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Ask the Doc About Facial Lesions

1. Which Facial Lesions are Benign?

There are many types of facial lesions. The majority are benign and can be treated for cosmetic reasons. These include seborrheic keratoses, which are typically brown and can be slightly raised or significantly raised with a wart-like appearance. Your physician can treat these with cryotherapy (liquid nitrogen). Melasma is a skin condition triggered by sunlight and hormones, which appears as dark patches on the forehead, upper lip, and cheeks. The best treatment for melasma is prevention using a physical sunscreen and always wearing a hat when sun-exposed. Once it has occurred, melasma is best treated with a combination of lightening lotions, glycolic peels, Retin, and topical Vitamin C.

2. Which Facial Lesions are Cancerous?

The lesions we need to be on the watch for are Actinic Keratoses, Keratinocyte Carcinoma, and Melanoma.

ACTINIC KERATOSES appear as rough, red, and scaly patches on sun-damaged skin. In the course of a year, 0.1% of these will become skin cancer, 20% will resolve, and 80% will progress. Because of this, they should be treated by a physician. Options are cryotherapy or a prescription cream used under supervision. It is IMPORTANT to note that the daily use of a physical sunscreen (think Zinc or Titanium Dioxide) will increase the chance of an actinic keratosis spontaneously resolving on its own.

KERATINOCYTE CARCINOMA is a group of skin cancers that may be either Squamous Cell or Basal Cell. These need to be diagnosed by a physician and will require a biopsy. These are usually treated with excision.

MELANOMA is the most aggressive skin cancer and needs aggressive treatment.

3. How do I Protect Myself from Sun Damage and Possible Skin Cancers?

While genetics and skin type play a role in the cause of skin cancers, the effect of sun exposure and subsequent sun damage cannot be ignored. The use of an effective sunscreen daily is very important.

4. What is a Topical Sunscreen Agent?

ULTRAVIOLET A (UVA) makes up 95% of the UV radiation we are exposed to. UVA leads to photoaging, hyperpigmentation and may contribute to the development of skin cancer.

ULTRAVIOLET B (UVB) makes up 5% of the UV radiation reaching the earth’s surface. UVB can cause sunburn, skin cancer, hyperpigmentation, and skin inflammation.

SUNSCREEN AGENTS are broadly classified into two groups – CHEMICAL AND PHYSICAL.

CHEMICAL SUNSCREENS contain a variety of ingredients to provide coverage against both UVA and UVB radiation. Studies show that these ingredients are absorbed into your system. Research is ongoing as to whether there is harm from the absorption of these ingredients. Oxybenzone and Octinoxate are believed to impair coral reef growth and are now banned in Hawaii.

PHYSICAL SUNSCREENS commonly contain titanium dioxide and zinc oxide. They reflect light in the visible light range but work as chemical filters in the UV range. They are stable in the sun and so do not need chemical stabilizers in their formulation. They have an EXCELLENT SAFETY PROFILE, and studies show that they are not systemically absorbed. Physical sunscreens are the preferred choice for children, and I prefer them for all my patients.

To recap:
* If you have facial skin lesions, have your physician examine and diagnose them.
*Always wear sunscreen. I strongly suggest that you use one of the newer physical sunscreens that are now formulated to be non-greasy and light. They do make a difference.

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Posted in: Skin Care, Skin Conditions

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