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Erma L. Benitez, M.D.
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Mature Skin

The most common form of skin cancer is a basal cell carcinoma. It usually appears as a small, shiny bump or pinpoint red bleeding area on the head, face, nose, neck or chest. It's more common in older fair-skinned people with blond or red hair and blue or green eyes. Untreated, these skin cancers can bleed and crust over. They grow slowly and rarely spread to other parts of the body. When treated early, squamous cell and basal cell skin cancers have a 95 percent cure rate.

Malignant Melanoma is a less common but more serious form of skin cancer. This skin cancer usually appears as a dark brown or black mole-like growth with irregular borders and variable colors. Men of the age of 50 are at the highest risk for melanoma, but it can affect anyone of any age. Melanoma is more likely to strike people who had severe childhood sunburns. The most frequent sites for melanoma are the upper back in both men and women, the chest and abdomen in men, and the lower legs of women.

Any change in an existing mole or the rapid appearance of a new mole, could be a sign of melanoma and should be examined immediately by Dr. B. Melanoma can spread to other organs and can be fatal.

Other Growths
Several other skin growths are very common in older individuals. These include:

"Age spots" or "liver spots"
These flat, brown areas are called lentigines. The have nothing to so with the liver - they are caused by the sun and usually appear on the face, hands, back, and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial "fade" creams will not make lentigines disappear, but effective prescription medications and surgical resurfacing treatments are available.

Seborrheic Keratoses - These brown or black raised spots or wart-like growths look like they were stuck on the skin surface. They are not cancerous and are very common in older people. If annoying, they can be easily removed by Dr. B.

Cherry Angiomas - These are harmless, small, bright red raised bumps created by dilated blood vessels. They occur in more than 85 percent of middle-aged and elderly people, usually on the trunk. Electrocautery, laser surgery, or other surgical therapies remove these spots.

Skin Diseases
Some skin diseases more common in older people are shingles (herpes zoster), seborrheic dermatitis, varicose veins, and leg ulcers.

Shingles/Herpes Zoster - Shingles is an infection of a nerve caused by the same virus that causes chicken pox. Early symptoms are localized pain, headache, or fatigue. Shingles can affect people of all ages, but is more common (and painful) in older adults.

The virus attacks a nerve root and follows the course of that nerve, causing a line of painful blisters on the scalp, face, trunk, or extremities. The disease almost always affects one side of the body only and lasts for several weeks. Anti-viral medication can reduce the severity of the attack and reduce the change of lingering pain afterwards.

Shingles can become serious and cause complications. Dr. B should be contacted immediately if shingles is suspected, especially if the condition appears near the eyes, as treatments are most effective if stated within 3 days of onset.

Seborrheic Dermatitis - The signs of seborrheic dermatitis are redness and greasy-looking "scales" on the skin. Areas of the skin with a high concentration of oil glands, such as the scalp, sides of the nose, eyebrows, eyelids, behind the ears and the middle of the chest are usually affected. Seborrheic dermatitis occasionally affects other areas such as the navul, breasts, buttocks and skin folds under the arms.

Seborrheic dermatitis can be successfully treated and may even go away on its own, but it tends to recur. Frequent shampooing and washing are very helpful Dr. B may prescribe topical medications, including low-strength cortisone preparations and special shampoos.

Varicose Veins - These are enlarged leg veins that appear blue and bulging. They are common in older individuals. The vein becomes twisted and swollen when blood returning to the heart against gravity flows back into the veins through a faulty valve. This condition is seldom dangerous. The aching associated with varicose veins can be eased by avoiding standing for long periods, by keeping feet elevated when sitting or lying down and by wearing support hose or elastic bandages. More severe cases can be treated with surgery or radio frequency treatments. Sclerotherapy injections or laser therapy may remove smaller varicose veins, also called "spider veins".

Varicose Ulcers - A backflow of blood (reflux) in the veins may lead to sustained high pressure and can cause ulcers, called varicose ulcers. When a crock or cut occurs in the skin of the leg, it may fail to heal because of poor blood flow. The injury can develop into an ulcer or a sallow wound that may contain pus and become infected. The ulcers may last for months or even years. Special dressings and careful management of the wound may speed healing.

Varicose ulcers often develop at the ankles. They may be accompanied by swelling and red, itchy, scaly skin around the ulcer. Another cause of ulcers on the legs is poor blood flow in the arteries. This condition is associated with medical disorders such as arteriosclerosis, hypertension, diabetes, mellitus, and smoking. There are many other causes of ulcers. If you have an ulcer, see Dr. B.

Bruising (Purpura) - Many seniors complain of "black and blue" marks or bruises, particularly on the arms and legs. These are usually a result of the skin becoming thinner with age and sun damage. Loss of fat and connective tissue weakens the support around blood vessels, making them more susceptible to injury. If you put pressure on the area a bump, sometimes you can prevent the bruise. Bruising sometimes is caused by medications that interfere with blood clotting by certain internal diseases. Bruising in areas always covered by clothing should be evaluated.

Itching - A very common problem with aging skin is itching. Although often associated with dry skin, itching also has other causes. Elderly skin appears to be more sensitive to fabric preservatives, wool, plastics, detergents, bleaches, soaps and other irritants. Certain days may also make the skin itchy. Identifying and limiting exposure to the cause is important. Prolonged itching may lead to lack of sleep and fatigue. Dr. B can often offer some medical remedies for itching if moisturizing alone is ineffective and can perform test to detect internal disorders that cause itching.