How We Diagnose and Treat Skin Cancer in 2019

Skin cancer remains one of the most prevalent cancers in the US population with one in five Americans expected to be diagnosed with the disease by age 70. Actinic keratoses, the most common precancers, affects 58 million Americans while invasive melanoma, the most deadly form of skin cancer, is expected to kill 7,230 Americans in 2019. In all cases, early detection is the most important factor for survival. Professional skin screenings and annual exams can be a question of life or death.

What Is Different At Kline Dermatology

SCALE AND SCOPE: The Kline Dermatology practice has over three decades of expertise and has treated over 8,500 melanoma patients and tens of thousands of skin cancer patients.

TECHNOLOGY: At our practice, we are always advancing our techniques to provide better, more accurate and less invasive diagnostic and treatment methods for patients be that through state-of-the-art tools that allow us to perform skin pathology without cutting or tracking new lesions with serial photography.

Here Is What Skin Cancer Diagnosis And Treatment Looks Like At Our Dermatology Practice In 2019:

1. Every skin exam at Kline Dermatology begins with a high tech digital imaging scan with DermSpectra to record a baseline exam. We know that digital imaging is the future of diagnosis because it allows us to track and compare critical skin changes and, most importantly, to find new lesions over time with an accuracy that is unmatched by the human eye.

2. Every pigmented lesion is then assessed through a dermascope – sometimes twice over if someone appears to be higher risk.

3. Any lesions that we think merit a closer look, are assessed using an FDA-approved reflectance confocal microscope (RCM) machine called the VIVASCOPE, which has been termed the modern ‘biopsy without cutting’. This highly technical machinery allows the diagnosis process to not only be less painful but (in most cases) result in less scarring when used by an expert. The machine allows the dermatologist to see an area that is 8x8mm in diameter, an area of examination that has never been possible to do without inflicting a large scar on a potentially cosmetically sensitive area or by performing multiple biopsies.

4. For patients that have many pre-cancers or if a patient makes a lot of basal cell carcinomas, then our practice recommends utilizing one, two or all four of the following treatments that are available in-office:

• Blue light therapy, also known as photodynamic therapy (PDT) which selectively removes pre-cancers from an entire area of skin.

• Imiquimod or fluorouracil medications (usually used aggressively which can cause skin blistering) are used gently and slowly applied at our practice so that skin cancer and pre-cancers in a surrounding skin area (i.e. that have yet to fully form) will slowly resolve and whittle away

• Red Light Photodynamic Therapy – which has been used globally and extensively to eliminate skin cancer without surgery using a safe topical chemical (Levulan) and red light.

• Niacinamide, an oral pill that is used for acne and rosacea that has been shown to reduce the rate of some skin cancer formation.

5. At Kline Dermatology, we place a special priority on how we perform and read biopsies to make sure they are as thorough as possible. At our practice is it particularly important to read a biopsy at several levels to ensure specimen accuracy and to minimize sampling errors.

Why Does Technology Matter When It Comes To Diagnosing And Treating Skin Cancer?

• Higher-resolution digital images enable us to pinpoint new spots that might not be visible to the naked eye and/or get a better picture of otherwise ‘benign’-looking spots that may turn out to be early melanomas that can easily be removed in-office without further health risk to a patient.

• The level of technical accuracy that we bring to our patients also enables us to minimize the need for unnecessary biopsies simply because a patient is (understandably) nervous if they see changes in the skin. Biopsies are still an invasive, surgical procedure and leave scars, even when done by an expert. It’s always best to minimize this if possible.

Skin Cancer Prevention Advice From The Skin Cancer Experts

Even with the best technology and expertise at our disposal, we always stress that the most important part of diagnosing and treating skin cancer is prevention. Beyond the usual (and critical) recommendations outlined by your dermatologist and the American Academy of Dermatology (AAD) on sunscreen use and sun exposure, here are some additional points that we share with all of our patients:

• Not all sunscreens are created equal and sometimes patient preference makes for more frequent use and so can prove better than even “the best sunscreens”. In general, however, we recommend the purchase of a sunscreen made in Spain, ISDIN’s Eryfotona Actinica, a formula has been shown to therapeutically reduce pre-cancers and alter DNA abnormalities that lead to skin cancer

• All patients in the office are also asked to use Heliocare during prolonged sun exposure periods to reduce DNA damage. While this is a cosmeceutical, it was developed by the head of the Madrid Skin Cancer Clinic and handed over to a team that chose to sell it over-the-counter rather than as a prescription.

• For those with long-term chronic exposure, we always recommend sun protective clothing in addition to other sun protective methods. Look for products that are UPF 50+.

• Drivers, golfers and those that fly at high altitudes are particularly susceptible to skin cancer and sun damage and so need to protect their skin with hats and sunscreen.