Your Skin Cancer Questions Answered

May 12, 2010 — -- Today on live television, Sam Champion had a small procedure performed to remove a small spat of skin cancer. The operation, which you can see by clicking here, sparked a lot of questions about skin cancer.

We invited you to send in your questions and Dr. Doris Day, a New York dermatologist, kindly volunteered to answer them for you.

Read her answers below, and then find out more about skin cancer by clicking here to go to our Skin Cancer Resource page.

Question 1: I have had a few precancerous spots surgically removed by my dermatologist. I noticed on the segment today that Sam's doctor waited to review the slides before stitching him up. My doctor stitched me up right away. Do I need to be alarmed at that?

Dr. Day: There are different methods for removing skin cancer. Both are correct. With Mohs surgery in particular, the patient waits while the specimen is processed, but in other cases, when the site is stitched up right away, it is still sent to the lab and when the report comes back, the doctor will let you know if the area is completely clear or if more work needs to be done at the site.

Question 2: What if you can see suspicious spots, but don't do anything. How long can you let these go? I am 56, very fair skinned and had bad sunburns as a teen. Each spot is about the size of a pea or smaller, raised and grayish-whitish on the top. I have two spots not near each other that I have had for about two years.

Dr. Day: Basal cell carcinoma and squamous cell carcinoma are generally slow-growing and remain local. Melanoma is more problematic and can spread more quickly. Any new or changing lesions should be evaluated by your dermatologist. There is no amount of time that any particular lesion obeys, but the sooner they are evaluated and treated the better the outcome. Sometimes the dermatologist may opt to observe and follow lesions over time, or they may reassure you that the lesions are not precancerous and no further treatment is necessary.

Question 3: I know melanoma is the most serious of skin cancers. I'm looking for some reassurance that if treated early, it can be fine. My husband had surgery for melanoma six years ago at age 27. It was not in the lymph nodes at that time. I know he should get regular checkups and watch for any signs, but I worry because I constantly hear that it is so deadly. That is what Sam said on the show today. Can people with melanoma go on to live long and cancer-free lives?

Dr. Day: Melanoma is the highest risk of the skin cancers, but when caught early it has a better than 96 percent cure rate, and those people go on to have full, healthy, melanoma-free lives. They do need to have regular skin cancer screenings, as well as regular eye exams, since melanoma can also occur in the eyes. Also, all first degree relatives (siblings and children) need to be screened regularly since their risk is increased as well.

Question 4: What are the best ingredients to look for in a sunscreen to protect from UVA and UVB?

Dr. Day: Avobenzone, zinc oxide and titanium dioxide. Other ingredients are mexoryl, helioplex and avotriplex. You should also wear a physical protection hat and sun protective clothing, and stay in the shade when possible. Look for an SPF of 30 or higher, and one with broad-spectrum UVA/UVB coverage on the label.

Read more about sunscreen and its ingredients by clicking here.

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.

For the other types of basal cell carcinoma, you can have a procedure called curettage and dessication -- this is the simplest and often least-expensive treatment. There is often a slightly larger scar from this procedure. The other method is a simple excision where the lesion is removed with a margin of normal skin and sent to the lab for evaluation. I Moh's micrographic surgery is usually reserved for recurrent basal cell carcinoma on the body or on the face.

Question 9: I live with my two children and mother. We are an African-American family and our skin color rages from a light reddish brown to dark brown tone. My family's skin is sensitive. My mother and youngest son, 12, have eczema. Which OTC product would you recommend to provide us with protection from the sun and not to irritate our skin at the same time?

Dr. Day: I would start with sun avoidance where possible -- staying in the shade, wearing hats and clothing with UV protection built in. One brand I like for sensitive skin is Mustela. They make products for sensitive skin, mostly for children but good for adults as well. LaRoche Possay also has products that contain mexoryl which are great for sun protection and they also have a line for sensitive skin that has worked well for my patients with eczema.