Pseudomelanoma AKA Recurrent Nevus

Pseudomelanoma (also known as a “Recurrent nevus”) is a cutaneous condition in which melantic skin lesions clinically resemble a superficial spreading melanoma at the site of a recent shave removal of a melanocytic nevus.

Problem with the Recurrent Nevus

The melanocytes left behind in the wound regrows in an abnormal pattern. Rather than the even and regular lace like network, the pigments tends to grow in streaks of varying width within the scar. This is often accompanied by scarring, inflammation, and blood vessel changes - giving both the clinical and histologic impression of a melanoma or a severe dysplastic nevus. When the patient is reexamined years later without the assistance of the original biopsy report, the physician will often require the removal of the scar with the recurrent nevus to assure that a melanoma is not missed.

Saucerization biopsy

Also known as “scoop”, “scallop”, or “shave” excisional biopsy, or “shave” excision. A trend has occurred in dermatology over the last 10 years with the advocacy of a deep shave excision of a pigmented lesion. An author published the result of this method and advocated it as better than standard excision and less time consuming. The added economic benefit is that many surgeons bill the procedure as an excision, rather than a shave biopsy.

This save the added time for hemostasis, instruments, and suture cost. The great disadvantage, seen years later is the numerous scallop scars, and a very difficult to deal with lesions called a “recurrent melanocytic nevus”. What has happened is that many “shave” excisions does not adequately penetrate the dermis or subcutanous fat enough to include the entire melanocytic lesion. Residual melanocytes regrow into the scar. The combination of scarring, inflammation, blood vessels, and atypical pigmented streaks seen in these recurrent nevus gives the perfect dermatoscopic picture of a melanoma.

When a second physicians re-examine the patient, he or she has no choice but to recommend the reexcision of the scar. If one does not have access to the original pathology report, it is impossible to tell a recurring nevus from a severely dysplastic nevus or a melanoma. As the procedure is widely practiced, it is not unusual to see a patient with dozens of scallop scars, with as many as 20% of the scar showing residual pigmentation. The second issue with the shave excision is fat herniation, iatrogenic anetoderma, and hypertrophic scarring. As the deep shave excision either completely remove the full thickness of the dermis or greatly diminishing the dermal thickness, subcutanous fat can herniate outward or pucker the skin out in an unattractive way. In areas prone to friction, this can result in pain, itching, or hypertrophic scarring.

See also

* Ballon cell nevus ; Balloon cell nevi are a cutaneous condition characterized histologically by large, pale, polyhedral balloon cells.

* Skin lesion; Most dermatoses present with skin lesions of more or less distinct characteristics. Macroscopically, these original lesions are known as the “primary lesion”, and identification of such lesions is “…the most important aspect of dermatologic examination.” However, these lesions may continue to develop or be modified by regression or trauma, producing “secondary lesions”. Additionally, on the microscopic level, these lesions can also be characterized by a distinct set of vocabulary.

What is a skin tag?

A skin tag is a common, acquired benign skin growth that looks like a small piece of hanging skin. Skin tags are often described as bits of skin- or flesh-colored tissue that projects from the surrounding skin from a small, narrow stalk. They typically occur in characteristic locations including the neck, underarms, eyelids, and under the breasts (especially where underwire bras rub directly beneath the breasts). Although skin tags may vary somewhat in appearance, they are usually smooth or slightly wrinkled and irregular, flesh-colored or slightly more brown, and hang from the skin by a small stalk. Early or beginning skin tags may be as small as a flattened pinpoint-sized bump around the neck. Some skin tags may be as large as a big grape.

Where do skin tags occur?

Skin tags can occur almost anywhere there is skin. However, favorite areas for tags are the eyelids, neck, armpits, upper chest (particularly under the female breasts), and groin folds. Tags are typically thought to occur in characteristic locations where skin rubs against skin or clothing.

Who tends to get skin tags?

Nearly half of the population is reported to have skin tags at some time. Although tags are generally acquired (not present at birth) and may occur in anyone, more often they arise in adulthood. They are much more common in middle age and they tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags in the underarm and neck areas. Since they are thought to arise more readily in areas of skin friction or rubbing, tags are also more common in overweight people.

Picture of skin tags

Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags, as skin tags are more frequent in pregnant women. Tags may be easily removed during or after pregnancy.

Skin tags are a benign condition and not directly associated with any other major medical conditions, since tags are commonly found on healthy people.

Is a skin tag a tumor?

Skin tags are a type of growth or tumor, albeit a completely benign and harmless one. Tags are not cancerous (malignant) and not found to have potential to become cancerous if left untreated.

What does a skin tag look like under a microscope?

The outer layer of the skin (the epidermis) shows overgrowth (hyperplasia), and it encloses an underlying layer of skin (the dermis) in which the normally-present collagen fibers appear abnormally loose and swollen. Usually there are no hairs, moles, or other skin structures present in skin tags.

What problems do skin tags cause?

These tiny skin growths generally cause no symptoms unless they are repeatedly irritated as, for example, by the collar or in the groin. Cosmetic removal for unsightly appearance is perhaps the most common reason they are removed. Occasionally, a tag may require removal because it has become irritated and red from bleeding (hemorrhage) or black from twisting and dying of the skin tissue (necrosis). Sometimes they may become snagged by clothing, jewelry, pets, or seatbelts, causing pain or discomfort. Overall these are very benign growths that have no cancer (malignant) potential.

Occasionally a tag may spontaneously fall off without any pain or discomfort. This may occur after the tag has twisted on itself at the stalk base, interrupting the blood flow to the tag.

Skin Rashes - Where Do They Come From?

A skin rash shows up as an area of inflammation or change in the texture, and/ or color of your skin. It can be caused by a number of different things including irritation, disease, or allergic/ non-allergic reactions to foods, chemicals, plants, animals, insects or other environmental factors.

So many rashes appear because the skin is an active player in the immune system. Antigens are things like viruses or proteins that we react to. These antigens need to be presented to our immune system in a very controlled way; otherwise we would react to too many things. The skin is the site at which antigen presenting cells introduce the antigens to lymphocytes. These lymphocytes are in a sense the paratroopers of our body. A complicated process of making sure that we are not overreacting takes place. All of this occurs in the skin once these lymphocytes have been activated they produce many chemicals that cause inflammation. When we become allergic to an antibiotic or other drug, the action takes place mainly in the skin as well as in the lymph glands. Viral infections also frequently produce rashes as viral particles are presented to our immune system in the epidermis. In a sense the skin is like the schoolyard which is where many of the fights occur.

Rashes can appear on your entire body or be limited to a specific area, and what it looks like and how it feels can vary depending on the cause and type of rash. Some common types of rashes include:

* eczema (also called atopic dermatitis), which is commonly seen in children. It can cause dry, chapped, bumpy areas around your elbows and knees, and can be very itchy. It can sometimes become very serious causing red, scaly and swollen skin all over your body. (Visit Eczema Guide.ca for more information)
* irritant contact dermatitis, which is caused by your skin coming into contact with something that irritates it, such as a chemical, soap or detergent. This type of rash can be red, swollen and itchy.
* allergic contact dermatitis is caused by your skin coming into contact with something you’re allergic to, such as rubber, hair dye or nickel (which is a metal that is found in some jewelry). A nickel allergy can show up as a red, scaly, crusty rash wherever the jewelry touched your skin. Urushiol, which is an oil or resin that’s found in poison ivy, oak and sumac, can also cause this kind of rash.

If you develop a rash, don’t scratch it! If you do, the rash can take longer to heal and you might develop an infection or scar. There are a wide range of over-the-counter products available to treat rashes, but it’s important to see your doctor first and determine what’s causing the rash and the most effective treatment.

* If the rash is caused by an allergy, then treatment will focus on identifying and avoiding the allergen.
* It it’s caused by eczema, your doctor may suggest special moisturizers (emollients) to help retain the water in your skin; not only will this help to keep your skin soft and smooth, it will help reduce the itching. Short, cool showers are also a good idea because hot showers and baths can dry out your skin more. Also use a mild soap (read more on Mild Cleanser.ca ) and be sure to apply more emollients after you’ve showered.
* For poison ivy, cool showers and calamine lotion often help and if the rash is severe, your doctor may prescribe an antihistamine to reduce the itching and redness.

It’s important to try to find out what’s causing the rash because the best way to prevent it is to avoid the problem food, substance, medicine or insect. If a poison plant is your problem, learn what it looks like and avoid it. It may also help to wear long sleeves and pants when you go camping or hiking. If insect bites are causing your rash, then consider applying insect repellant before going outside. For eczema, stay away from harsh soaps that may dry out your skin, and make an effort to moisturize with creams or lotions.

By SkinCareGuide.ca

Natural Acne Scar Treatments

Hormonal changes and overly active sebaceous (oil) glands that commonly occur in adolescence usually cause acne, however acne can still affect adults as well. Zits, pimples, acne, cystic skin eruptions, blackheads and white heads all fit into the acne skin malady category.

The temptation to squeeze the spots and remove the infected matter, albeit tempting, will not reform your skin to its natural radiance. In fact, secondary infection by bacteria being pushed back into the deeper layers of the skin can cause more pain, inflammation and most likely future scaring. Once the bacteria have been released, it can re-infect the surrounding skin. The facial scars are actually remnants of the bacterial infection caused by ‘procedure.’

The unfair fact is that adult acne will affect 25 percent of men and 50 percent of women in their adult lives. We know that identifying hormonal changes as the main cause of adult acne aren’t entirely proven. There isn’t just one cause. Acne in adult women can be linked to cosmetic use, some hair products and can frequently be brought on by the hormonal fluctuations associated with pregnancy. Certain types of prescription medications can also cause adult acne. Some strains of acne, such as Acne vulgaris, don’t typically show up in adults until midlife. Adult acne also forms differently, whereas adolescent acne begins on the forehead and cheek area, adult acne tends to show more on the chin, jaw line and neck.

With all this new adult acne erupting (pardon the pun) more than before, natural acne and scar treatments are gaining more acceptance as consumers want to make healthier more sustainable choices for their skincare.

Your skin has an amazing natural ability to regenerate itself and a new layer of skin growth will generally cover any scarring, but in the rare cases where this does not occur then a more advanced scar treatment is in order. Always consult with your doctor or dermatologist before beginning any facial treatments to be sure you are not causing further damage.

A healthy, well-balanced diet plays a large role in helping your body and skin to regenerate itself to its optimal condition. Many dermatologists recommend a diet high in natural minerals. These minerals are to maintain the health of the skin cells, which in turn should prevent a further outbreak of acne and repair damaged tissue. Diets, which include plenty of green vegetables, un-cooked vegetables such as carrots, spinach and cucumbers, have also helped many to maintain smooth, blemish-free skin. The idea is to try to create a new fresh layer of skin so that the scars reduced or eradicated.

Are you drinking enough water?

By consuming a regular amount of water daily, you can improve the look of your skin. The average human body is comprised of 60 percent water. Drinking more water, instead of sugar-laden sodas or energy drinks will keep the skin moist and smooth; it will also clear away the dead skin cells, flush toxins and aid in the regeneration of new skin cells. Mixing water with natural ingredients like citrus, fruit or vegetable juices, can also be helpful to exfoliate the skin.

With a proper nutritious diet, vitamins and plenty of water, most see results within a few months. It can take up to a year for acne scars to heal completely. Acne scars do not show up overnight and removing them can take the same amount of time if not more. It takes patience, but with the proper motivation for beautiful, glowing skin, it will be well worth the wait.

Of course, some scars may be so deep as to require dermalogical treatments such as lasers or painful acid peels. Try the natural methods first, as theses procedures can be quite costly. Any effort you make to regenerate your skin naturally will only help the dermatologist’s treatments even further.

Always remember to gently cleanse and moisturize your skin everyday as well. Applying harsh, drying chemicals to your acne will usually cause further inflammation and breakouts. One natural treatment that had shown good results is to mix pure sandalwood oil with rose water, apply it to your scar(s) and leave on the skin overnight. Cleanse face as usual in the morning.

Are Chemical Peels Right for You?

With so many beauty products, facial treatments and surgical procedures available these days, it can be overwhelming to choose a treatment that is right for you. First off, when trying any new skincare treatment or procedure, it is always important to do your research, seek out reputable sources and never be afraid to ask questions, after all, it is your face – you only have one, so treat it accordingly. Selecting the right specialist or understanding details of a surgical procedure will be time consuming, be prepared to put in the time necessary to make the best choice. Below are some tips to help you get started.

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Choose carefully. The Consumer Guide to Plastic Surgery recommends you:

· Check educational, training, background credentials and experience to ensure that he or she is well-qualified

· Ask how many times they have performed this procedure

· Ask to see before and after photos of patients who have had chemical peels - in some cases offices will give you contact information of previous patients as referrals.

Dermatologists, plastic surgeons, licensed estheticians and registered nurses can all perform chemical peels. However, depending on the type of peel, you might need to see a doctor. Ensure your procedure is both safe and effective.

Schedule a skin consultation. A chemical peel is an aggressive treatment, it’s important that you get an in-depth analysis of your skin beforehand. When at the consultation, make sure the specialist knows your medical history and any prescriptions you may be taking. Be prepared to ask questions, such as what is my skin type? What are my skin concerns? How can chemical peels improve my skin? What kind of peel is best for my skin type?

Become a peel expert. There are three types of chemical peels: superficial, medium and deep. In addition, they increase substantially in cost depending on the peel. The cost ranges from $150 to $300 for superficial peels; $1,000 to $2,000 for medium peels and $2,500 up to $5,000 for deep peels, according to Smart SkinCare:

Superficial: The mildest of chemical peels, superficial peels treat fine lines, discoloration, dryness, roughness and mild acne. Results are subtle and you will need regular maintenance sessions. Estheticians typically perform superficial peels. Common solutions: Alpha hydroxy acids or AHAs (e.g., glycolic acid, lactic acid), salicylic acid

Medium: These peels penetrate deeper into the skin, producing a second-degree burn. Medium peels treat wrinkles, pigmentation problems, sun damage and blemishes. You will need at least a week to recover. You’ll also need several peels to achieve desired results. Common solution: Trichloroacetic acid (TCA)

Deep: These peels target deep wrinkles, dramatic discoloration and skin lesions. Deep peels are the most effective, providing pronounced and long-lasting results. However, they are also riskier with longer recovery time—most people take two weeks off from work. A certified, experienced plastic surgeon must perform these peels. This peel is performed once. Common solution: Phenol

Consider your skin type. Be aware that a chemical peel is not always the best option for your skin type. These are several examples when a chemical peel isn’t appropriate or can be helpful. In most cases, a chemical peel should not be used on dry or sensitive skin. A peel might cause dryness, flakiness, itching and further inflammation. If you have inflammatory acne and deep cysts, you should also consult a dermatologist, as a chemical peel might not be the best treatment for those conditions.

Chemical peels are a good choice if you experience mild to moderate acne or acne scars: The acids in the peel work to both kill active blemishes on the surface and to prevent new blemishes from forming. By accelerating the exfoliation process, a chemical peel delivers clearer, healthier-looking skin.

Become an expert on your chemical peel. Before having the chemical peel, make sure you ask every question possible to ensure you are aware of the entire procedure and its potential complications.

Examples like; what strength is the peel? How many sessions will I need? What are the pros and cons? What kind of discomfort, pain and other reactions can I expect during the procedure? How should my skin react after the chemical peel?

Communication is key in making your chemical peel a safe experience. Clarify you are experiencing normal reactions or seek immediate attention if you think you are not. Remember if something doesn’t feel right, only you can speak up about it.

About two to four weeks prior to your chemical peel, the specialist will ask you to incorporate pre-care products into your daily regimen. These products are designed to thin out the skin’s surface, allowing the peel to penetrate deeper and evenly. Your medical expert might prescribe Retin-A, an AHA product or hydroquinone cream.

When using these new products, you might have to discontinue your old ones. Your specialist will give you specific information about what products to use and avoid.

Depending on the type of peel, your results might be subtle or dramatic. Every skin type reacts a bit differently. Be realistic about the results and fully understand to what degree the peel will improve your skin and whether you will need additional sessions to maintain results.

Helpful Hints to Heal Acne

While we all wish to have perfect skin, some days are more important than others - whether it’s a job interview, an important date, or a social gathering where you may be introduced to many new people, looking our best during these special occasions is usually a priority. While acne should be the last thing on our minds, many times the additional stress brought on by these very important occasions can result in just that – unwanted acne.

If you have ever awakened to a big day only to find a BIG SPOT where it shouldn’t be, read the below tips to help prevent and heal acne more regularly to help avoid those nasty last minute acne issues.

Acne Tip #1

Drink plenty of water – plain and simple. This is probably one of the best ways to prevent future acne. Doctors recommend this easy exercise to remember – whatever your body weight is in pounds, divide that number by two to get the number of ounces of water you should consume for optimal skin flushing and overall health. Add a slice of lemon juice to further enhance the cleansing effects. Your goal is to flush all the toxins in your body and cleanse your skin from inside out. This will also help your body run smoothly by cleaning out unnecessary toxins that help build bacteria onto your skin.

Acne Tip #2

Resist the urge to pop - popping your pimples incorrectly is something you don’t want to do. There are dermatologist recommendations how to do this properly, but most folks want the offending item removed much earlier than it is safe to do so. While it can be a quick fix to your acne, the incorrect action could result in a scar that could become very noticeable if you make a habit of popping. Even worse, most dermatologists tell us the majority of the plugged oil creating the acne goes back into the underlying skin layer, which will reform as more acne later. If you really need to pop, try to follow a safe procedure.

Acne Tip #3

Change your bed linens regularly –changing your linens weekly is ideal. Repeatedly placing your skin on the surface of a pillow or sheet will allow bacteria and oil to build up, creating an environment for further outbreaks.

Following these simple actions can help tremendously when it comes to having acne free skin.

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