SKIN CANCER

Basal Cell Carcinoma

Squamous Cell Carcinoma

(Basal cell and squamous cell carcinomas)

Skin cancer is by far the most prevalent malignancy in the United States, with more than 800,000 cases a year. The two most common forms are basal cell carninoma, which arises in the lowest part of the epidermis or surface layer of the skin and squamous cells carcinoma, which originates in the cells that make up the skins outer surface. Both types are readily curable if detected early and treated properly.

These two cancers are heralded by growths or skin sores that do not heal. A basal cell cancer is typically an irregular shape. It may appear as a flat  spot or a firm lump that is scaly and crusty or smooth and shiny. A squamous cell cancer also appears as a scaly or crusty patch that may bleed occasionally.

Squamous cell cancers develop most often on the rim of the ear, the mouth and scalps of bald men. People with fair skin, red hair and blue eyes are most vulnarable to both cancer types.

Excessive exposure to the sun's ultraviolet rays is the most common cause of skin cancer. Occupational exposure to coal tar, pitch, creosote, arsenic and radium also increase the risk.

Diagnostic Studies And Procedures

A dermatologist often suspects skin cancer from the appearance of a sore or other lesion but a skin biopsy is essential to make a definitive diagnosis and to determine the type.

These  skin cancers rarely metastasize to distant parts of the body but the squamous cell type may invade nearby organs. Thus, MRI or a CT scan may be ordered if the cancer is near the eyes or other pathway to the brain.

Medical Treatments

Removal is the usual treatment for skin cancer, although radiation is sometimes used when surgery is not possible. Chemotherapy with topical 5-fluorouracil may also be considered.

There are several different surgical methods; the choice depends on the cancer appearance, size, location and type. A small surface cancer can be treated with curettage - the scraping away of the cancerous tissue with a sharp surgical instrument. Bleeding is stopped with electrodesiccation, the use of an electric needle that also cauterizes a zone of normal tissue surrounding the lesion, reducing the likelihood of recurrence.

Dilation Curettage Set

Cryosurgery is the use of liquid nitrogen spray or a device called a cryoprobe to freeze the cancerous tissue and destroy the malignant cells with minimal scarring. Laser surgery can also be used to pinpoint and kill certain types of skin cancer cells

Surgical excision involves removing the growth along with a margin of normal tissue, then closing the wound with stitches or skin clips. A skin graft and plastic surgery may be needed.

In the Mohs procedure, layers of tissue are cut away in an expending circle around the cancer and each layer is examnied microscopically to determine the extent of malignant cells. Successive layers are removed until only normal tissue is found. Plastic surgery may be needed as a follow-up procedure.

Alternative Therapies

Meditation, hypnosis and visualization can be helpful in controlling pain and promoting healing. A diet that includes foods rich in antioxidants - vitamins C, E and A (or beta carotine, its precursor), can help protect against cancer. Vitamin E oil applied to the excised areas may hasten healing and reduce scarring but check with your doctor before applying this (or anything else) to the wound.

Self-Treatment

While self-treatment cannot cure skin cancer, it is the key to prevention and avoiding recurrences, because most skin cancers are related to damage from the sun's ultraviolet rays, you should minimize your exposure. Avoid being outside during the peak sunlight hours from 10am to 2pm. If you must be out then, wear a hat with a wide brim and loose fitting but tightly woven clothing that covers most exposed skin. Use a sunscreen with a sun protection factor (SPF) of at least 15 on remaining exposed skin; reapply it often. For a baby, ask your doctor to recommend a safe sunscreen and make sure that she wears a sun hat and protective clothing.

Remember  that sand, snow and water reflect the sun's rays and thus magnify their potential harm to skin. Tanning booths and sun lamps can also give off harmful ultraviolet rays..

Other Causes of Skin Lesions

Moles, warts and other benign skin growths and discolorations sometimes resemble skin cancer. Skin disorders such as psoriasis and dermatitis can be confused with malignant lesions.

SKIN SELF-EXAMINATION

Know the warning signs of skin cancer and examine your skin thoroughly and regularly in a brightly lit room. Examine your body front and back, then the right and left sides with arms raised. Check your forearms, upper underarms and palms carefully. Examine the feet, including the spaces between toes and the soles. Look at the back of the neck and the scalp. Part the hair and lift it for a closer look. Check the lower back and buttocks. See a doctor promptly if you note the appearance of:

> Any new skin growth that does not disappear in four to six weeks.

> Any lesion that grows and turns translucent, brown, black or multicolored.

> Any mole, birthmark or beauty mark that increases in size changes color or texture or develops an irregular outline.

> Any open sore or wound that does not heal for more than four weeks or heals and then recurs.

> Any skin spot or growth that continues to itch, hurt, crust over, form a scab, erode or bleed for several weeks.

HEART ATTACK

Heart Attack Symptoms and Warning Signs

Cold weather apparently can increase the risk of heart

IMPORTANT!!

IF U THINK YOU ARE HAVING A HEART ATTACK, PLEASE CALL 911 OR YOUR EMERGENCY MEDICAL SYSTEM  IMMEDIATELY.


Some heart attacks are sudden and intense ~ the 'movie heart attack', where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort feeling. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:  

Symptoms of a possible heart attack include chest pain

 
CHEST DISCOMFORT: Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.    

DISCOMFORT IN OTHER AREAS OF THE UPPER BODY: Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

SHORTNESS OF BREATH: May occur with or without chest discomfort.  

OTHER SIGNS: These may include breaking out in a cold sweat, nausea or lighth eadedness

Heart Attacks and Drinking Warm Water

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

If you or someone you're with has chest discomfort, especially with one or more of the other signs, don't wait longer than a few minutes (no more than 5) before calling for help. Call 911
  or your emergency response number
... and get to a hospital right away.

Calling 911 or your emergency response number is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive ~ up to an hour sooner than if someone gets to the hospital by car. The staff are also trained to revive someone whose heart has stopped. You'll also get treated faster in the hospital if you come by ambulance.

HOW DO I KNOW IF A HEART ATTACK HAS OCCURED?

A doctor who's studied the results of several tests must diagnose a heart attack. The doctor will

*review the patient's complete medical history.

*give a physical examination.

*use an electrocardiogram (e-lek"tro-KAR'de-o-gram) (ECG or EKG) to discover any abnormalities caused by damage to the heart. An ECG is a medical device that makes a graphical record of the heart's electrical activity.


*sometimes use a blood test to detect abnormal levels of certain enzymes in the bloodstream.
Blood tests confirm (or refute) suspicions raised in the early stages of evaluation that may occur in an emergency room, intensive care unit or urgent care setting. These tests are sometimes called heart damage markers or cardiac enzymes.

Related AHA publications:

• "What Are the Warning Signs of Heart Attack?" in Answers By Heart kit (also in Spanish kit)
• "What Is a Heart Attack?" in Answers By Heart kit
• AHA Heart Attack Web Site

Related AHA Scientific Statements:
Myocardial Infarction

AYURVEDA

This ancient healing system from India stresses the mind/body relationship in the maintenance of good health. As in other Asian medical practices, a balance of vital energy, in the case, prana, is considered the key. The system is based on balancing three basic life forces or doshas-vata, responsible for all movement in the body, pitta, which controls digestion and energy production and kapha, responsible for all movemont in the body's structure and stability. Illness occurs when any of the doshas is out of sync; individuals must know their dominant doshas and follow a diet and lifestyle that keeps it balanced with the others.

ORIGINS

Ayurveda, meaning the 'science of life and longevity' in Sanskrit, is believed to be about 5,000 years old, predating all other medical systems. The two classic Ayurveda text-books are more than 2,000 years old. Charaka Samhita, named for the person who was the ayurvedic counterpart of Hippocrates, outlines the principles of health maintenance and treatment of disease and Sushruta Samhita describes elaborate surgical procedures, including reconstructive plastic surgery, gallbladder removal and other operations that most people consider modern.

Ayurvedic medicine spread with the Hindu culture to Indonesia, Tibet and eventually to the West, where some of its principles were picked up by the ancient Greek physicians. As Buddhism developed, this healing system was carried to China and other Asian countries.

During the 1800s, the British banned all ayurveddic schools in India, replacing them with Western medical schools. For the next century, ayurvedic medicine was relegated to folk practices in rural areas. When India regained its independence in 1947, ayurvedic schools were again legalized. Today, there are 100 ayurvedic schools in India, equal in number to the Western ones and many Indian physicians incorporate both styles of medicine into their practices.

In recent years, Ayurveda has spread to the United States. Major clinics have been established in Lancester, Massachusetts and Albuquerque, New Mexico.

PRACTITIONERS

In India, Ayurvedic practitioners must undergo five to six years of training in a traditional ayurvedic medical school before they can treat patients. In the United States, this training is abbreviated into a short course of several months at an ayurvedic institute. Whichever training they have received, ayurvedic physicians are not licensed to practice medicine here, unless they are trained also in another discipline, such as traditional medicine, osteopathy or chiropractic.

WHEN IT IS USED

Unlike Western medicine, which comes into play when illness strikes, Ayurveda is incorporated into a person's lifestyle. It governs all aspects of life, such as diet, exercise and sexual practices. An ayurveda practitioner is consulted only to identify and correct an imbalance among the three life forces. At ayurveda clinics in the United States, patients are usually treated by both a Western and an ayurvedic physician.

HOW IT WORKS

Ayurvedic philosophy hold that each person is born with a particular ratio of doshas, with one dominating. This dominant dosha determines personality type and also influences one's susceptibility to certain illness. For example, pitta people tend to have fiery dispositions and are prone to developing high blood pressure and digestive disorders, so a pitta-related disease may be treated with a bland diet and numerous herbal remedies. Because the mind is seen as an intergral force in maintaining health and overcoming illness, meditation or yoga may also be employed.

WHAT TO EXPECT

An ayurvedic doctor begins by assessing the patient's dosha pattern. Pulses play a critical role in this assessment - a pratitioner feels pulse throughout the body, looking for dosha imbalances as reflected in the nature of a pulse. Seven types of body tissue - plasma, red blood cells, muscle, fat, bone, nerve and reproductive tissue - are also examined.

Ayurveda physicians do not focus on a specific disease or an organ system, but instead treat the entire body and mind. Purification to rid the body of toxins is an important part of treatment; methods may include sweat baths, enemas, nasal washes, bloodletting and oild massages. The practitioner will also recommend a specific diet, meditation or yoga routine and herbal remedies.

PRECAUTIONS

BEFORE AGREEING TO AYURVEDIC TREATMENTS, ASK ABOUT COSTS AND CANCELLATION POLICIES. SOME CLINICS ASK FOR ADVANCE PAYMENT AND REQUIRE TWO WEEK'S NOTICE OF CANCELLATION TO QUALIFY FOR A REFUND.