Dr. Rockoff received his undergraduate degree from Yeshiva College with the distinction of Summa Cum Laude. He received his medical degree from the Albert Einstein College of Medicine. His internship and two years of Pediatric residency were at the Bronx Municipal Hospital Center, followed by training in Dermatology at the combined residency program at Tufts and Boston Universities. Dr. Rockoff is certified by both the American Board of Dermatology and the American Board of Pediatrics.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Excessive exposure to sunlight is the main cause of skin cancer. Sunlight contains ultraviolet (UV) rays that can alter the genetic material in skin cells, causing mutations. Sunlamps, tanning booths, and X-rays also generate UV rays that can damage skin and cause malignant cell mutations.
From the least to most dangerous, skin cancer refers to three different conditions: basal cell carcinoma, squamous cell carcinoma (the first stage of which is called actinic keratosis) and melanoma. The two most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma. Together, these two are also referred to as nonmelanoma skin cancer. Melanoma is generally the most serious form of skin cancer because it tends to spread (metastasize) throughout the body quickly.
Skin cancer is the most common form of human cancer. It is estimated that
over 1 million new cases occur annually. The annual rates of all forms of skin
cancer are increasing each year, representing a growing public concern. It has
also been estimated that nearly half of all Americans who live to age 65 will
develop skin cancer at least once.
The most common warning sign of skin cancer is a change in the appearance of
the skin, such as a new growth or a sore that will not heal.
The term "skin cancer" refers to three different conditions. From
the least to the most dangerous, they are:
The two most common forms of skin cancer are basal cell carcinoma and
squamous cell carcinoma. Together, these two are also referred to as nonmelanoma
skin cancer. Melanoma is generally the most serious form of skin cancer because
it tends to spread (metastasize) throughout the body quickly. Skin cancer is also known as skin neoplasia.
This article will discuss the two kinds of nonmelanoma
skin cancer.
Basal cell carcinoma
What is basal cell carcinoma?
Basal cell carcinoma is the most common form of skin cancer and accounts for
more than 90% of all skin cancer in the U.S. These cancers almost never
spread (metastasize) to other parts of the body. They can, however, cause damage
by growing and invading surrounding tissue.
What are risk factors for developing basal cell carcinoma?
Light-colored skin, sun exposure, and age are all important factors in the development of basal cell carcinomas. People who have fair skin and are older have higher rates of basal cell carcinoma. About 20%
of these skin cancers, however, occur in areas that are not sun-exposed, such as
the chest, back, arms, legs, and scalp. The face, however, remains the most
common location for basal cell lesions. Weakening of the immune system, whether
by disease or medication, can also promote the risk of developing basal cell
carcinoma. Other risk factors include
exposure to sun. There is evidence that, in contrast to squamous cell carcinoma, basal cell carcinoma is promoted not by accumulated sun exposure but by intermittent sun exposure like that received during vacations, especially early in life. According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, which are areas that receive high amounts of UV radiation.
age. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.
exposure to ultraviolet radiation in tanning booths. Tanning booths are very popular, especially among adolescents, and
they even let people who live in cold climates radiate their skin year-round.
therapeutic radiation, such as that given for treating other forms of cancer.
A basal cell carcinoma usually begins as a small, dome-shaped bump and is
often covered by small, superficial blood vessels called telangiectases. The
texture of such a spot is often shiny and translucent, sometimes referred to as
"pearly." It is often hard to tell a basal cell carcinoma from a
benign growth like a flesh-colored mole without performing a biopsy. Some basal
cell carcinomas contain melanin pigment, making them look dark rather than
shiny.
Superficial basal cell carcinomas often appear on the chest or back and look more like patches of raw, dry skin. They grow slowly over the course of months or years.
Basal cell carcinomas grow slowly, taking months or even years to become
sizable. Although spread to other parts of the body (metastasis) is very rare, a
basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows
nearby.
How is basal cell carcinoma diagnosed?
To make a proper diagnosis, doctors usually remove all or part of the growth
by performing a biopsy. This usually involves taking a sample by injecting a
local anesthesia and scraping a small piece of skin. This method is referred to
as a shave biopsy. The skin that is removed is then examined under a microscope
to check for cancer cells.
How is basal cell carcinoma treated?
There are many ways to successfully treat a basal cell carcinoma with a good
chance of success of 90% or more. The doctor's main goal is to remove or destroy
the cancer completely with as small a scar as possible. To plan the best
treatment for each patient, the doctor considers the location and size of the
cancer, the risk of scarring, and the person's age, general health, and medical
history.
Methods used to treat basal cell carcinomas include:
Curettage and desiccation: Dermatologists often prefer this method, which
consists of scooping out the basal cell carcinoma by using a spoon like
instrument called a curette. Desiccation is the additional application of an
electric current to control bleeding and kill the remaining cancer cells. The
skin heals without stitching. This technique is best suited for small cancers in
non-crucial areas such as the trunk and extremities.
Surgical excision: The tumor is cut out and stitched up.
Radiation therapy: Doctors often use radiation treatments for skin cancer
occurring in areas that are difficult to treat with surgery. Obtaining a good
cosmetic result generally involves many treatment sessions, perhaps 25 to 30.
Cryosurgery: Some doctors trained in this technique achieve good results
by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the
growth to freeze and kill the abnormal cells.
Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this
technique of removing skin cancer is better termed "microscopically
controlled excision." The surgeon meticulously removes a small piece of the
tumor and examines it under the microscope during surgery. This sequence of
cutting and microscopic examination is repeated in a painstaking fashion so that
the basal cell carcinoma can be mapped and taken out without having to estimate
or guess the width and depth of the lesion. This method removes as little of the
healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs
micrographic surgery is preferred for large basal cell carcinomas, those that
recur after previous treatment, or lesions affecting parts of the body where
experience shows that recurrence is common after treatment by other methods.
Such body parts include the scalp, forehead, ears, and the corners of the nose.
In cases where large amounts of tissue need to be removed, the Mohs surgeon
sometimes works with a plastic (reconstructive) surgeon to achieve the best
possible postsurgical appearance.
Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (imiquimod [Aldara]). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.
How is basal cell carcinoma prevented?
Avoiding sun exposure in susceptible individuals is the best way to lower the
risk for all types of skin cancer. Regular surveillance of susceptible
individuals, both by self-examination and regular physical examination, is also
a good idea for people at higher risk. People who have already had any form of
skin cancer should have regular medical checkups.
Common sense preventive techniques include
limiting recreational sun exposure;
avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);
wearing broad-brimmed hats and tightly-woven protective
clothing while outdoors in the sun;
regularly using a waterproof or water resistant
sunscreen with UVA protection and SPF 30 or higher;
undergoing regular checkups and bringing any suspicious-looking or
changing lesions to the attention of the doctor; and
avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light.). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every
two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."
A skin tag is a small benign growth of skin that projects from the surrounding skin. Skin tags can vary in appearance (smooth, irregular, flesh colored, dark pigment, raised). Skin tags generally do not cause symptoms unless repeatedly irritated. Treatment for skin tag varies depending on the location on the body.
Melanoma is a type of skin cancer which begins in skin cells called melanocytes and affects more than 53,600 people in the United States each year. These melanocytes can grow together to form benign moles which, after a change in size, shape, or color can be a sign of melanoma. Caused by sun exposure, early detection becomes extremely important to avoid a spread to other areas of the body. Diagnosis is confirmed through a biopsy of the abnormal skin and treatment depends on the extent and characteristics of the patient.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Actinic keratoses are rough, scaly patches of skin that are considered precancerous and are due to sun exposure. Prevention is to cut sun exposure and wear sunscreen.
A pilonidal cyst is a cyst that forms near the cleft of the buttocks. The cysts are thought to be caused by the penetration of loose hairs into the skin. Symptoms and signs include pain, swelling, redness, warmth, and drainage of pus from the area of the cyst. Treatment of a pilonidal cyst involves incision and drainage.
Vitamins are organic substances that are essential for the proper growth and functioning of the body. Calcium is a mineral essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting.
Freckles are flat circular spots on the skin that may be red, yellow, tan, light brown, brown, or black in color. Lentigo is the term used to describe certain types of darker freckles. Ephelis typically appear during the sunny months. Freckles can be prevented with sunscreens, the use of wide-brimmed hats, sun-protective clothing, avoiding peak sun hours, and seeking shade and staying indoors.
Blepharitis is inflammation of the eyelids. Acne rosacea, Staphylococcal bacteria, allergies, sensitivities to makeup or contact lens solutions, head lice, or other conditions may cause blepharitis. Symptoms and signs include itchy eyelids, burning sensation in the eyes, crusting of the eyelids, light sensitivity, red, swollen eyelids, loss of eyelashes, and dandruff of the lashes and eyebrows. Proper eyelid hygiene and a regular cleaning routine controls blepharitis.
Birthmarks and other abnormal skin pigmentation is caused by the body's inability to produce enough melanin. Abnormal skin pigmentation can cause conditions such as vitiligo, pigmentation loss, melasma, albinism, port wine stains, macular stains and hemangioma.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Lichen sclerosus is a skin disease that causes white spots to form on the skin, which later grow into large, thin, and crinkled patches of skin that tear easily. Symptoms include itching, pain, blisters, and bleeding. Patches on the upper body usually go away over time, but patches in the genital region may scar if left untreated, causing problems with urination or sex. Treatment may involve surgery or the use of a very strong cortisone cream.
Moles are small skin growths that may appear flat or raised and are often tan, brown, black, reddish brown, or skin colored. They are typically about the size of a pencil eraser. There are three types of moles. Monthly skin self-exams are essential in the early detection of abnormal moles and melanomas.
Sun sensitivity (photosensitivity) is an inflammation of the skin induced by the combination of medications or substances and sunlight. The affect on the skin is redness, which looks similar to a sunburn. Generally, these reactions are either phototoxic or photoallergic. Phototoxic drugs are more common than photoallergic drugs. Symptoms of phototoxic reactions are a burning and stinging sensation and then redness. Symptoms of photoallergic reactions are itching, redness, swelling, blisters of the affected area. Treatment generally is discontinuation of the medication and topical application of creams.
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Sunscreens are crucial for sun protection. Sun damage to the skin from exposure to ultraviolet rays is a risk factor for skin cancer and melanoma. To avoid sunburn, people should limit sun exposure during the peak hours of 10 a.m. to 3 p.m., wear protective clothing, and use a sunscreen. People with sensitive skin should use a sunscreen with an SPF of 30 or more.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.
How does chemotherapy work?
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.
What does chemotherapy do?
Depending on your type of cancer and how advanced it is, chemotherapy can:
Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cell...