Last May, Tawny Willoughby rocked facebook and news media with a selfie of her skin cancer treatment. You may have already seen her photo.
Many of my patients have asked me what was going on in this photo. So, I thought I would give a little explanation. I actually contacted Tawny myself, and she graciously responded to confirm details of her treatment. Actually, I see patients who have this treatment every week and her response is very common. In fact, I have been through one of these treatments myself. I dug up some old photos that noone has seen before because that was 2008 and the word “selfie” wasn’t in anyone’s vocabulary. See the photo of my neck and chest.
So here’s the scoop…
What is this treatment and why would we do this to someone? Patients like Tawny and myself can treat a large area of sun-damaged skin to try to bring out and treat any damaged areas that are both visible and not visible to the naked eye. Dermatologists use a number of different chemotherapeutic creams to treat in this way. The most common creams used in this way are Carac, Efudex, 5-flurouracil, imiquimod, Aldara, Zyclara, and Picato. The creams are applied from 2-30 days (depending on which cream) to an area of suspected sun damage. Any spots that are pre-cancerous or cancerous will get red, scabby and crusty as you see in the photos. Yes, all the spots that are red and crusted are AT LEAST precancerous. Following the treatment course, the areas are allowed to heal. It usually does a GREAT JOB and most patients are delighted with the long term result. The skin is smoother, softer, healthier and younger looking once it heals. But YES, IT LOOKS TERRIBLE in the meantime.
Is there another way? Yes! We usually use these creams to treat precancerous spots called actinic keratosis. Some of them are also FDA to treat superficial skin cancers including superficial basal cell carcinoma. Another method to treat precancerous spots is a treatment called photodynamic therapy. With this procedure a patient comes into the office and a liquid called Levulan is applied to the affected area (usually the face or scalp). The Levulan is preferentially absorbed by the abnormal cells while it incubates for 45-90 minutes. Then, the patient sits in front of a blue light for about 15 minutes. There is an interaction between the light and the Levulan solution in the abnormal skin cells that causes death to the abnormal cells. With this treatment, there is less down time. The patient will have what appears to be a decent sunburn that peels for about 7 days. The good news is that the patient is much more presentable than when a patient uses one of the creams. We perform this procedure in the office. It is covered by Medicare and most major insurers now. This procedure also provides an excellent cosmetic outcome.
So, if you are concerned that you have damaged your skin and you would like to consider one of these treatments, we can discuss that in the office. Personally, I have used the cream on my neck and chest years ago as you see above. Plus, I usually do photodynamic therapy on my face once or twice a year.
If you would like to learn more about precancerous actinic keratoses and wonder if you have some, check out this link from the AAD and these images on google or the handout on our medical education page.
Have you personally had one of these treatments? If so, please feel free to share your photos and experience by commenting here on our blog or facebook. Let your story, like Tawny’s, be an inspiration and education for those who are listening.