ACTINIC KERATOSIS (abbreviated, AK; Pre-cancerous)

Sun exposure can damage your skin regardless of your skin color. Whether you are light-skinned or dark, the ultraviolet light in the rays of the sun damage and age your skin.

Light skinned individuals are more likely to develop scaly pink, scaly growths (i.e. lesions) in areas of sun exposure. These are called Actinic Keratoses and are pre-cancerous. Up to 10% of Actinic Keratoses may change into skin cancer over many years.

When your dermatologist or trained health professional examines your skin, they are searching for pre-cancerous growths (Actinic Keratoses) or a non-spreading skin cancer like a Basal Cell Carcinoma. They are also checking to be certain that you don’t have a more serious skin cancer like a Squamous Cell Carcinoma or a Melanoma. Fortunately, most skin cancers are discovered early, and are successfully treated without serious consequences.

Remember that you are physically unable to examine several areas of your own body, including your back, buttocks, back of thighs, and posterior scalp. A camera phone may enable you to look at some of these areas. Early detection of a skin cancer can save your life and that of a family member.

RISK FACTORS FOR PRE-CANCERS, ACTINIC KERATOSES

The Risk Factors for a pre-cancerous lesion like an Actinic Keratosis, are the same as that for Skin Cancer, Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma.

Skin cancer occurs in all races regardless of their skin color. It is more common in fair-skinned individuals. People who use tanning beds are also at greater risk of developing skin cancer. You may be at risk of developing skin cancer if you have:

  • Fair-skin, light-colored hair (blonde, red) and eyes (blue, green, gray)
  • Excess sun exposure
  • Lived or living in areas of intense sunlight (e.g. Florida, the Caribbean, northern Australia)
  • Medications which make you sensitive to sunlight (e.g. doxycycline, hydrochlorothiazide (HCTZ), naproxen, amiodarone)
  • Tanning beds or sun lamps
  • History of severe sunburns
  • Underlying diseases which make you sensitive to sunlight (e.g. lupus erythematosus, collagen vascular diseases, porphyria)
  • Inherited skin condition which increases your risk of sun damage (e.g. xeroderma pigmentosum, epidermolysis bullosa, albinism)
  • Underlying immune disorders (e.g. AIDS, organ transplant patients, immunosuppressive drugs)
  • A Family history of Actinic Keratoses or skin cancer

DIAGNOSIS OF PRECANCER, ACTINIC KERATOSES

Actinic keratoses usually appear in areas of intense sunlight exposure (e.g. face, ears, nose, lips, scalp, arms, and hands.) Actinic Keratoses may vary in size and color. They usually have a pink, scaly appearance. If you rub the affected skin areas, the skin will feel rough to the touch. Sometimes an Actinic Keratosis will grow rapidly and produce a growth that resembles a horn. This is called a “cutaneous horn”. A cutaneous horn may have an Actinic Keratosis or non-melanoma skin cancer (Basal Cell Carcinoma or Squamous Cell Carcinoma) at its base.

Actinic keratoses are usually diagnosed by visual exam by your dermatologist or trained medical professional. If an Actinic Keratoses does not have a classic appearance, a skin biopsy may be required to be certain that it is not skin cancer.

Dermatologists or trained medical professionals can perform a skin biopsy during your office visit using local anesthesia. The procedure is fast, safe, and usually heals with minimal scarring. A small sample of your skin is sent to a pathology laboratory for processing and examination under a microscope by a pathologist. A pathology report on your skin lesion is usually available within 7 days. If your growth is an Actinic Keratosis, no further treatment is necessary as the biopsy will cure your Actinic Keratosis.

A skin biopsy is normally covered by Medicare, Medicaid, and insurance companies minus any co-payments or deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TREATMENT OPTIONS FOR PRE-CANCERs, ACTINIC KERATOSES

Actinic keratoses are pre-cancerous so they should be evaluated during your visit to your doctor’s office. Your dermatologist or medical care professional can help you decide on the best treatment for your Actinic Keratoses:

1/ Cryosurgery Treatment for Actinic Keratoses

This the most common type of treatment for Actinic Keratoses. A cold spray of liquid nitrogen is briefly applied to the Actinic Keratoses. The treated areas will become frozen and turn white. The white color fades within a few minutes. The treatment site then becomes red and slightly swollen for several days followed by crusting. For the best cosmetic result, do not disturb this crust and allow the treatment site to heal over the next 3-4 weeks. Occasionally, small blisters will form at the treatment sites. These can be opened using a needle which has been cleaned first with rubbing alcohol.

Cryosurgery is normally covered by Medicare, Medicaid, and insurance companies minus any co-payments or deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

2/ Chemical Treatment for Actinic Keratoses

Actinic keratoses can be treated with an anti-cancer cream, gel, or solution. 5-Fluorouracil (CaracTM, FluroplexTM, TolakTM) and imiquimod cream (AldaraTM, ZyclaraTM) are commonly used. They are usually applied on alternate days 2-3 times a week for 2-4 weeks.

Treated areas will become red, swollen, and may crust over during your 2-4 week treatment course. It will then take an additional 3-4 weeks for your skin to heal after stopping the anti-cancer cream. Patients must avoid getting the anti-cancer cream in their eyes as an anti-cancer cream can cause eye irritation.

Medicare, Medicaid, and some insurance companies may not cover the cost or will delay approval for an anti-cancer cream for actinic keratoses.
If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

3/ Blue or Red Light Therapy for Actinic Keratoses

Blue or red light therapy is used when there are more extensive actinic keratoses on the face, neck, trunk, and extremities. This therapy is also called photodynamic therapy (PDT). Blue or Red light treatments leave the skin smooth “like a baby’s skin”. Red light therapy may penetrate slightly deeper than Blue light therapy. For this reason, Red light therapy may increase your healing time after PDT treatment.

Therapy consists of the application of a special solution or gel to the treatment area at your doctor’s office. The solution gets into the “nooks and crannies” of your skin and makes your skin sensitive to Blue and Red light. After waiting 1 hour for the face or scalp, or 3 hours for other body areas, Blue Light Treatment is administered from a light stand for 10 to 16.5 minutes. For Red Light Therapy, the light source is smaller in size and usually requires two, 10 minute treatments for a small area. A larger light source for Red Light Therapy is pending approval.

You should avoid sunlight and protect yourself from the sun for the next 24-48 hours as you may become sun sensitive. After Blue or Red light treatment, your skin becomes red and slightly swollen. Your skin will usually heal within a few weeks leaving behind improved, smoother skin.

Medicare, Medicaid and Insurance plans usually cover Blue or Red Light Treatment for Actinic Keratoses minus any co-payments or deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

4/ Curettage and Electrodessication for Actinic Keratoses

Small pre-cancerous lesions can be removed by “burning off” the growths by curettage and electrodessication. Often, a skin biopsy of the growth will be performed at the same time.

This treatment is usually covered by Medicare, Medicaid, and insurance companies minus any co-payment or deductible required by the insurance company. If you have a second insurance policy (“secondary insurance”, this will usually cover your co-payment.

5/ Laser resurfacing and Chemical Peels for Actinic Keratoses

Extensive Actinic Keratoses and aged skin can also be treated with laser resurfacing (Secret ProTM, MixtoTM laser, PiQo4TM laser, FraxelTM laser, UltrapulseTM laser, and many others). A moderate-to-deep chemical peel can also improve the skin’s appearance as well as eradicate Actinic Keratoses.

Medicare, Medicaid, and insurance companies usually do not cover laser treatment or chemical peels for Actinic Keratoses.

BASAL CELL CARCINOMA (abbreviated, BCC or BCE)

Basal Cell Carcinoma (abbreviated BCC or BCE for basal cell epithelioma) is the most common type of skin cancer. It is 3-4 times more common than traditional cancers like breast cancer, lung cancer, colon cancer, and others.

When your dermatologist or trained health professional examines your skin, they are searching for pre-cancerous growths (Actinic Keratoses) and for non-spreading skin cancer like Basal Cell Carcinoma. They are also checking to be certain that you don’t have a more serious skin cancer, like a Squamous Cell Carcinoma or a Melanoma.

Remember that you are physically unable to examine several areas of your own body, including your back, buttocks, back of thighs, and posterior scalp. A camera phone may enable you to look at some of these areas. Early detection of a skin cancer can save your life and that of a family member. Most skin cancers are discovered early, and are successfully treated without serious consequences.

Fortunately, Basal Cell Carcinoma, the most common cancer of any type, does not normally spread (i.e. metastasize) from its site of origin. However, BCC can enlarge and grow deeply into the skin which can affect the surrounding skin structures. On the face, a BCC can damage the nose, ears, eyes, and mouth resulting in scars and disfigurement.

In contrast, the second most frequent skin cancer, a squamous cell carcinoma, rarely spreads locally or into your blood stream (metastasize). The third most frequent skin cancer, a melanoma, is considered the most dangerous of all types of cancer due to its easy ability to metastasize.

RISK FACTORS FOR BASAL CELL CARCINOMA

The risk factors for Basal Cell Carcinoma are the same as for pre-cancerous growths like Actinic Keratoses, as well as cancerous growths like a Squamous Cell Carcinoma, and Melanoma.

Skin cancer occurs in all races regardless of their skin color. It is more common in fair-skinned individuals. You may be at risk of developing skin cancer if you have:
. Fair-skin, light-colored hair (blonde or red) and eyes (blue, green, gray)
. Excess sun exposure
. Living or lived in areas of intense sunlight (e.g. Florida, the Caribbean, northern Australia)
. Medications which make you sensitive to sun light (e.g. doxycycline, hydrochlorothiazide (HCTZ), naproxen, amiodarone)
. Tanning beds or sun lamps
. History of severe sunburns
. Underlying diseases which make you sensitive to sunlight (e.g. lupus erythematosus, collagen vascular disease, porphyria)
. Inherited skin condition which increases your risk of sun damage (e.g. xeroderma pigmentosum, epidermolysis bullosa, albinism).
. Underlying immune disorder (e.g. AIDS, organ transplant patients, immunosuppressive drugs)
. A Family history of pre-cancerous Actinic Keratoses or skin cancer

DIAGNOSIS OF A BASAL CELL CARCINOMA

Your dermatologist or trained medical professional will examine your skin to look for suspicious growths. Basal cell carcinomas can have a variety of appearances from a white or pink, translucent “bump” to a draining, non-healing “sore”. Basal cell carcinoma may also look like a pink scar or even a brown spot.

To diagnose a Basal Cell Carcinoma (BCC), your dermatologist or trained medical professional can perform a skin biopsy under local anesthesia at the time of your office visit. This is the only way to confirm the diagnosis of skin cancer. A skin biopsy procedure is fast, safe, and usually heals with minimal scarring.

If you have a suspicious growth, a small sample of skin is surgically removed (i.e. biopsied) under local anesthesia. This specimen is sent to a pathology laboratory for processing and examination under a microscope by a pathologist. A pathology report is usually available within 7 days. Your dermatologist or medical care professional will discuss your pathology report with you at the time of your next doctor’s visit. If a skin cancer diagnosis is found on your pathology report, treatment options will be discussed with you.

A skin biopsy is usually covered by Medicare, Medicaid, and insurance companies minus any co-payments and deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TREATMENT OPTIONS FOR BASAL CELL CARCINOMA

Even though Basal Cell Carcinomas (BCC) rarely ever spread elsewhere
(i.e metastasize), they can grow deeper into the skin and enlarge causing local tissue destruction. This may lead to the partial or complete loss of your nose, ears, lips, or eyes if not treated early on. Basal cell carcinomas can also cause disfigurement. Your dermatologist or medical care professional can help you decide the best treatment for a basal cell carcinoma.

Treatment options for Basal Cell Carcinoma (BCC) depend on the location, size, type of BCC, and age of the patient. Your dermatologist or trained health care profession must consider many different conflicting factors. For example, if the BCC is located near an eye, ear, nose, mouth, or temple areas, it is considered high risk. If the base of the BCC is less than 1.0 cm (0.4 inches) in size, it is considered low risk; over 1.0 cm in size, higher risk. A superficial BCC can be easily treated while a sclerotic / fibrotic BCC may be larger than it appears and requires more aggressive treatment. Less invasive procedures are generally recommended for elderly patients and for those with severe disabilities.

TREATMENT OPTIONS FOR PRE-CANCERs, ACTINIC KERATOSES

Actinic keratoses are pre-cancerous so they should be evaluated during your visit to your doctor’s office. Your dermatologist or medical care professional can help you decide on the best treatment for your Actinic Keratoses:

1/ Cryosurgery Treatment for Actinic Keratoses

This the most common type of treatment for Actinic Keratoses. A cold spray of liquid nitrogen is briefly applied to the Actinic Keratoses. The treated areas will become frozen and turn white. The white color fades within a few minutes. The treatment site then becomes red and slightly swollen for several days followed by crusting. For the best cosmetic result, do not disturb this crust and allow the treatment site to heal over the next 3-4 weeks. Occasionally, small blisters will form at the treatment sites. These can be opened using a needle which has been cleaned first with rubbing alcohol.

Cryosurgery is normally covered by Medicare, Medicaid, and insurance companies minus any co-payments or deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

2/ Chemical Treatment for Actinic Keratoses

Actinic keratoses can be treated with an anti-cancer cream, gel, or solution. 5-Fluorouracil (CaracTM, FluroplexTM, TolakTM) and imiquimod cream (AldaraTM, ZyclaraTM) are commonly used. They are usually applied on alternate days 2-3 times a week for 2-4 weeks.

Treated areas will become red, swollen, and may crust over during your 2-4 week treatment course. It will then take an additional 3-4 weeks for your skin to heal after stopping the anti-cancer cream. Patients must avoid getting the anti-cancer cream in their eyes as an anti-cancer cream can cause eye irritation.

Medicare, Medicaid, and some insurance companies may not cover the cost or will delay approval for an anti-cancer cream for actinic keratoses.
If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

3/ Blue or Red Light Therapy for Actinic Keratoses

Blue or red light therapy is used when there are more extensive actinic keratoses on the face, neck, trunk, and extremities. This therapy is also called photodynamic therapy (PDT). Blue or Red light treatments leave the skin smooth “like a baby’s skin”. Red light therapy may penetrate slightly deeper than Blue light therapy. For this reason, Red light therapy may increase your healing time after PDT treatment.

Therapy consists of the application of a special solution or gel to the treatment area at your doctor’s office. The solution gets into the “nooks and crannies” of your skin and makes your skin sensitive to Blue and Red light. After waiting 1 hour for the face or scalp, or 3 hours for other body areas, Blue Light Treatment is administered from a light stand for 10 to 16.5 minutes. For Red Light Therapy, the light source is smaller in size and usually requires two, 10 minute treatments for a small area. A larger light source for Red Light Therapy is pending approval.

You should avoid sunlight and protect yourself from the sun for the next 24-48 hours as you may become sun sensitive. After Blue or Red light treatment, your skin becomes red and slightly swollen. Your skin will usually heal within a few weeks leaving behind improved, smoother skin.

Medicare, Medicaid and Insurance plans usually cover Blue or Red Light Treatment for Actinic Keratoses minus any co-payments or deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

4/ Curettage and Electrodessication for Actinic Keratoses

Small pre-cancerous lesions can be removed by “burning off” the growths by curettage and electrodessication. Often, a skin biopsy of the growth will be performed at the same time.

This treatment is usually covered by Medicare, Medicaid, and insurance companies minus any co-payment or deductible required by the insurance company. If you have a second insurance policy (“secondary insurance”, this will usually cover your co-payment.

5/ Laser resurfacing and Chemical Peels for Actinic Keratoses

Extensive Actinic Keratoses and aged skin can also be treated with laser resurfacing (Secret ProTM, MixtoTM laser, PiQo4TM laser, FraxelTM laser, UltrapulseTM laser, and many others). A moderate-to-deep chemical peel can also improve the skin’s appearance as well as eradicate Actinic Keratoses.

Medicare, Medicaid, and insurance companies usually do not cover laser treatment or chemical peels for Actinic Keratoses.

BASAL CELL CARCINOMA (abbreviated, BCC or BCE)

Basal Cell Carcinoma (abbreviated BCC or BCE for basal cell epithelioma) is the most common type of skin cancer. It is 3-4 times more common than traditional cancers like breast cancer, lung cancer, colon cancer, and others.

When your dermatologist or trained health professional examines your skin, they are searching for pre-cancerous growths (Actinic Keratoses) and for non-spreading skin cancer like Basal Cell Carcinoma. They are also checking to be certain that you don’t have a more serious skin cancer, like a Squamous Cell Carcinoma or a Melanoma.

Remember that you are physically unable to examine several areas of your own body, including your back, buttocks, back of thighs, and posterior scalp. A camera phone may enable you to look at some of these areas. Early detection of a skin cancer can save your life and that of a family member. Most skin cancers are discovered early, and are successfully treated without serious consequences.

Fortunately, Basal Cell Carcinoma, the most common cancer of any type, does not normally spread (i.e. metastasize) from its site of origin. However, BCC can enlarge and grow deeply into the skin which can affect the surrounding skin structures. On the face, a BCC can damage the nose, ears, eyes, and mouth resulting in scars and disfigurement.

In contrast, the second most frequent skin cancer, a squamous cell carcinoma, rarely spreads locally or into your blood stream (metastasize). The third most frequent skin cancer, a melanoma, is considered the most dangerous of all types of cancer due to its easy ability to metastasize.

RISK FACTORS FOR BASAL CELL CARCINOMA

The risk factors for Basal Cell Carcinoma are the same as for pre-cancerous growths like Actinic Keratoses, as well as cancerous growths like a Squamous Cell Carcinoma, and Melanoma.

Skin cancer occurs in all races regardless of their skin color. It is more common in fair-skinned individuals. You may be at risk of developing skin cancer if you have:

  • Fair-skin, light-colored hair (blonde or red) and eyes (blue, green, gray)
  • Excess sun exposure
  • Living or lived in areas of intense sunlight (e.g. Florida, the Caribbean, northern Australia)
  • Medications which make you sensitive to sun light (e.g. doxycycline, hydrochlorothiazide (HCTZ), naproxen, amiodarone)
  • Tanning beds or sun lamps
  • History of severe sunburns
  • Underlying diseases which make you sensitive to sunlight (e.g. lupus erythematosus, collagen vascular disease, porphyria)
  • Inherited skin condition which increases your risk of sun damage (e.g xeroderma pigmentosum, epidermolysis bullosa, albinism).
  • Underlying immune disorder (e.g. AIDS, organ transplant patients, immunosuppressive drugs)
  • A Family history of pre-cancerous Actinic Keratoses or skin cancer

DIAGNOSIS OF A BASAL CELL CARCINOMA

Your dermatologist or trained medical professional will examine your skin to look for suspicious growths. Basal cell carcinomas can have a variety of appearances from a white or pink, translucent “bump” to a draining, non-healing “sore”. Basal cell carcinoma may also look like a pink scar or even a brown spot.

To diagnose a Basal Cell Carcinoma (BCC), your dermatologist or trained medical professional can perform a skin biopsy under local anesthesia at the time of your office visit. This is the only way to confirm the diagnosis of skin cancer. A skin biopsy procedure is fast, safe, and usually heals with minimal scarring.

If you have a suspicious growth, a small sample of skin is surgically removed (i.e. biopsied) under local anesthesia. This specimen is sent to a pathology laboratory for processing and examination under a microscope by a pathologist. A pathology report is usually available within 7 days. Your dermatologist or medical care professional will discuss your pathology report with you at the time of your next doctor’s visit. If a skin cancer diagnosis is found on your pathology report, treatment options will be discussed with you.

A skin biopsy is usually covered by Medicare, Medicaid, and insurance companies minus any co-payments and deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TREATMENT OPTIONS FOR BASAL CELL CARCINOMA

Even though Basal Cell Carcinomas (BCC) rarely ever spread elsewhere
(i.e metastasize), they can grow deeper into the skin and enlarge causing local tissue destruction. This may lead to the partial or complete loss of your nose, ears, lips, or eyes if not treated early on. Basal cell carcinomas can also cause disfigurement. Your dermatologist or medical care professional can help you decide the best treatment for a basal cell carcinoma.

Treatment options for Basal Cell Carcinoma (BCC) depend on the location, size, type of BCC, and age of the patient. Your dermatologist or trained health care profession must consider many different conflicting factors. For example, if the BCC is located near an eye, ear, nose, mouth, or temple areas, it is considered high risk. If the base of the BCC is less than 1.0 cm (0.4 inches) in size, it is considered low risk; over 1.0 cm in size, higher risk. A superficial BCC can be easily treated while a sclerotic / fibrotic BCC may be larger than it appears and requires more aggressive treatment. Less invasive procedures are generally recommended for elderly patients and for those with severe disabilities.

SURGICAL TREATMENTS

1/ Cryosurgery for Basal Cell Carcinoma

This treatment is rarely used anymore to treat skin cancer. Cryosurgery of skin cancer can result in scarring and occasionally disfigurement. Some dermatologists use cryosurgery for superficial Basal Cell Carcinomas (BCC) and Squamous Cell Carcinomas (SCC) in elderly patients, and in resistant BCCs and SCCs which have ill-defined borders or depth.

This type of cryosurgery treatment consists of spraying liquid nitrogen in two freeze-thaw cycles of one minute a piece. The treated areas will become frozen and turn white. After two freeze-thaw cycles, the white color fades within several minutes. The treatment site then becomes red and swollen and may form a draining sore over a few days. The area will take 4-6 weeks or longer to heal. For the best cosmetic result, gently cleanse the treatment site 1-2 times a day with a mild soap and water. Apply Vaseline to moisturize the area.

Cryosurgery of skin cancer is normally covered by Medicare, Medicaid, and insurance companies minus any co-payments and deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

2/ Curettage and electrodessication for Basal Cell Carcinoma

This is one of the most common ways to treat non-melanoma skin cancers like Basal Cell Carcinomas and Squamous Cell Carcinoma. This is sometimes abbreviated ED&C or EDC or EC or CE (electrodessication and curettage), F&C or FC (fulguration and curettage).

This treatment consists of scraping the skin cancer area followed by burning (i.e. electrodessication or fulguration) the scraped area. This is usually repeated 2 or 3 times to destroy the underlying skin cancer.
It works best for skin cancers that are small (i.e. less than 1.0 cm (0.4 inches) in size.

This treatment is usually covered by Medicare, Medicaid, and insurance carriers minus a co-payment or deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

3/ Excision of Basal Cell Carcinoma

Your dermatologist or medical professional can “cut out” (i.e. excise) your skin cancer using a scalpel. The excised skin cancer is sent to a pathologist for processing and examination under a microscope to be certain that the skin specimen margins are free of skin cancer. Some skin cancer excisions are large and may require a skin flap or skin graft to cover the skin cancer surgery site. Excision is usually performed on skin cancer that is over 1.0 cm (0.4 inches) in size.

This treatment is covered by Medicare, Medicaid, and insurance carriers minus a co-payment or deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

4/ Laser Treatment for Basal Cell Carcinoma

A laser is sometimes used to treat superficial skin cancer. Your dermatologist or medical professional may use a focused beam of light to destroy superficial non-melanoma skin cancer, Basal Cell Carcinoma and Squamous Cell Carcinoma.

Medicare, Medicaid, and insurance carriers may cover laser treatment for skin cancer minus a co-payment of deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

5/ Mohs surgery for Basal Cell Carcinoma

Mohs surgery is named after Fredric E. Mohs (1910-2002) who pioneered this procedure. Mohs surgery is generally performed on high risk areas around the eyes, ears, nose, or mouth areas, and for recurrent skin cancer. There is up to a 99% cure rate with Mohs surgery which is superior to most other forms of skin cancer treatment. Superficial Radiation Therapy (SRT) also has a very high cure rate of 98-99%.

If you are referred to a Mohs surgeon, the Mohs surgeon will evaluate your skin cancer site. Your skin cancer will be removed in stages, usually the same day. A layer of skin is removed in each stage and the tissue examined under a microscope at an on-site laboratory. This is repeated until the skin cancer has been completely removed. During your office visit to a Mohs surgeon, you will have to wait between each stage for your skin to be evaluated under a microscope. Plan for your visit to a Mohs surgeon to take several hours or longer.

Medicare, Medicaid, and insurance carriers generally pay for Mohs surgery and Superficial Radiation Therapy (SRT) minus any insurance co-payment or deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TOPICAL TREATMENT FOR BASAL CELL CARCINOMA

Your dermatologist or medical professional may also use a topical anti-cancer cream, gel, or solution for treatment of small, superficial Basal Cell Carcinomas. This anti-cancer cream may also be used to treat a skin cancer surgery site in order to prevent recurrence.

Small, superficial Basal cell carcinomas can be treated with an anti-cancer cream, gel, or solution. 5-Fluorouracil (CaracTM, FluroplexTM, TolakTM) and imiquimod cream (AldaraTM, ZyclaraTM) are commonly used. They are usually applied 5-7 days a week for 4-6 weeks or longer. Treated areas will become red, swollen, and may crust over before healing about 3-4 weeks after discontinuing the anti-cancer cream therapy. Patients must avoid getting the anti-cancer cream in their eyes as the cream, gel, or solution can cause eye irritation.

Medicare, Medicaid, and some insurance companies may not cover the cost or will delay approval for an anti-cancer cream for basal cell carcinoma. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

BLUE OR RED LIGHT TREATMENT FOR BASAL CELL CARCINOMA
(also known as PHOTODYNAMIC THERAPY (PDT)

Blue or Red light therapy is sometimes used to treat single or multiple, superficial non-melanoma skin cancer (Basal Cell Carcinoma and Squamous Cell Carcinoma.) This therapy should not be used for large or deep skin cancers.

Therapy consists of the application of a special solution or gel to the treatment area at your doctor’s office. The solution or gel gets into the “nooks and crannies” of your skin and makes the skin sensitive to blue light. After waiting 1 hour for the face or scalp, or 3 hours for other body areas, Blue Light Treatment is administered by a light stand for 10 to 16.5 minutes. In contrast, Red Light Therapy has a smaller light stand. Red light from the smaller light stand is presently given for 10 minutes to 2 adjacent treatment areas. A larger Red Light Therapy light stand is pending approval.

After your Blue Light or Red Light Treatment, you should avoid sunlight and protect yourself from the sun for the next 24-48 hours as you may become sun sensitive. After Blue or Red Light Treatment, your skin becomes red and slightly swollen. Your skin will usually heal within a few weeks and be much softer and smoother.

Medicare, Medicaid and Insurance plans may cover Blue or Red light therapy for basal cell carcinoma minus any co-payments or deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

SUPERFICIAL RADIATION THERAPY (SRT) FOR BASAL CELL CARCINOMA

Radiation therapy has been used to treat skin cancer since 1896. Treatment is based on Wilhelm Rontgen remarkable discovery of X-rays on November 8, 1895. Over the last century, radiation therapy has evolved. In the past 6 years, safe, reliable radiation machines have been developed that use tungsten instead of radioactive materials to treat Basal Cell and Squamous Cell Carcinomas.

Sensus HealthcareTM has been a pioneer in radiation therapy and manufactures the Sensus SRT 100, 100+, and Vision radiation machines for skin cancer treatment. SRT uses superficial radiation for the skin in contrast to the hospital radiation machines which are used to treat breast, colon, prostate, and other cancers located below the skin surface.

The Advantages of Superficial Radiation Therapy (SRT) for Basal Cell Carcinoma and Squamous Cell Carcinoma are:

  • No needles
  • No pain
  • No infection
  • No bleeding, even if you are taking blood thinners
  • No cutting
  • No down time. SRT is better for areas on the hands and legs
  • Ability for your dermatologist or medical professional to have wide treatment margins around your skin cancer growth which makes recurrence less likely
  • Minimal or no scarring. The treatment site may heal with slight loss of color or treatment site hair loss. The skin may re-color and some hair may re-grow over time.
  • Superficial Radiation Therapy usually gives the best cosmetic result particularly for non-melanoma skin cancers on the nose, ear, or mouth areas.
  • 98-99% cure rate This is among the highest cure rate of all skin cancer treatment methods.

SRT therapy is usually not used on children with rare skin cancer disorders, patients with genetic disorders like xeroderma pigmentosum or albinism, or rare skin cancers that are resistant to radiation therapy.

Superficial Radiation Therapy (SRT) is covered by Medicare, Medicaid, and insurance carriers minus a deductible or co-payment. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TREATMENT FOR ADVANCED BASAL CELL CARCINOMA

There are a number new drug therapies which may shrink or help to control Basal Cell Carcinoma:

Cemiplimab-rwic (LibtayoTM , which is administered intravenously)

Sonidegib (OdomzoTM) or Vismodegib (ErivedgeTM) which are taken orally.

These drugs can be used before surgery to shrink an advanced Basal Cell Carcinoma or after surgery on Basal Cell Carcinomas resistant to surgery.
OdomzoTM and ErivedgeTM are commonly prescribed by your dermatologist and monitored during your office visits.

These treatments are covered by Medicare, Medicaid, and other insurance carriers minus a deductible or co-payment. A second insurance policy (“secondary insurance”) will usually cover your co-payment.

SQUAMOUS CELL CARCINOMA (abbreviated, SCC

Squamous cell carcinomas (SCC) are a common type of skin cancer which typically appear on sun-exposed areas of your body. SCC are caused by the ultraviolet rays in sunlight. From 1-2 million people develop SCC in the United States every year. This is more than one million people in the United States who have traditional cancers each year (e.g. breast cancer, colon cancer, prostate cancer, and more).

When your dermatologist or trained health professional examines your skin, they are searching for pre-cancerous growths (Actinic Keratoses) and a non-spreading skin cancer like a Basal Cell Carcinoma. They are also checking to be certain that you don’t have a more serious skin cancer, like a Squamous Cell Carcinoma or a Melanoma. Fortunately, most skin cancers are discovered early, and are successfully treated without serious consequences.

Remember, you are physically unable to examine several areas of your own body, including your back, buttocks, back of thighs, and posterior scalp.
A phone camera can sometimes help you examine these areas. Early detection of a skin cancer can save your life and that of a family member.

Squamous cell carcinoma often develops from an untreated precancerous growth called an Actinic Keratosis. SCC may also appear elsewhere on the body including inside the mouth, on the lips, or on the genitals. These same areas are at high risk of the SCC spreading locally or internally (metastasizing).

Squamous cell carcinomas are more aggressive than Basal Cell Carcinomas. A SCC usually develops in sun-exposed on the face, neck, trunk, and extremities. As there is a risk of spreading locally or into the blood stream (metastasizing), all SCC should be treated and monitored.

SCC lesions may have many different appearances. Usually they appear as a red bump which may be scaly or crusted over. A SCC growth may be non-healing and itch or bleed. It may heal up for a few weeks but then return at the same site. Generally, any suspicious area should be checked by your dermatologist or trained medical professional.

RISK FACTORS FOR SQUAMOUS CELL CARCINOMA

Skin cancer occurs in all races regardless of their skin color. It is more common in fair-skinned individuals. People who use tanning beds are also at greater risk of developing skin cancer. You may be at risk of developing skin cancer if you have:

  • Fair-skin, light-colored hair (blonde or red) and eyes (blue, green, gray)
  • Excess sun exposure
  • Living or lived in areas of intense sunlight (e.g. Florida, the Caribbean, northern Australia)
  • Medications which make you sensitive to sun light (e.g. doxycycline, hydrochlorothiazide (HCTZ))
  • Tanning beds or sun lamps
  • History of severe sunburns
  • Underlying diseases which make you sensitive to sunlight (e.g. lupus erythematosus, collagen vascular disease, porphyria)
  • Inherited a skin condition which increases your risk of sun damage (e.g. xeroderma pigmentosum, epidermolysis bullosa, albinism).
  • Underlying immune disorders (e.g. AIDS, organ transplant patients, immunosuppressive drugs)
  • A Family history of pre-cancerous Actinic Keratoses or skin cancer

DIAGNOSIS OF SQUAMOUS CELL CARCINOMA

To diagnose a Squamous Cell Cell Carcinoma (SCC), your dermatologist or trained medical professional can perform a skin biopsy under local anesthesia at the time of your office visit. This is the only way to confirm the diagnosis of skin cancer. A skin biopsy procedure is fast, safe, and usually heals with minimal scarring.

If you have a suspicious growth, a small sample of skin is surgically removed (i.e. biopsied) under local anesthesia. This specimen is sent to a pathology laboratory for processing and examination under a microscope by a pathologist. A pathology report is usually available within 7 days. Your dermatologist or medical care professional will discuss your pathology report with you at the time of your next doctor’s visit. If a skin cancer diagnosis is found on your pathology report, treatment options will be discussed with you.

A skin biopsy is normally covered by Medicare, Medicaid, and insurance companies minus any co-payments and deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this usually cover your co-payment.

TREATMENT OPTIONS FOR SQUAMOUS CELL CARCINOMA

Treatment for Squamous Cell Carcinoma (SCC) depends on the location, size, type of SCC, and age of the patient. Squamous Cell Carcinoma, like Basal Cell Carcinoma, can cause disfigurement due local invasion and destruction of underlying skin structures. SCC also has the potential to spread locally or into your blood stream (metastasize). It is important that you receive appropriate treatment for your SCC. Your dermatologist or medical care professional can help you decide the best treatment.

Many conflicting factors come into making a treatment decision. If the SCC is located near an eye, ear, nose, mouth, or temple areas, it is considered more high risk. If the base of the SCC is less than 1.0 cm (0.4 inches) in size, it is considered low risk. If the lesion base is over 1.0 cm (0.4 inches) in size it is high risk. If the SCC is poorly differentiated, there is a greater risk of skin cancer recurrence. Your dermatologist or medical care professional can help you decide your best treatment option.

A skin biopsy is normally covered by Medicare, Medicaid, and insurance companies minus any co-payments and deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this usually cover your co-payment.

SURGICAL THERAPIES

1/ Cryosurgery Treatment for Squamous Cell Carcinoma

This treatment is rarely used anymore to treat skin cancer. Cryosurgery of skin cancer can result in scarring and occasionally disfigurement. Some dermatologists use cryosurgery for superficial Squamous Cell Carcinoma (SCC) and Basal Cell Carcinomas (BCC); SCC and BCC in elderly patients; and in resistant SCCs and BCCs which have ill-defined borders or depth.

This type of cryosurgery treatment usually consists of spraying liquid nitrogen in two freeze-thaw cycles of one minute a piece. The treated areas will become frozen and turn white. After two freeze-thaw cycles, the white color fades within several minutes. The treatment site then becomes red and swollen and may form a draining sore over a few days. The area then takes 4-6 weeks or longer to heal. For the best cosmetic result, gently cleanse the treatment site 1-2 times a day with a mild soap and water. Apply Vaseline to moisturize the area.

Cryosurgery of skin cancer is normally covered by Medicare, Medicaid, and insurance companies minus any co-payments and deductibles required by the insurer. If you have a second insurance policy (“secondary insurance”), this usually cover your co-payment.

2/ Curettage and electrodessication Treatment for Squamous Cell Carcinoma

Curettage and electrodessication is one of the most common ways to treat non-melanoma skin cancers like Basal Cell Carcinoma and Squamous Cell Carcinoma. This procedure is commonly abbreviated ED&C or EDC or EC, or CE (electrodessication and curettage), F&C or FC (fulguration and curettage).

This treatment consists of scraping the skin cancer area followed by burning (i.e. electrodessication or fulguration) the scraped area. This is usually repeated 2 or 3 times during the same office visit to destroy the underlying skin cancer. It works best for skin cancers that are small (i.e. less than 1.0 cm (0.4 inches) in size.

Treatment is usually covered by Medicare, Medicaid, and insurance carriers minus a co-payment or deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

3/ Excision of Squamous Cell Carcinoma

Your dermatologist or medical professional may cut out (i.e. excise) your skin cancer using a scalpel. The excised skin cancer is sent to a pathologist for processing and examination under a microscope to be certain that the skin specimen margins are free of skin cancer. Some skin cancer excisions are large and may require a second surgery to cover the skin cancer treatment site with a skin flap or skin graft. Excision is usually performed on skin cancer that is over 1.0 cm (0.4 inches) in size.

This treatment is covered by Medicare, Medicaid, and insurance carriers minus a co-payment or deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

4/ Laser Treatment for Squamous Cell Carcinoma

A laser is sometimes used to treat superficial skin cancer. Your dermatologist or medical professional uses a focused beam of light to destroy superficial non-melanoma skin cancer, Squamous Cell Carcinoma and Basal Cell Carcinoma.

Medicare, Medicaid, and insurance carriers may cover laser treatment for skin cancer minus a co-payment of deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

5/ Mohs surgery for Squamous Cell Carcinoma

Mohs surgery is named after Fredric E. Mohs (1910-2002) who pioneered this procedure. Mohs surgery is generally performed on high risk areas around the eyes, ears, nose, or mouth areas, and for recurrent skin cancer. There is up to a 99% cure rate with Mohs surgery which is superior to most other forms of skin cancer treatment. Superficial Radiation Therapy (SRT) also has a very high cure rate of 98-99%.

If you are referred to a Mohs surgeon, the Mohs surgeon will evaluate your skin cancer site. Your skin cancer will be removed in stages, usually the same day. A layer of skin is removed in each stage and the tissue examined under a microscope at an on-site laboratory. This is repeated until the skin cancer has been completely removed. During your office visit to a Mohs surgeon, you will have to wait between each stage for your skin to be evaluated under a microscope.

Mohs surgery treatment may leave a large, open sore at your skin cancer treatment site. These open sores may require a second operation to repair the Mohs surgery treatment site with a skin graft or skin flap.

Medicare, Medicaid, and insurance carriers generally pay for Mohs surgery and Superficial Radiation Therapy (SRT) minus any insurance co-payment or deductible. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

SUPERFICIAL RADIATION THERAPY (SRT) FOR SQUAMOUS CELL CARCINOMA

Radiation therapy has been used to treat skin cancer since 1896. Treatment is based on Wilhelm Rontgen remarkable discovery of X-rays on November 8, 1895. Over the last century, radiation therapy has evolved. In the past 6 years, safe, reliable radiation machines have been developed that use tungsten instead of radioactive materials to treat basal cell and squamous cell carcinomas.

Sensus HealthcareTM has been a pioneer in radiation therapy and manufactures the Sensus SRT 100, 100+, and Vision radiation machines for skin cancer treatment. SRT uses superficial radiation for the skin in contrast to the hospital radiation machines which are used to treat breast, colon, prostate, and other cancers located below the skin surface.

The advantages of radiation therapy are:

  • No needles
  • No pain
  • No infection
  • No bleeding, even if you are taking blood thinners
  • No cutting
  • No down time. SRT is better for areas on the hands and legs
  • Ability for your dermatologist or medical professional to have wide treatment margins around your skin cancer growth which makes recurrence unlikely
  • Minimal or no scarring. The treatment site may heal with slight loss of color or treatment site hair loss. The skin may re-color and some hair may re-grow over time.
  • Superficial Radiation Therapy usually gives the best cosmetic result particularly for non-melanoma skin cancers on the nose, ear, or mouth areas.
  • 98-99% cure rate This is among the highest cure rate of all skin cancer treatment methods.

SRT therapy is usually not used on children with rare skin cancer disorders, patients with genetic disorders like xeroderma pigmentosum and albinism, or rare skin cancers that are resistant to radiation therapy.

Superficial Radiation Therapy (SRT) is covered by Medicare, Medicaid, and insurance carriers minus a deductible or co-payment. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TREATMENT FOR ADVANCED SQUAMOUS CELL CARCINOMA

There are a number new drug therapies which may help shrink or help to control advanced Squamous Cell Carcinoma:

Cemiplimab-rwic (LibtayoTM ) and Pembrolizumab (KeytrudaTM) which are administered intravenously. These drugs can be used before surgery to shrink an advanced Squamous or Basal Cell Carcinoma or after surgery on skin cancer resistant to surgery.

These treatments are covered by Medicare, Medicaid, and other insurance carriers. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

MELANOMA

Melanoma is considered the most dangerous of ALL types of cancer due to its easy ability to spread into the blood stream (i.e. metastasize).
However, if Melanoma is diagnosed early, the cure rate can be 100%.

Melanoma arises in the pigment-producing cells of your skin, called melanocytes. Melanocytes give your skin its color. Melanocytes are located in the base layer of the epidermis. The epidermis is the outermost layer of your skin and is just the thickness of a piece of paper.

Melanomas often develop as a new growth, not in an existing “mole”.
It is important to have your skin checked by a family member, dermatologist, or trained medical professional. You should realize that you are unable to see many areas of your body, including your back, buttocks, back of your thighs, and scalp. A camera phone may assist you in your self-inspection of these areas. Remember, early detection of a melanoma can save your life and that of a family member. Over 100,000 people develop melanoma in the United States each year and 7,000 die from it.

WHAT “MOLES’ SHOULD BE CHECKED?

  • Any mole that is growing rapidly or changing in shape or color
  • Any mole that bleeds or oozes
  • Any growth that is itching, painful, or bleeding
  • A streak (usually brown or black) that appears in a fingernail or toenail
  • Any non-healing “sore” or growth

RISK FACTORS

Many Melanomas can be prevented by protecting your skin from the sun. Sunscreens with a Sun Protection Factor (SPF) of 30 or higher are very effective in blocking the harmful ultraviolet rays of the sun. Protecting yourself from the sun and wearing sun protective clothing also helps to prevent Melanoma as well as pre-cancerous growths (Actinic Keratoses), and non-melanoma skin cancer (Basal Cell Carcinoma and Squamous Cell Carcinoma).

If you have a family history of Melanoma, your risk is increased for developing melanoma. A family history of non-melanoma skin cancer also puts you at greater risk of Melanoma.

Risks factors for developing Melanoma are similar to that of pre-cancerous growths like Actinic Keratoses and cancerous growths like Basal Cell Carcinoma and Squamous Cell Carcinoma.

  • Fair-skin, light-colored hair (blonde, red) and eyes (blue, green, gray)
  • Excess sun exposure
  • Living or lived in areas of intense sunlight (e.g. Florida, the Caribbean, northern Australia)
  • Medications which make you sensitive to sun light (e.g. doxycycline, hydrochlorothiazide (HCTZ))
  • Tanning beds or sun lamps
  • History of severe sunburns
  • Underlying diseases which make you sensitive to sunlight (e.g. lupus erythematosus, collagen vascular disease, porphyria)
  • Inherited a skin condition which increases your risk of sun damage such as xeroderma pigmentosum, epidermolysis bullosa, albinism.
  • Underlying decreased immunity due to AIDS, organ transplants, and/or Immunosuppressive medications)
  • A Family history of pre-cancerous Actinic Keratoses or skin cancer

In addition, many patients with melanoma may have a strong family history of melanoma or have a history of multiple atypical (dysplastic) “moles” sometimes 50 or more.

DIAGNOSIS

A Melanoma often appears on the skin with no pre-cursor growth. There is a pre-existing “atypical mole” on the skin less than 50% of the time. People are reminded to remember their ABCs for diagnosing Melanomas.

A is for an Asymmetrical appearance
B is for an irregular Border
C is for an atypical brown, tan, black Color or multi-color. In some instances, the atypical growth may appear pink or have no color. This is called an Amelanotic Melanoma. This is a rare type of Melanoma which is often diagnosed late due to the lack of pigment changes.
D is for Diameter or size of the lesion. Although most Melanomas are 0.6 cm (about ¼ inch) or more in Diameter when they are diagnosed, some melanomas may be only the size of a pencil mark.
E is for Evolving. A growth than is changing in size, shape, color, or elevation should be biopsied. Also, if the growth is itching, oozing, bleeding, or crusting, it should be biopsied.
F is for Funny-Looking. This is included in ABCs of melanoma detection as it helps to guide whether to do a skin biopsy. If all the skin lesions appear “funny-looking” then this pattern may be normal for an individual. But, if a growth does not look like it belongs with other skin growths, it should be biopsied. This is known as the “ugly duckling sign”.

Melanoma can occur in all people, regardless of their skin color. People of color develop melanoma in areas where they get little sun exposure. 60-75% of all melanomas in people of color are found on their hands, soles of the feet, and nail areas.

**The Bottom Line is that All suspicious growths should be biopsied.**

Your dermatologist or trained medical professional will carefully examine your skin. They may use a lighted magnifying device called a dermatoscope to better see your skin. Any growth that looks suspicious should be biopsied. This involves removing a sample of your skin under local anesthesia. A skin biopsy is a fast, safe, and usually heals with minimal scarring.

To diagnose a Melanoma, your dermatologist or trained medical professional can perform a skin biopsy under local anesthesia at the time of your office visit. This is the only way to confirm the diagnosis of skin cancer. A skin biopsy procedure is fast, safe, and usually heals with minimal scarring.

Your skin biopsy specimen is sent to a pathology laboratory for processing and examination under a microscope by a pathologist. A pathology report is usually available within 7 days. Your dermatologist or trained medical professional will discuss your pathology report with you at the time of your next doctor’s visit. If a skin cancer diagnosis is found on your pathology report, treatment options will be discussed with you. Remember, if a Melanoma is diagnosed early, it can be cured 100% of the time.

A skin biopsy is covered by Medicare, Medicaid, and other insurance carriers. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TREATMENT OPTIONS FOR MELANOMA

Treatment for Melanoma depends on its size, depth, and location. Melanoma that has NOT penetrated below the surface of the skin is known as “melanoma in situ” or Stage 0. These tumors are usually excised with up to 1.0 cm margins and have a 100% cure rate.

Melanoma that has penetrated through the top layer of skin, known as the epidermis into the underlying dermis, is considered Stage I. These lesions carry a good prognosis with wide surgical excision with 1 cm or larger margins.

The majority of Melanomas are treated by simple excision with no need for further cancer treatment needed. Mohs surgery is currently being evaluated for Melanoma treatment.

If the Melanoma has penetrated through the epidermis more than 0.8 mm (Breslow’s level) into the dermis, the tumor is classified as a Stage II. At this point, patients are usually referred to a specialty Melanoma Clinic for a sentinel node biopsy and wide surgical excision. If the lesion extends into the sentinel node, it is reclassified as Stage III. If the tumor spreads beyond the lymph nodes to other parts of the body it is classified as Stage IV. Each of these stages carries a less favorable prognosis.

Melanoma treatment is covered by Medicare, Medicaid, and other insurance carriers. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

TREATMENT FOR ADVANCED MELANOMA

When the Melanoma spreads into the lymph nodes (Stage III) or to more distant parts of the body (Stage IV), the Melanoma is considered advanced and additional treatments are required. These treatments are covered by Medicare, Medicaid, and other insurance carriers. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

IMMUNOTHERAPIES FOR ADVANCED MELANOMA

Medications that boost the immune system are known as immunotherapy drugs. These include:

Pembrolizumab (KeytrudaTM) [infused intravenously for Stage IIB, and Stage
IIC after melanoma surgery to prevent tumor progression; this therapy
has been very promising]

Pembrolizumab (KeytrudaTM) [infused intravenously for Stage III and
Stage IV patients]

Ipilimumab (YervoyTM) [infused intravenously for Stage III and IV patients]

Nivolumab (OpdivoTM) [infused intravenously for Stage III and Stage IV
patients]

Nivolumamb-ipilimumab combination [infused intravenously for Stage IV
patients]

Talimogene laherparepvec or T-VEC (ImlygicTM) injected into the tumor for
Stage III and Stage IV patients

Earlier immunotherapies were the first to be FDA-approved but are not as helpful as the newer therapies listed above.

Interferon alfa-2b (Intron ATM) [infused intravenously or injected
subcutaneously or intramuscularly for high-risk Stage II and Stage III
patients]

Pegylated interferon alfa-2b (PegintronTM, SylatronTM)

Interleukin-2 (ProleukinTM/ aldesleukin) [infused intravenously for Stage IV patients.]

TARGETED DRUG THERAPY FOR ADVANCED MELANOMA

New targeted therapies for advanced melanoma are all taken by mouth.
They target a defective, cancer-producing version of the gene called BRAF.
About half of Melanoma patients have this mutant gene. Only patients with the mutant gene will benefit from Targeted Drug Therapy.

Targeted oral drug medications for Melanoma include:

Nivolumab (OpdivoTM) and ipilimumab (YervoyTM) intravenously followed by
the oral drugs, dabrafebub (TafinlarTM) and trametinib (MekinistTM)
This combination is superior to other drug combinations for patients with
advanced BRAF V600 metastatic melanoma. The results have been very
hopeful.

Dabrafenib (TafinlarTM)

Trametinib (MekinistTM)

Combination of Dabrafenib and Trametinib for Stage III and IV patients
Vemurafenib (ZelborafTM), Cobimetinib-(CotellicTM)-vemurafenib combination for Stage IV patients

Encorafenic-binimetinib (BraftoviTM-MektoviTM) for Stage IV patients

Atezolizumab (TecentriqTM)-cobimetinib (CotellicTM)-vemurafenib
(ZelborafTM), combination for patients with BRAF V600 mutation-positive
melanoma

These treatments are covered by Medicare, Medicaid, and other insurance carriers. If you have a second insurance policy (“secondary insurance”), this will usually cover your co-payment.

RADIATION THERAPY FOR ADVANCED MELANOMA

Early studies show that experimental radiation therapy with some medications may be beneficial.

SUN SAFETY STRATEGIES FOR PREVENTING SKIN CANCER

While pre-cancerous growths and skin cancer can usually be successfully treated, the best strategy is to prevent them in the first place.
SkinCancerAwareness.com recommends the following:

(1) Choose your parents wisely as a family history of skin cancer puts you at increased risk for skin cancer. Obviously, this is facetious.

(2) Avoid sunburns

(3) Cover up with clothing; wear a broad-rim hat for sun protection

(4) Avoid tanning and never use a tanning bed. Get a spray tan if you must have a tanned look.

(5) Stay in the shade when outdoors or bring an umbrella/ sunbrella

(6) Use a sunscreen preferably with a Sun Protection Facor (SPF) of 30 or higher about 1-2 hours before you go outside. Reapply sunscreen every 2 hours if you are swimming or have excessive sweating.

(7) Examine your skin once a month when showering. You may need to get a partner to examine areas that you cannot personally see on yourself such as your scalp, back of neck, back, buttocks, and posterior thighs.

(8) Make an appointment regularly for a skin examination by a dermatologist or other trained medical professional