Got some spots frozen off today. Updated.

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piller
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Got some spots frozen off today. Updated.

Post by piller »

One spot was biopsied, then the rest was frozen off. Several more spots were frozen. Liquid nitrogen stings.

I just got the call from the Dermatologist. Squamous cell carcinoma. If you have skin cancer, that is the least dangerous of them. I have an appointment to have it cut out. Things could have been much worse. I have a good Dermatologist and it was caught before it spread.
Last edited by piller on Thu Oct 24, 2019 11:04 am, edited 1 time in total.
D. Brian Casady
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Old No7
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Re: Got some spots frozen off today.

Post by Old No7 »

I'll think I'll be getting a few done soon -- good luck with the outcome Brian!

A buddy of mine has had 4 surgeries already 'cause he didn't react quickly enough to a changing mole (shape, size, color, etc.) You gotta be aware of these things as we get older.

Hopefully our resident "Doc" will see this and chime in with some words of wisdom for us.

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JimT
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Re: Got some spots frozen off today.

Post by JimT »

I do my own.
Sharp knife to remove.
Apply red hot iron.

Also stings a little.

:lol:
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Grizz
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Re: Got some spots frozen off today.

Post by Grizz »

JimT wrote: Fri Oct 18, 2019 8:57 am I do my own.
Sharp knife to remove.
Apply red hot iron.

Also stings a little.

:lol:
branding iron ? ?
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JimT
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Re: Got some spots frozen off today.

Post by JimT »

Grizz wrote: Fri Oct 18, 2019 9:28 am
JimT wrote: Fri Oct 18, 2019 8:57 am I do my own.
Sharp knife to remove.
Apply red hot iron.

Also stings a little.

:lol:
branding iron ? ?
Sort of. The scars fade in time. Kinda.
Did this one 30 or 35 years ago.
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jnyork
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Re: Got some spots frozen off today.

Post by jnyork »

Dermatology clinic every six months to get 'em froze off.
wm
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Re: Got some spots frozen off today.

Post by wm »

My wife works for the leading Dermatologist in mid Michigan. He is kind of a legend for his ability to diagnosis …… certainly no quack …… and he prefers to use heat. In fact he uses a soldering gun. No lie.

He's used it on me!

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JimT
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Re: Got some spots frozen off today.

Post by JimT »

THAT IS A GOOD ONE WM!!

I may have to try that.
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Re: Got some spots frozen off today.

Post by octagon »

Had some froze off by this good looking gal, built like M Monroe. Never felt a thing 8)
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Re: Got some spots frozen off today.

Post by Griff »

Every six months for me. When I first saw him nearly 30 years ago, he was a newly minted Dr., and told me, "You're my retirement program." I didn't appreciate then, nor now! Especially as I'll be soon breaking in a new dermatologist. But, I'm sorta glad I'll be around to see him retire!!!
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Re: Got some spots frozen off today.

Post by M. M. Wright »

Every 6 months for me. Course I had a melanoma (55mm) removed from in front of my right ear several years ago so they want to keep an eye on me. Lots of "barnacles" frozen either by my Dermatologist or my VA primary.
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Re: Got some spots frozen off today.

Post by AJMD429 »

You can classify skin cancers as two kinds. Melanomas, and the others. The others are the more common types, probably comprising 95% of skin cancers, and are almost all either basal cell skin cancers or squamous cell skin cancers.

Generally, squamous cell skin cancers look like wounds that were videoed over a period of a few weeks and then the video is run backwards. They usually look nasty and ooze and bleed. Basal cell skin cancers usually look like little pearly bloodshot warts, although sometimes the area is flat and just look like a little lake of paraffin was spilled on the skin.

People seldom die of basal cell or squamous cell cancers of skin, partly because they don't tend to metastasize, and partly because they're usually obviously abnormal looking. The most subtle and problematic ones are the ones on the face because especially if they are on the nose, there is not much room to loosen and remove skin after you cut them off, plus they tend to be like icebergs and have a lot more below the surface than you realize. The good news is that they seldom metastasize, so a skilled plastic surgeon can take care of the worst of them what's the main problem being dealing with the scars.

The things a lot of people get frozen off in great quantities are usually something called actinic keratoses, which if left long enough, can turn into these non-melanoma skin cancers. They often just look like little scaly irritated reddish areas.

The actinic keratoses and basal cell skin cancers in particular tend to almost always be where there has been heavy sun exposure over a long number of years, so all of the precautions about sun exposure apply.

The really scary ones are the melanomas. They're the ones that can easily kill you, and they can go from barely noticeable to not stoppable in well under a year...!

They tend to have a darker color than the other spots on any given person, and if looked out under magnification, almost always have some element of black in them. The black may be a subtle lace like overlay, or tiny flecks, or simply an area within a larger brown lesion. They do not have to be particularly large, nor raised, nor irregular in appearance, although those factors should raise the suspicion even more.

The first melanoma I ever saw in one of my patients was on a 26 year old woman who came in for a physical on a Thursday. She had had her third child six weeks prior to that, so had just seen her gynecologist on Monday for a follow-up pelvic exam and Pap smear. Therefore I did not check her private parts, even though she was in her birthday suit. Checking a Pap and pelvic exam would be a part of a normal family physicians physical, but I figured that had already been done so why unnecessarily invade the modesty of a new patient I had never met on her first visit.

Well, God has a way of having our back when we screw up, and was certainly looking after this young lady. I can hear him now muttering under his breath, "... Well, ma'am, you know those hemorrhoids you had during your pregnancy...? I'm afraid those are going to stick around for a while so you go back in a couple weeks and give that idiot doctor a second chance to save your life..." Since this is a family-friendly forum, I won't go into great detail about where the tiny little fine point Sharpie-sized black dot was that I thought might just be a little poop since people with hemorrhoids don't always clean thoroughly due to the pain. However when I touched it with my glove it didn't rub off. Suffice it to say if you want to know where the melanoma was, look up the term "posterior fourchette." :shock:

I asked her how long she had had a little black spot there, but since she wasn't doing self skin exam (like she should have been), she had no idea there was a spot there at all. This was prior to the days of cell phones, so I was unable to reach her husband to find out if he knew whether the spot had been there forever, and which case it might not be a problem, or if it was new or changing. So I called her gynecologist, who told me I shouldn't worry about a spot there because skin cancer was caused by the sun, and there's no way you would get a melanoma there. Thankfully, even though I was a young and inexperienced doctor, I knew enough to realize that the specialist was clueless about skin cancer, despite the fact that gynecologists often say they are "primary care doctors for women" :roll:

I took it off that day, with good margins, and the pathology came back melanoma 0.9 millimeter deep. Beyond a millimeter, the likelihood of local invasion becomes great, and typically everything within 3 to 4 inches in all directions has to be removed. I have another patient where that happened a couple decades before she became my patient, and she has a bag for urine, and no uterus....or vagina. :|

So the moral of the story is, even if it's a tiny spot, and even if it is not where you get "excessive sun", and even if you are young, get it checked out...! Make sure your doctor is thorough (doesn't skip areas just because they are 'personal'), and knows about skin (a dermatologist or good family physician should totally know how to spot a melanoma).

I know it is mainstream to tell everyone that melanoma is caused by the sun, but I'm not sure this is correct. I think doctors are making the mistake of lumping all skin cancers together. If I recall correctly, melanocytes don't even come from the same embryonic cell line at the basal and squamous cells, so their behavior might be expected to be quite different. Regardless, the reality is that it IS different, whatever the reason. Unlike basal cell skin cancer, melanoma does occur in young people, nearly as often as in older people. If you look at the sites melanoma occurs on, is not more common on the scalp, even on bald men, unlike basal cells. When you look at the back, instead of being common up on the shoulder area where you get your heavy sunburn, it is the most common in the middle of the back where a woman's bra would fasten. On the front of the torso, it is more common on the breast then in the necklace area, even for women, again not making sense if it is triggered by sun exposure.

Finally, if you look on a per square inch basis, it is more common in the genital folds or around the anal area on a female than it is on their abdomen or thighs, and I certainly fail to see how that would remotely correlate with sunburn. I even removed a Clark's Nevis (as close as you can get to melanoma but still be 'precancerous') from the tip of a woman's "smaller equivalent to the male erectile organ" a decade or so ago, and another was on a hemorrhoid I removed from a 35 year old woman that was a Clark's.

There is some truth to the fact that if you approach a patient who was recently diagnosed with melanoma, clipboard in hand, and ask about their lifetime history of sun exposure, you are more likely to receive a long list of sunburns, then if you do the same thing to a random person who's never had melanoma. The problem is, when you are dealing with a population who is convinced that sun causes melanoma, and you are talking to a melanoma survivor, you are talking to someone who has spent the past few weeks reliving every single sun exposure they've had and thinking "why me?" which tends to color the results quite a bit.

What does probably contribute to the risk of melanoma is certain types of skin, that are genetically predisposed to melanoma. It may be coincidental, but those types of skin do burn more easily, so that could throw off our data. People with easily burned skin types do get more melanoma, but may not really need to have a burn to get those melanomas. Similarly, people with difficult to burn skin types get fewer melanomas, but appear to get fewer melanomas even if they have gotten sunburned.

The bottom line is that people should do a skin exam every 4 weeks at home. It is much easier to make something happen every 4 weeks then once a month, because you can keep it on the same day of the week and part of your routine instead of trying to remember to squeeze it in when you shower before heading to work on the first of the month, especially if you're running late and it's Monday. Better to make self exam day Saturday or Sunday when you will be better able to focus and not feel rushed. Most people can do a good skin exam in less than 2 minutes, although people with extremely high numbers of spots, especially if they vary quite a bit in color and shape and size, really need professional skin exams as often as every 3 months. Sometimes good high-resolution photographs of problematic areas can be taken by the patient as long as they help the skin photograph be focused by using a piece of paper or something with a sharp edge near the lesion in question.

Women should do a breast exam on themselves every 4 weeks for the same reason, so what I tell them is to go ahead and do their skin exam on the same day, but if they have a spouse around make sure they do all of that on a day that he is home, so he can help check the harder to see areas. The best way to remember all this is a simple calendar right on the bathroom mirror with every 4th Friday circled or whatever day you prefer. Other methods, such as putting it in the checkbook calendar, or a refrigerator magnet, or the things women hang over the shower head with pictures of boobs on them, but worst of all, a 'smartphone', pretty much FAIL to get the job done. Just use a little calendar on the back of mirror with every 4th Sunday or whatever circled....!

People who live alone may be able to check their own backs using two mirrors, but the light has to be just right, the mirrors good quality, and their vision good. If they have a large number of spots, they probably won't be able to check themselves very well. But a spouse can check a back really easily. (Keep in mind that if you have made your wife really angry with you, she might suddenly get blurry vision and not notice that big melanoma on your back.) Although men don't get melanoma quite as often in the genital are as women do, both genders should check that area. People who live alone can do it fairly easily by placing a mirror on a stool in a room where there is good overhead light, such as most bathrooms, and standing over it. You just have to have one hand free to move parts aside so you can see in the nooks and crannies. Trying to do the same thing laying down requires a second hand to hold a mirror, and light will probably be an issue, plus whatever you are laying down on will obscure part of what you need to check. Obviously, people with a spouse should just check each other. (I warn my female patients* that you can't detect melanomas in the dark, nor feel them with your face, although it is possible that their husband may be doing some kind of medical research.)

I recommend that people go to a good medical website and look at pictures of melanomas. If you just use a regular search engine, you get too many other strange skin lesions and other types of skin cancer mixed in. Melanomas are hard to describe verbally without the words also describing something called seborrheic keratosis, which are very common and very harmless. It's kind of like trying to tell someone to look out for the neighbors dog, and they tell you they've never seen a dog. So you describe a dog to them; "...they have four legs, and are covered with fur, and have a pointy nose and floppy ears and a tail that usually wags..." You find out later that they climbed up in a tree in fear as soon as they saw the other neighbors goat.... :D

That's about all I know about skin cancers, other than how to take them off....!

*...the ones with a sense of humor, at least...ones lacking that usually find other doctors... :roll:
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Re: Got some spots frozen off today.

Post by piller »

Melanoma tend to be the ones where the codon that stops the promoter codon has been messed up. The promoter codon then runs wild. Squamous cell ones tend to have an error in the stop codon. They may not get pushed to grow, but they just do not know when to stop. The error which lets the promoter codon run wild is the one which causes fast growing and invasive abnormal cells.
Codons are 3 pair sets of DNA pieces. Your DNA is read by your body in pieces of 3 pairs. The pairs are made up of a combination of 4 different chemicals. Certain combinations say start reading here, certain combinations say stop here. It takes more than one set of three pairs for most things. Some codons say skip over what comes next and do not make what the blueprint recipe calls for. The DNA that is in there and not used in known as Introns. The DNA that is read and used to make something are Exons. Certain codons say repeat the next set of instructions. Codons are usually read in sets of 3 sets of 3 for each instruction. Our RNA reads the DNA and can even do minor repairs when something goes wrong.

That is a quick overview of what is happening in our cells. Biology 650, the Molecular Biology of Cancer, was offered as an elective for Pharmacy Students and was a core curriculum course for certain PhD students at Kansas University. Not many Pharmacy Students going for our Bachelors Degree were interested, but we were the only non PhD students allowed to take that class. It was actually a very informative class.
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Re: Got some spots frozen off today.

Post by Griff »

Doc & Piller,

Thanks for reinforcing what my Dermatologist has been saying for decades. Yep, the self check is difficult, but not impossible.
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Re: Got some spots frozen off today.

Post by piller »

It is a good idea to find a good dermatologist and go for annual appointments. I am 54 and have hat one cancer removed, plus several pre-cancerous places frozen off. Sure, the liquid nitrogen stings. No big deal. There are lots of things which we do all the time where there is some voluntary discomfort. Have you ever been fishing and had a hook accidentally draw blood? That hurts as much or more than the liquid nitrogen does. Did getting stuck by a hook that you could easily remove by yourself ruin your fishing trip? Of course not. Having a menanoma that is not caught before it spreads to other parts can ruin more than just a fishing trip.

A good Primary Care Physician and a good Dermatologist can prevent or stop cancers from killing you, or even worse, messing you up so bad that you wish you were dead. We lever gun shooters are a relatively small bunch, and we can't really afford to lose any of our number to preventable causes.
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Re: Got some spots frozen off today. Updated.

Post by piller »

My experience is that the squamous cell carcinoma both itches and hurts at the same time, but it hurts when scratched.
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Old No7
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Re: Got some spots frozen off today. Updated.

Post by Old No7 »

piller wrote: Thu Oct 24, 2019 11:22 am My experience is that the squamous cell carcinoma both itches and hurts at the same time, but it hurts when scratched.
Hmmm... I'm having one on my back that is similar to that looked at tomorrow. :?

And hey...

THANKS TO OUR RESIDENT DOC for the excellent info he posted above!!!

I had to laugh at this statement he made though...
AJMD429 wrote: I warn my female patients that you can't detect melanomas in the dark, nor feel them with your face, although it is possible that their husband may be doing some kind of medical research.
I wish my Doc had a sense of humor! :wink:

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wm
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Re: Got some spots frozen off today. Updated.

Post by wm »

My wife works for a derm …… and the fact is most of us will end up dealing with these if we live long enough. In particular men seem to get them as a result of sun exposure so ears (baseball caps exposure), back of neck, nose, and upper chest. If you were a 'beach guy' all bets are off and you could have them anywhere.

Most importantly though is to check your scalp, especially if you have thin hair. They are easy to over look there and if they go deep they can quickly get into the skull bone. I have a buddy who lost a foot because of one the top of his foot that got into the bone.

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Re: Got some spots frozen off today. Updated.

Post by AJMD429 »

Here's a few representative images from the internet on this topic:

This is an actinic keratosis - scaly reddish patches. Precancerous for squamous cell skin cancers. Usually frozen off or sometimes treated with creams like 5-fluorouracil or imiquimod.

Image


This is an early basal cell cancer - notice the pearly, bloodshot appearance. Dimpling in the center if the lesion is raised is common but not always present - the earlier ones are NOT EVEN RAISED - just a translucent 'lake' of bloodshot paraffin in appearance. Biggest problem is if on nose or face or ears and they get too advanced - plastic surgery challenge. Usually not lethal though. Some protocols using liquid nitrogen in between pre and post treatment with imiquimod show promise but usually they are cut away surgically.

Image


This is a typical squamous cell skin cancer - they tend to ulcerate and bleed early on. More aggressive than basal cells but still not usually lethal.

Image


This is a classic melanoma - dark brown or black and irregular in color and shape - but OFTEN they are just tiny nondescript darkish spots, and since they are so rapidly progressing and potentially lethal - have a HIGH index of suspicion -

Image


This is a type of pre-melanoma, or dysplastic nevus - no black yet but a lacy darker overlay on a lighter background. THESE are the ones you hope to have removed - BEFORE they transition to melanomas...!

Image
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Re: Got some spots frozen off today. Updated.

Post by mark »

Thank you MD for the lucid descriptions of skin cancers, particularly melanomas.

I am seventy years of age, and get a skin check yearly for at least fifteen years.

My middle daughter has lost her mother in law with a recurrence of melanoma.

We went to the funeral.

Regards Mark
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