Question 5: I have a large brown "freckle" on my nose right where the sunglasses rest on my nose. It is usually just a brown freckle. When I start applying retin A it turns very dark brown and peels. But it doesn't seem to ever go away. It is about ½ cm. in diameter and medium brown. It is almost circular, and it is a solid color. Does this sound like something I need to worry about? Also, I have a "freckle" on my chest that is light to medium brown with an irregular border. Again, it is about ½ cm in diameter. It has an area that is darker on one side. Should I be worried about this? I am Caucasian with regular coloring, brown hair and green eyes. I had a severe, blistering sunburn all over my body at age 15 in Mexico.
Dr. Day: Any new or changing spot should be evaluated by your dermatologist. It may just be a sun spot or a freckle, and there may be simple treatments, but if any treatment or biopsy needs to be done, your dermatologist can evaluate and help guide you through that process.
Question 6: I have a pimple size basal cell spot on my forehead just above my eyebrow. My dermatologist suggests Mohs, which is more expensive to have than just simply cutting it away. Being that there is so little fatty tissue there between my skin and skull wouldn't it make sense to only have it cut away and monitor the area? It seems like an unnecessary additional expense to me. What do you suggest?
Dr. Day: Both are effective and it really becomes a matter of personal choice.
Question 7: I quit using tanning beds about 10 years ago after using them for about 10 years in my 20s and early 30s. Is there a way to undo that damage? Does the skin cancer risk ever go back down, like when a person quits smoking?
Dr. Day: First of all, excellent that you stopped the tanning beds! Exposure to ultraviolet rays, from any source, is cumulative, and creates "micro scars" in the skin. Your skin is always making new cells so some of the damage is naturally reversed over time just by stopping the "insult."
Beyond that, resurfacing procedures, such as with the fractional CO2 are effective in accelerating that process and promoting healthier skin cells. Chemical peels are also effective in the right candidate. These treatments have come a very long way and can even be used on areas other than the face, but should be performed by trained aesthetic physicians such as dermatologists or plastic surgeons in order to have the best results and the safest treatments. Topicals are also helpful. I like retinoids, vitamin C and nicacinamide as well as various peptides.
Question 8: I was diagnosed with basal cell carcinoma last October. They recommended Mohs surgery. I am not insured, and am still paying off the bill for the diagnosis and therefore, cannot afford the surgery. Is there another alternative to remove the cancer? A cream? A medical school that uses volunteers as patients?
Dr. Day: Depending on the type of basal cell carcinoma, there are different treatment options you can try. If it is a superficial basal cell carcinoma, you can use aldara, which is a cream that helps your own immune system treat the skin cancer. After the treatment course, you should have another biopsy to make sure its completely cleared.