Carlson Laser Aesthetics

Clients rely on skin health professionals to answer their questions accurately and honestly. Clinical estheticians are often faced with treating more than hyperpigmentation, acne, rosacea and visible aging because additional dermatological irregularities and curiosities are commonly brought to their attention. Although many cutaneous concerns should be treated by a physician, being able to identify various lesions can be helpful to the esthetician in developing treatment plans and determining when to refer to a physician for suspicious abnormalities. There is often a fine line between conditions that are dangerous and those that are merely cosmetically bothersome—understanding the difference is crucial to healthy, happy clients.

As the protective barrier for the body, the skin is constantly exposed to various offenders. The amount of stress placed on this vital organ often results in various physiological changes. The pathway in which these conditions are formed—and whether or not they spread and damage surrounding tissue—determines the level of threat they are to the overall health of the client. Noncancerous skin growths, such as seborrheic keratoses, sebaceous hyperplasias, cherry hemangiomas and verrucae planae (flat warts) are examples of skin concerns that are visually unappealing but not considered harmful. Cancerous lesions such as basal cell carcinomas, squamous cell carcinomas and melanomas, as well as those lesions with the potential of progressing into skin cancer, such as actinic keratoses, can be life-threatening in some circumstances.

Cause for concern

Skin cancer is the most common type of cancer in the United States, and its various presentations can make it difficult to identify without proper physician examination. Cancerous lesions invade and destroy surrounding normal skin cells and tissues and, although prevention by using daily sunscreen and antioxidants is best, appropriate treatment is crucial once any type of skin cancer develops. Any and all questionable skin growths should be examined by a dermatologist before topical treatment is applied.

Actinic keratoses (AK). These are abnormal growths resulting from overexposure to UV rays. AK are considered pre-cancerous and, if left untreated, they can develop into squamous cell carcinomas (SCC). The appearance of AKs is rough and scaly, and they can be tan, red, pink or flesh-colored. Studies show that up to 60% of SCC begins as AK.¹ They can be treated by physicians in several ways, including cryosurgery (freezing of the lesions), curettage (scraping of abnormal surface tissue), 5-aminolevulenic acid photodynamic therapy (PDT), surgical excision and topical destructive cream medications. Clinical studies have also shown chemical peels, such as Jessner’s solutions and trichloroacetic acids (TCA) preparations, to be effective treatments as well.²

Basal cell carcinoma (BCC). They can be as simple as a tiny, clear, pearly or flesh-colored bump or may be more apparent, such as an open sore or shiny red, pink, brown or black lesion that can be mistaken for a mole. Although BCC is considered the least threatening form of skin cancer because it grows the slowest and is the least likely to metastasize, or spread, it can be incredibly locally destructive or disfiguring.

Squamous cell carcinoma (SCC). This has a red, rough or flaky appearance and often causes thickening of the skin. Ulcerations may occur and cause a chronic open sore. SCC primarily affects the superficial layers of the epidermis and approximately 97% of SCC does not spread; however, if metastasis does occur, scarring, disfigurement or death is possible.³

Melanoma. This is a dark-colored cancer of the skin’s pigment-producing cells, known as melanocytes. This is the most dangerous form of skin cancer due to its ability to metastasize and spread to lymph nodes, blood, distant tissues and organ systems. If detected and treated early while it is still thin, melanoma can typically be cured. Once it spreads, melanoma can be extremely difficult to treat and often leads to death. If a mole presents any of these characteristics, or if it changes in size, shape, color or texture, it should be emphasized to the client to have it evaluated by a dermatologist in the near future.

Cosmetic annoyances

The following skin concerns are completely benign. Although they will not cause harm, many require special treatment considerations. Many of these harmless lesions look similar to skin cancers; therefore, it is important that nonphysician skin care professionals have their clients properly diagnosed by a knowledgeable physician.

Moles. These are a completely normal part of human anatomy, and most adults will have 10–40 moles.⁴ Although they can be flesh-colored, the majority are dark in color because of the involvement of pigmented melanocytes in their development. Moles occur when multiple melanocytes grow bunched together. Although many moles are normal and harmless, clients prone to the development of moles are also more prone to skin cancer. Any mole that changes in size, color or shape should be examined to ensure it is not cancerous. If removal is desired—even if just for cosmetic reasons—moles should be surgically excised and examined by a pathologist.

Seborrheic keratoses (SK). These are typically dark-colored lesions that appear to be stuck on the surface of the skin. They are waxlike and often have a rough, uneven texture. SK are considered to be the most common noncancerous dermatological concern. They can be found anywhere on the body, but are more commonly found in sun-exposed areas. SK are not contagious and although their exact cause is unknown, they seem to be linked to heredity. Studies show that, although patients with SK can develop skin cancer and SK can look strikingly similar to skin cancer, this type of keratosis does not progress into a cancerous lesion.⁵ SK should be removed by a physician using electrocautery (burning the lesion with electric currents), cryosurgery or curettage. Treatment with chemical peels or microdermabrasion will not cause harm; however, complete clearance of SK is not typically possible with these methods of treatment.

Article Written By: Jennifer Linder, MD