender or painful then it is time to have them removed and checked for cancer.

The following ABCDEs are important signs of moles that could be cancerous:

Asymmetry – one half of the mole does not match the other half.

Border – the border or edges of the mole are ragged, blurred or irregular.

Colour – the colour of the mole is not the same throughout or has shades of tan, brown, black, blue, white or red.

Diameter – the diameter of a mole is six millimetres or larger.

Evolution – moles which have changed over a period of time.

Remember, there is a forecast for a sizzling summer this year. So, we should continue to remind ourselves to protect the rest of the body from sunburn. Use of sunscreen is one way to do it. There is a lot of misconception about what kind of sunscreen to use and how to apply.

Sun Protection Factor (SPF) 30 provides 30 times greater sun protection than unprotected skin when exposed to damaging sun’s ultraviolet B (UVB) rays. This does not mean you can stay in the sun for 30 hours without burning yourself. Sunscreen should be applied liberally and often depending on how much you sweat and how wet you are. Make sure the sunscreen blocks UVB and UVA. Higher SPF provides better protection. Wear protective clothings, wide brimmed hat, sunglasses which block both ultraviolet rays.

The best protection against sun’s damaging rays is to stay away from the sun and take your vitamin D regularly. I guess that is too much to ask, especially when our summers are so short. So enjoy the sun but be sun smart.

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Have you checked your toenails lately?

Big Toe with Fungal Infection.

Now that summer is here, people from all walks of life have given up on shoes and socks. Sandals, flip flops or bare feet, yes people walking bare feet, is the norm. Now look at your feet then look at your toenails. Are they full of calluses, plantar warts, ingrown toenails and/or totally deformed nails due to fungal infection?

Wow, that sounds horrific. None the less not life threatening. So, you will live long enough to fiddle fuddle with your toenails, with nail clippers and all sorts of sharp instruments people use to fix the problem themselves until they end up getting infection. And if you are a diabetic then gangrene and amputation may be the end point.

Wow again! But don’t panic. If this is getting scary then get a glass of wine (will keep your heart and feet warm), relax and read. Just pay attention to your feet and toes and toenails and you won’t lose your foot.

Nails protect the tips of our fingers and toes. Two most common problems I see with toenails are ingrown toenails and fungal infection.

Ingrown toenail of the big toe usually occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Ingrown toenails can be prevented by keeping feet nice and clean. Wear roomy shoes and clean cotton socks. Allow the outer corners of the nail to grow over the skin margins placing small piece of cotton soaked in an antiseptic just under the outer corners of the nail. Cut the nails straight. Antibiotics will help relieve acute infection but will not cure the primary problem. Eventually, surgical procedure done in the office under local anaesthetic becomes necessary.

Fungal infection of the nails is common as well. It affects toenails more than finger nails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Fungus infection is best treated with anti-fungal therapy orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence. If they are thick, stubborn, deformed, ugly and painful then surgery is required.

If you love your feet and toenails then keep your feet clean and shiny…yes you can do it.

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Non-melanoma Skin Cancer can Disfigure You

92 year old male with a two month history of left forearm lesion. The lesion was excised under local anesthetic. Pathology report: 2.5 cm diameter, well differentiated, invasive squamous cell carcinoma, completely excised. (Dr. Noorali Bharwani)
92 year old male with a two month history of left forearm lesion. The lesion was excised under local anesthetic. Pathology report: 2.5 cm diameter, well differentiated, invasive squamous cell carcinoma, completely excised. (Dr. Noorali Bharwani)

What is the most the most common cancer in Canada?

This is no brainer. It is skin cancer.

There are two types of skin cancers: melanoma (also known as malignant melanoma) and non-melanoma skin cancer. Non-melanoma skin cancers are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). We discussed melanoma in the last column. Today, we will discuss BCC and SCC.

BCC and SCC are malignant tumours but typically are not life threatening and are usually successfully treated in doctors’ offices. If they are not treated then they grow slowly over a period of time and require bigger excision and this can be disfiguring. Especially, if they are on the face, head and neck – the most common sites of sun exposure.

Excessive sun exposure is responsible for 90 per cent of non-melanoma skin cancers and two thirds of melanomas.

What are the risk factors? People who have fair skin, have tendency to freckle, have high degree of sun exposure, make excessive use of sun beds, had previous radiotherapy or phototherapy and those who have genetic predisposition.

BCC arises from the lowest layer of the epidermis, called the basal cell layer. About 80 per cent of non-melanoma skin cancers are BCC.

BCC usually grow slowly. It is very rare for a basal cell cancer to spread to nearby lymph nodes or to distant parts of the body. But if a basal cell cancer is left untreated, it can grow into nearby areas and invade the bone or other tissues beneath the skin. They are locally invasive and disfiguring.

After treatment, BCC can come back in the same place on the skin. People who have had BCC are also more likely to get new ones elsewhere on the skin.

The first line treatment of BCC is often surgical excision. Many non-surgical alternatives are available but if it is not adequately treated then two thirds of recurrent tumors appear in the first three years of treatment and 18 percent appear between five and 10 years after treatment.

SCC – about 20 per cent of non-melanoma skin cancers are squamous cell carcinomas. They commonly appear on sun-exposed areas of the body such as the face, ears, neck, lips, and backs of the hands. They can also develop in scars or skin ulcers elsewhere.

SCC tends to be more aggressive than BCC. They are more likely to invade fatty tissues just beneath the skin, and are more likely to spread to lymph nodes and/or distant parts of the body, although this is still uncommon. Treatment is same as for BCC.

If you like to worship sun, then expect to burn and eventually get cancer.

Next week, what do you know about sunscreens?

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Melanoma treated in early stages has good prognosis.

Now that the summer is fast approaching, we should revisit the topic of skin cancer. Today, we will discuss melanoma, next week we will visit non-melanoma skin cancers and in the third week we will discuss appropriate use of sunscreen.

In early stages, surgical removal of melanoma is usually successful. Once the melanoma has spread then the prognosis is grim. Recently, FDA has approved certain drugs to be used in late stage melanoma. But these drugs do not cure the cancer and the side-effects are many. The current prognosis for survival in metastatic melanoma is nine months or less, with 9,000 people dying in the U.S. each year.

For Canadian males, the rate for melanoma has tripled since the late 1960s. For Canadian females, the rates have varied over the years but still show a gradual increase. The death rate from melanoma continues to rise about two percent annually. Approximately, two per cent of melanomas occur in patients under the age of 20 years, and about 0.4 per cent of melanomas occur in pre-pubertal children.

Melanoma arises from cells called melanocytes. These cells contain melanin (melas = black) – a principal pigment responsible for the color of human skin, hair, and eyes. Melanin also acts as a filter to decrease the harmful effects of ultraviolet rays to the dermis.

When the skin is exposed to ultraviolet radiation, there is immediate increase in the number of melanocytes and production of melanin pigment. This results in tanning. The amount of melanin produced is genetically determined. That is why some people burn easily without tanning.

The risk of skin cancer is increased in individuals who spend too much time outdoors; children who have had episodic sunburn, and if there is a family or personal history of skin cancer (especially melanoma). Males are affected more than females.

Melanoma is usually found on the backs or chest in men and lower legs in women. These areas are most exposed to sunlight. Melanoma can also occur in eyes, mouth or internal organs although these areas are not directly exposed to sun.

Examples of melanoma on the abdominal wall skin:
Abdominal wall skin melanoma.
Abdominal wall skin melanoma.

There are four different types of melanomas:
-superficial spreading melanoma: most common, looks like a spreading mole
-nodular melanoma: 10 per cent of cases, looks like a dome rising from a mole
-lentigo maligna: less common, looks like an irregular stain in older Caucasians, not related to moles
-acral lentiginous melanoma: found in all skin types in the sole of the feet, palms of the hands, undersides of the fingers or finger nails or toe nails

Prevention is better than cure. We should avoid sunburn and generally reduce exposure to ultraviolet radiation by staying out of the midday sun, wearing protective clothing, and seeking shade and applying sunscreen.

Now, that cannot be too difficult!

Example of recurrent melanoma:
Example of recurrent melanoma.

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