DID YOU GROW UP IN A SUNNY CLIMATE?
Do you have fair skin? Have you had a lot of sunburns in your life? Did you ever make a habit of laying out in the sun or using tanning beds? Do you have a family history of skin cancer? If you answered yes to any of these questions, you should be aware of how skin cancer presents and keep an eye out for concerning lesions on your own skin. And this is coming from a fair-skinned semi-red-head who has had quite a few sunburns in his life. As a dermatologist, I regret some of those decisions I made in my earlier years and want to educate you on how to actively avoid sun damaged skin and skin cancer.
SUN DAMAGE MANIFESTS IN A FEW DIFFERENT WAYS
If you have had a lot of sun in your life and you now have numerous freckles, wrinkles, or mottled red or brown pigmentation in sun-exposed areas (especially forehead, cheeks, and sides of the neck), you already have evidence of sun damaged skin. Sun damage causes mutations in the skin cells and often leads to pre-cancers, which are persistent scaly spots. The most common areas for these pre-cancers are the forehead, temples, cheeks, nose, ears, forearms, and backs of the hands. The rate of progression from pre-cancer to skin cancer is quite low for each individual spot. However, that risk is additive. What I mean is that, if you have one pre-cancer, the chance that it progresses to skin cancer in the next year is less than 1%. If you have numerous pre-cancers, though, that risk adds up and can be sizeable.
TREATMENT OPTIONS FOR sun damaged skin
CRYOTHERAPY
The most common treatment for pre-cancers is cryotherapy or freezing them with liquid nitrogen (if you’ve seen a dermatologist, you know what I’m talking about!). While you might think we dermatologists enjoy spraying this stuff, I can assure you that I feel your pain. I’ve had a couple of pre-cancers myself and can attest that liquid nitrogen on the skin is painfully cold! I would think of cryotherapy as a spot treatment similar to pulling weeds. You see a weed and you pull it. The downside to this is that there are weeds that are starting to grow under the surface and you don’t get those because you can’t see or feel them yet. For patients who have numerous pre-cancers or a larger field of sun damage, we often use what we call field therapies. These are more similar to roundup, where you spray the whole area and get both the ones you can appreciate above the surface as well as the ones in the background that are yet to emerge. The main field therapies we use are fluorouracil cream, photodynamic therapy, and chemical peels.
FLUOROURACIL CREAM
Fluorouracil is chemotherapy that stops cancer cells from dividing so quickly. We use it as a cream, so you do not have to worry about systemic side effects of chemotherapy like hair loss, nausea, etc. The side effects of this cream are almost always limited to the skin. I have my patients apply this cream to the areas with precancers twice daily for 2-3 weeks. After using it for about a week, you’ll notice that it’s making certain spots red and irritated. These are the precancers being targeted. By the end of the course, you should look “spotty” as it finds the precancers and leaves the normal skin unaffected. This can be irritating and, the more skin you apply it to, the more irritating the treatment will be. I often recommend treating smaller areas at a time to make it more tolerable. This cream is extremely effective. The main upside to this treatment is that it gives the patient control over their treatment and offers an option that you can do at home, rather than having to come into the clinic to have the precancers treated.
PHOTODYNAMIC THERAPY
This is what your dermatologist may refer to as “blue light” or “red light.” Again, the point is to preferentially damage precancer cells while leaving normal skin cells spared. We do this by applying a sensitizing substance called levulinic acid. This preferentially soaks into the rapidly dividing precancer cells. Then, when you sit under the blue or red light, the levulinic acid is activated by the light and damages the precancers. The main upside to this treatment is that it is more convenient for patients who would like an in-office treatment and don’t want to have to apply a cream for 2-3 weeks at a time. The downside is that it can be uncomfortable and even sting while you sit under the light and you are more sensitive to sunburn for the next 48 hours.
CHEMICAL PEELS
We use a deeper chemical peel when we are treating precancers. A superficial chemical peel (such as we would use for sunspots and freckles) wouldn’t go deep enough to help in this situation. We use trichloroacetic acid for this peel and this stings quite a bit for about 10 minutes while it does its job on the skin. After 10 minutes or so, the pain is gone and you walk out of the clinic totally comfortable. The peeling starts a few days later and most people peel for a week or more. The upside to this treatment is that it can also improve the appearance of fine lines and wrinkles. The downside is the discomfort during the procedure and the downtime from peeling and redness after the treatment.
Dr. Innes is a board-certified dermatologist in Layton, Utah. If you feel you have sun damaged skin and would like a skin check, call 801-773-4865 or schedule online by going to tannerclinic.com/appointments. You can learn more at https://tannerclinic.com/dermatology or on social media (Follow @thefrugalderm on Facebook, Instagram, and Youtube).
