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Actinic keratosis - A sun-caused, scaly growth. The actinic keratosis is a precancer that may become a squamous-cell skin cancer (carcinoma). Scientific studies say that between 1% and 20% of actinic keratoses may turn into squamous-cell skin cancer. It is usually found on sun-exposed skin. It is usually composed of a dry white scale on a pink or brown mat of tissue, usually about half the size of a dime. The actinic keratosis is a growth or tumor and is, by definition, one that stays high up in the skin and has not had a chance to go into the body.

Aminolevulinic acid (ALA) - A naturally occurring chemical in the human body that is converted to protoporphryn IX, especially in actively growing cells (usually a sign of disorder like precancer or cancer). Certain wavelengths of light cause protoporphryn to absorb light energy, killing cells in which protoporphryn is present in excess. This is the basis for photodynamic therapy, a treatment that will almost certainly be used successfully for precancers in the not-too-distant future

Appendages - When used in dermatology, usually refers to parts of the epidermis and include the hair, nails and sweat glands (eccrine cooling sweat glands, apocrine arm/groin sweat/smelly glands).

Artery - Blood vessel through which blood flows away from the heart to the capillaries, where oxygen is released from the red blood cells for use by the body.

Atypical mole (AM) - A term favored by the U.S. National Institutes of Health (NIH), formerly known as a dysplastic nevus. The term atypical stands for unusual or strange, in this case. An atypical mole is an acquired, usually pigmented (colored) lesion (spot or bump) of the skin that is different from a common mole. (NIH, Consensus Statement, Jan 1992) Unfortunately, this is not a very helpful definition for the public. Such a definition of exclusion or elimination requires knowledge of what common moles would look like. So let us talk about what most classical (and that does not mean all) atypical moles would look like or do. Atypical moles (AM) may or may not occur in families. AM vary in size but are usually larger than common nevi (moles). AM may be completely flat spots you could not feel with your eyes closed or they may be papular, i.e., bumpy, able to be palpated or felt with the fingers. The borders or edges of AM are usually very irregular (notched or jagged) and ill-defined, i.e. the edges are not sharp. The colors of most AM range from pink to tan to dark brown on a pink background. Additionally, the colors in AM are usually variegated (mixed together without uniformity). Although AM may occur on almost any body location they favor the trunk. For a more thorough look at AM, see Moles or Nevi.

Atypical mole phenotype - Includes patients who have many AM's themselves but know of no one else in their families with any similar moles or with melanoma. Most atypical moles do not occur in families. Occurrence of a disease in several family members automatically makes one think of a genetic problem. Words that could be used to describe this individual patient, as the moles are non-familial, might include "sporadic" or "isolated," because this person's moles seem to occur on their own. This might lead one to think there is no genetic cause for the presence of the abnormal sporadic moles in such a person. Dr. Raymond Barnhill, a world-renowned melanoma expert, prefers to use the term "Atypical Mole Phenotype" which implies that there is some sort of expression of moles on the surface without implying that there is a genetic basis for sporadic AM's. The term atypical mole phenotype is probably a good compromise based upon current medical knowledge. However, the Web-site author believes that, in the future, science will likely find that atypical moles and all of their varying types and syndromes form a spectrum that is all based in genetics. Keep in mind that environment and other factors may influence the expression of an underlying genetic base.

Atypical mole syndrome - A collection of symptoms in one patient having sporadic atypical moles. At the far end of this syndrome's spectrum are patients who are victims of the FAM-M Syndrome. See Familial Atypical Mole ­ Melanoma, and also Atypical Mole Phenotype.

Basal-cell carcinoma (BCC) - A skin tumor or cancer that originally was thought to come from the basal cells, the lowermost cells of the epidermis that rest on the basement membrane. There are many different types of basal-cell carcinomas, as you will see in the basal-cell sub-section of this Web site. However, this tumor rarely spreads to distant locations in the body. This tumor is usually aggressive only locally, with the ability to destroy the structures immediately surrounding its visible location.

Basement membrane - The thin boundary layer between the epidermis and the dermis. It is made of a special collagen (Type IV) which may have some uncertain role in preventing tumor penetration into the dermis, which contains blood vessels. See Dermis and Epidermis in the Glossary.

Benign - Not malignant. See Malignant. However, just because a growth is "benign" and does not meet the definition of malignant does not mean that it cannot cause trouble. For example, the pressure of its blood supply may cause a benign hemangioma (blood-vessel tumor) to rupture in the brain or eye causing death or damage. "Benign" implies that the growth is not able to spread distantly by seeding or that it will not grow and invade the nearby tissues, replacing or destroying them to any threatening degree. This does not imply that benign growths will not cause cosmetic deformity; for example, dozens of benign sebaceous hyperplasia (oil-gland growths) may grow deep and wide on the face drastically affecting appearance, but they are not malignant.

Biopsy (skin) - Any piece of skin or tumor tissue removed from the patient that is to be sent to a laboratory, where it will be stained and examined under the microscope by a certified pathologist (we hope). A biopsy may be small or large. An incisional biopsy is the removal of a piece of tissue smaller than the entire problem spot (area) on the skin in order to get an idea of what the process (problem) is. An excisional biopsy is the removal of the problem spot (area) of skin or lesion plus some extra normal tissue (margin) around what the "naked eye" sees as abnormal in the hope of removing all of the problem (targeted) process.

Biopsy, inverted pyramidal - See inverted pyramidal biopsy. A technique developed by the Web-site author to cause the least scarring while obtaining a quality biopsy specimen.

Board Certified - Having passed a test given by a "board" of "authoritative" individuals. Some board-certification exams test only a doctor’s memory on paper or by computer, some tests are oral (verbal questions and answers) and some tests are physical, in which examiners observe the doctor being tested, and involve treatment or examination of a patient. Board examinations also provide the ability to restrict the practice of a certain portion of medicine to doctors who "studied" to perform that particular branch of medicine and are "qualified" to do so. Unfortunately, these boards may be used as tools to restrain trade or limit other specialists. Some college students could pass the board-certification examination for various medical and surgical specialties if given the proper books. It is difficult for board examinations to completely test the competency of the individual plastic surgeon to practice that particular branch of surgery/medicine. It is difficult for a board certification test to check all of the abilities of the surgeon to cut or sew because so extensive a test would have examiner bias, and if enough doctors were to fail, they might complain or sue to pass. The same examiner simply cannot test all the applicants at one time under equal conditions to remove the bias of his/her individual prejudice. This explains the need for computer-graded, multiple-choice questions to determine who becomes your doctor. The same problems occur in the boards of dermatology and all other branches of medicine. Most importantly, how does one test for ethics.

Bowen's Disease - Also known as Bowen's. Many doctors and authorities regard it as a form of squamous-cell carcinoma; however, there are some doctors who regard it as a precancer. The author prefers to regard Bowen's disease as a squamous-cell carcinoma of the intraepithelial type. Intraepithelial type cancers have not penetrated the basement membrane into the dermis. The cells in Bowen's are extremely unusual or atypical under the microscope. As we will discuss in another section of this Web site, the degree of atypia (strangeness, unusualness) seen under the microscope tells how cells may behave if they invade another portion of the body. Indeed, if cells of Bowen's invade below the epidermis and the basement membrane (layer that separates the epidermis from the dermis), sometimes the consequences can be grave, even lethal. The authors Lever, Graham and Helwig have noted that metastatic (spreading internally to other parts of the body) Bowen's can be deadly. On the other side of the coin, metastatic Bowen's is uncommon, so the doctors who do not wish to consider the possibility of internal invasion will "throw these cases out" and consider Bowen's just a precancer. However, the author feels that the loss of one patient's life is too much and that the best medicine considers every reasonable possibility and anticipates potential problems. The author's concern is that Bowen's cells like to grow down hair pores. This tendency for "poral invasion" may give the extremely atypical/unusual cells of Bowen's (intraepithelial squamous-cell carcinoma) access to the bloodstream if they break through the basement membrane. The author believes that the possibility of invasion may be increased by time, trauma and previously failed treatments. However, a diagnosis of Bowen's should not cause panic. On the contrary, if the Bowen's has not spread, it is much better news to have than a diagnosis of a moderately differentiated squamous cell. See Squamous-cell Carcinoma. The diagnosis (identification of a disease) of Bowen's portends (predicts) a good prognosis (prediction of the result) if the Bowen's is treated properly with the consideration that Bowen's cells like to "hide" in pores.

Breslow level - A grading system for melanoma developed to indicate the chance of survival for patients with melanoma.

Cancer - See Malignant. Malignancy is an equivalent term.

Clark's level - A grading system for melanoma developed by the world-famous dermatopathologist Wallace Clark, who was a professor of Dermatology at the University of Pennsylvania while Dr. Weber was in training there.

Clinical examination - A clinical examination is the examination that a doctor (preferably a dermatologist when it concerns the skin) can do with no more than his/her eyes, a magnifying glass and fingers. It does not include the examination of tissue under the microscope or with special cameras or computers. A clinical examination may be thought of as the kind of information found when a physician examined the patient in the late eighteenth century. By no means should a clinical examination be taken lightly, for it is the clinical examination that leads to more specific tests that may detect life-threatening cancers. A meticulous, correct, thorough and competent clinical exam is super-important.

Closure - See Repair; the terms are equivalent.

Collagen - The material that makes up the "leathery layer" of the skin or dermis. Collagen itself is not alive; it is secreted by the fibroblast cells (fiber cells). Fibroblasts create and live in the dermis (leathery layer) of the skin. Collagen is also the base or basis for scar tissue, the tissue by which the body heals or "glues itself together" when damaged.

Common nevus - To dermatologists, implies a usually very benign type of mole that is regular in color and shape and borders. Common nevi (plural) usually arise in youth as a black or brown spot and raise slightly in early adulthood. Common nevi sometimes become baglike and protruding later in adult life.

Contagious - Able to be spread from person to person or living object to nonliving object to living object (such as person to doorknob to person). Cancer itself is NOT contagious. Many infections can be contagious. Warts are one of the most common contagious growths on the human skin. Some viruses can initiate/cause skin and other cancers and may be contagious.

Cure rate - Cure rate is usually expressed in terms of the percent of patients that will be improved or alive over a given time period. In other words, a cure rate is a measure of the percentage of patients who are improved from a disease or are completely free or cured of cancer with respect to a certain interval of time. The cure rate is usually 100% minus the failure rate over that particular period of time. A cure rate does not always imply cure for cancer, but may be freedom from another type of disease. An example of a particular cure rate might be that patients have an 85% to 95% chance of being cured or completely free from signs of returning melanoma of the most superficial level after five years. This is called the five-year cure rate. For example, scraping and burning basal-cell carcinomas of "high risk" areas as a treatment may give only an 85% five-year cure rate. That means a 100% - 85% = 15% failure rate, or about one in six people have the tumor return to damage or harm them. Even worse, such a tumor may return to be more aggressive than before it was treated. See Failure rate in the Glossary.

Curettage & (Electro)Desiccation - The "scraping and burning" of a skin tumor, either benign or malignant, using a circular knife (sharp scoop) called a curette and often with an additional electric surgical device called a cautery. This treatment has varying degrees of cure and failure rates. See Cure rate and Failure rate in the Glossary.

Cutaneous - when referring to skin, usually means the dermis (see "dermis" in the glossary) or leather layer of the skin. Some doctors also use cutaneous to mean epidermis and dermis together.

Cyst of the skin - An "inpocketing" of living pore tissue that usually retains the dead debris normally shed from the surface of our skin. A cyst may be as small as a whitehead or as big as a golf ball with a tiny pore hole, which is responsible for the inpocketing, located somewhere around/near the cyst. Cysts are almost always benign, although they can develop bulbous roots. Rarely, squamous-cell cancers have been found growing in cysts, which is a reason to send a cyst for pathology (microscopic tissue exam) following the cyst's surgical removal. Cysts may become painful or infected by virtue of pressure or rupture of the keratin (debris) that they retain.

Defect - A hole or gap in the skin, fat, muscle or bone created when a skin tumor, cancer or growth has been removed surgically (specifically a surgical defect).

Dermatofibroma - Skin and scar fiber tumor. A dermatofibroma is a benign lesion or tumor of the skin that usually occurs on the legs of adults. There is a malignant variety/form called dermatofibrosarcoma, but it is very rare. When pinched at the edges, most dermatofibromas dimple or depress in the center forming a dell.

Dermatologic Surgeon - A dermatologist who may or may not have extra training in dermatologic surgery. Unfortunately some dermatology training programs do not offer extensive training in surgery, and some dermatologists have to seek training above and beyond that which is offered in the dermatology residency program. Alternatively some dermatology residency programs offer a tremendous amount of high quality surgical training and the doctor may even continue studying in an advanced fellowship such as a Mohs fellowship, dermatology fellowship, or cosmetic surgery fellowship, thereby further enhancing already superior skills. The quality of doctors found practicing dermatologic surgery runs the gambit from minor surgery to very advanced procedures and from doctors of limited talent to those of incredible talent.

Dermatologist - A doctor who after completing medical school studies in a residency setting under a professor or professors caring for patients studying skin disease. If the residency is proper and formal then the doctor may sit for an American Board of Dermatology examination, which is a division of the American Board of Medical Specialties.

Dermatopathology - Literally the study of skin tissue and abnormality under a microscope. Board Certified Dermatopathologists are more highly trained than dermatologists and pathologists in the reading of histology (stained microscopic) slides for skin lesions. The extra training involves study under other prominent dermatopathologists for years and the sitting of a board examination in this special study. Certified Mohs Surgeons of the American Academy of Mohs Surgery have been shown to have a 99.9% agreement with Board Certified Dermatopathologists in analyzing skin cancers removed by Mohs surgery during numerous comparative studies.

Dermis - The layer of the skin that lies just below the epidermis on most of the body. It is largely made up of collagen (fibrous or connective) tissue. The dermis, as a layer, makes up the bulk of the skin and is usually thickest on the back and the back of the neck. The dermis may best be thought of as the "leather layer" of the skin. The dermis protects the body from mechanical injury, binds water, stores water, maintains temperature and carries nerves to detect sensation and feeling. Blood vessels, lymph vessels, nerves, sweat glands, oil glands, hair follicles, hair erecting muscles, and other structures reside in or course through the dermis.

Dermoscope - A tool used by doctors to view a mole or suspicious spot on living skin. It is an instrument that is somewhat like a modified otoscope (ear-exam scope) with magnification of 10 power or more. The skin is coated with special oil and the dermascope light is shone at a special angle to the surface of the skin. Tissue is not stained or thinly placed. The dermoscope cannot take a biopsy or see deep into the centers of live tissue. Individual cells and parts of cells, i.e., the nucleus, cannot be seen. At this time, it is not a completely adequate substitute for a biopsy of many suspicious lesions.

Dermoscopy - Skin scoping or observing the skin directly using a special scope. Dermoscopy is usually performed on a mole or suspicious spot on living skin with an instrument that is somewhat like a modified otoscope (ear-exam scope) with magnification of 10 power or more. The skin is coated with special oil and the dermascope light is shone at a special angle to the surface of the skin. It is not a completely adequate substitute for a biopsy of many suspicious lesions at this time.

Dysplastic Nevus - Older term for what the U.S. National Institutes of Health (NIH) now calls an atypical mole. See Atypical mole in this glossary.

Dysplastic Nevus Syndrome - Older term for what the U.S. National Institutes of Health (NIH) now calls atypical mole syndrome. See Atypical mole syndrome in this glossary.

Elastin - Another component of the leathery layer of the skin, or dermis, that maintains the stretchiness of the skin. This is especially true on the face and around the hair pores. When the elastin around the hair pores breaks down from aging and sun exposure, hair pores collapse upon themselves and fill up with debris, resulting in cysts, whiteheads and/or blackheads.

Elastosis - The crumpling of sun-damaged elastic tissue in the skin, much like that of a rubber band when it is laid out in the sun to dry for days. Significant elastosis can make the skin look yellow and cross-grooved.

Epidermal layers - The layers of cells, dead and alive, that make up the epidermis. They are relatively unimportant for our skin cancer overview. From the outermost to the innermost layers, they consist of the stratum corneum (horny layer), stratum lucidum, stratum granulosum, stratum spinosum, and stratum germinitivum (basal layer). The germinitivim (deepest layer, at the base), as the name suggests, is the layer where the cells reproduce and grow. The melanocytes live in the stratum germinitivum.

Epidermis - The outermost layer of the skin. The epidermis contains no nerves or blood vessels, so the epidermis alone is incapable of sensation or bleeding. Composed of a protective outer layer of nonliving keratin-derived scale cells, the epidermis acts as an envelope or seal against the environment and exerts some control on the amount of moisture lost to the environment. The epidermis contains keratinocytes (cells that make keratin) and melanocytes (cells that make pigment), as well as other specialized cells.

Epiluminescence - The lighting up or shinning of the top (epi) surface of the skin. However the term's use in dermatology is the same as dermoscopy. See dermoscopy.

Excisional biopsy - The taking of a suspected lesion plus a margin of normal tissue around the lesion in the hopes of removing the entire lesion and any small cells of the lesion, invisible to the naked eye, that may be spreading out. Many medical textbooks/doctors say that benign moles should be removed with a two-to-three-millimeter area or margin, i.e., approximately the size of a small pencil eraser, around them. Many authorities think that the average nodular basal-cell cancers can be removed (with 90% confidence or 10% unsurety) by taking 3 millimeters (1/8 inch) of the normal tissue around the clinically visible edge of basal-cell cancer. Some newer studies suggest that a cure rate of 95% of squamous-cell skin cancer/carcinoma may require the excision of a five-millimeter border of normal tissue, meaning about 5% will be missed. Excisional surgery (see Standard surgical excision in the glossary) is the treatment of choice for melanoma and many other conditions.

Failure rate - Generally considered the opposite of cure rate over a certain interval of time. Just as is the case for cure rates, every single treatment has a specific failure rate under a given circumstance. Failure rates and cure rates are best expressed as a range of rates. It is very difficult for a study to provide an exact number when discussing the cure or failure rate of a particular treatment. For example, liquid-nitrogen therapy for skin cancer is much less effective in the region around the corner of the nose than it is on the forearm. Therefore, has liquid nitrogen has a higher failure rate in the area around the nose, UNLESS the surgeon is willing to damage a large area near the corner of the nose in order to effect a treatment.

Familial Atypical Mole - Melanoma (FAM-M) Syndrome - a term favored by the U.S. National Institutes of Health (NIH). The FAM-M syndrome is defined by "(1) occurrence of melanoma in one or more first or second degree relatives, (2) large numbers of moles, often greater than 50, some of which are atypical and often variable in size, and (3) moles that demonstrate certain distinct histologic (how a sample of mole looks under the microscope) features." (NIH, Consensus Statement, Jan 1992) In plain English, FAM-M means moles and melanomas that happen to run together in families. The moles look large and unusual to the naked eye and specially stained slices of mole cells look strange under the microscope to a trained doctor.

Fat - When referring to the skin only, fat is stored in cells and usually makes up the bulk of the subcutaneous layer. This is the only layer in which liposuction takes place. However, it is interesting that there are many locations for body fat that are not part of the skin, including omental fat around the intestines, fat in the eyesockets, fat inside bone, etc. Fat is composed of triglycerides, which can take on the form of oil, lipid or lard, depending on the temperature, when removed from the body. Fat is a highly concentrated energy source well suited to helping our distant ancestors cope with starvation. Some fat deposits are genetically determined. For more information on fat, please see the separate Web site www.Lipoinfo.com.

Hemangioma - Benign tumor, usually in the shape of a ball, but sometimes a flatter mat, formed by a collection of excess blood vessels in an area. Because blood vessel cells are usually transparent in thin smooth muscle cells, hemangiomas are usually the color of the blood that runs through them. If the blood has a lot of oxygen, or is more arterial, the color is usually bright red. If the color is dark, the blood is usually low in oxygen, venous or possibly stagnated.

Histology - The microscopic examination of individual tiny cells.

Histopathologist - Literally, one who studies tissue with a microscope. This all-encompassing term may include dermatologists, general pathologists and dermatopathologists. Not all of these specialties have the same experience with the same types of lesions. General pathologists spend much of their daily time in the hospital reading glass slides of internal organ specimens. Dermatopathologists and dermatologists mostly concentrate on skin and may be better trained in reading skin-tissue specimens from reading the most recent literature specific to their field, the skin. Nonetheless, there is good and bad in everything and there may be excellent general pathologists who specialize in melanoma and know it better than many dermatologists or dermatopathologists. The patient must do quite a bit of homework to determine the quality of a given histopathologist's specialization.

Horizontal section - A specimen of skin taken parallel to and just below the skin's surface, then tested with cellular stains and examined with a microscope. A thin horizontal section could be considered a shave excision and a thicker section could, if processed properly with correct edge orientation and staining, be considered Mohs Surgery, depending on the surgeon's training. Horizontal sections can show the entire contact edge of the tissue from which the specimen was taken. If a process (tumor or abnormal growth) involves the edges of the tested specimen, then it is highly likely that the process, be it tumor or abnormal growth, involves the edges of the tissue that remained behind in the body where the specimen was taken. In that case, further horizontal sections are taken until no tumor is detected. Horizontal sections can test the entire perimeter of a specimen; such sections have a very low failure or uncertainty rate when the Mohs form of horizontal sectioning is performed. If processed properly by the Mohs method, horizontal sections can become a highly accurate two-dimensional representation of a three-dimensional problem (problem, tumor or abnormal growth. See Mohs Surgery.

Horny layer - A term meaning the same thing as the stratum corneum. See Stratum corneum in the glossary.

Incisional biopsy - The taking of a piece of a tissue smaller than the skin area in question (lesion) in order to get an idea of what the process (tumor or abnormal growth) is. The specimen is examined under the microscope, usually after it is stained with special dyes that usually display the nucleus and nuclear material, as well as other parts of the cell(s). Incisional biopsy techniques include punching with a miniature cookie-cutter-like instrument, shaving, snipping with scissors, the author's special inverted pyramidal biopsy technique and partial scalpel sampling.

Insured Benefit - The payment by an insurance company for a covered procedure or examination. In these days of managed care and treatment, insurance companies have deliberately contrived gray zones regarding coverage of both diseases and treatments. Different insurance companies and, in many instances, different policies/plans issued by the same insurance company, vary tremendously in approving a given treatment. Currently, in America, difficult battles have been required in order to obtain coverage for many legitimate, truly necessary procedures. The possibly deliberate time delays involved in fighting the companies for coverage have injured and killed patients in the past. The time delays will continue to harm patients in the future as long as insurance companies with "deep pockets" can pay off powerful politicians who protect the insurance companies with special laws like ERISA.

Interferon therapy - Interferon is a natural chemical made by white blood cells to combat abnormal cells and communicate with healthy cells. Interferon has been shown to prolong the survival of melanoma patients. Interferon has been shown, as well, to have some limited effect against the least aggressive forms of basal- and squamous-cell carcinoma when injected into the skin over a certain period of time. This type of therapy may be helpful, for example, if a young fashion model does not wish to have surgery on a very superficial well-defined basal-cell cancer on the nose. However, the author believes that anyone receiving interferon therapy should be observed closely for many years to see whether or not the tumor is returning deeply so it may be stopped with other methods if the tumor is seen and is proven to have returned. It is not advisable to do technical studies, like biopsies, unless the naked eye reveals an abnormality or a bump that can be felt arises.

In situ - Used in dermatology and this Web site to mean intraepithelial or inside. Used in other contexts to mean the original or normal position of something. See Intraepithelial in the glossary.

Intraepithelial - Occurring within the epidermis or outer layer of the skin. Intraepithelial implies that the process (tumor, problem or growth) is completely contained in that upper layer (epidermis) and has not invaded or gone into the dermis. The term in situ is also used to indicate that a process is intraepithelial.

Intraepithelial squamous-cell carcinoma - Also known as Bowen's disease. Please see Bowen's Disease in glossary and in Web-site text.

Inverted pyramidal biopsy - A biopsy technique developed by the Web-site author that allows the surgeon to take biopsies as small as a pinhead to diagnose many skin cancers and as large as 8mm to diagnose atypical moles or melanoma. The shape of the biopsy is an inverted pyramid with its base at the skin's surface. The apex of the pyramid is at the deepest portion of the biopsy, usually into the dermis. The apex is the smallest portion of the biopsy specimen. Therefore, because the small apex is taken from the tissues with the potential to scar (dermis), the amount of scarring or noticeable marking is greatly reduced. Scarring is minimized while a quality biopsy specimen allowing proper diagnosis is achieved. Inverted pyramidal biopsies taken to diagnose non-melanoma skin cancer average about one to one and half times the size of a pinhead. The final scar is often invisible to the naked eye. If magnification is used, the scar looks like a miniature "Mercedes symbol." Young fashion models and people in the public eye tend to favor this technique for skin cancer diagnosis.

Keratin - A protein that forms the cytoskeleton (miniature skeleton within a cell) of the epidermal cells. Keratin filaments run within a cell from the inside of the outer membrane to weave a "basket" around the nucleus of the cell. Keratins are a principle part of the epidermis, hair, nails, horny tissues and enamel of the teeth. Keratin contains a high amount of sulfur because of the amino acid cystine. Keratin accounts for 30% of the cellular protein of living epidermal cells and 85% of cellular protein of the dead cells in the stratum corunem (scaly, dead or horny layer of the outer skin).

Keratoacanthoma - Also called "KA" by dermatologists. As the name implies, the lesion usually contains keratin and may look much like a red or pink volcano with an eruptive central plug of compact or fragmented scale. The KA is considered a form of squamous-cell carcinoma by most authorities. However, some doctors consider keratoacanthoma to be a disease of its own and not a malignancy. Indeed, in many cases, KA's behave in a rather benign fashion, neither locally destructive, nor invasive (spreading internally). Nevertheless, in medicine, we do not want to miss a potentially serious problem. Therefore, because many keratoacanthomas have been reported to invade deeply, grow rapidly and destroy body parts and important structures like the nose and eyes, certain KA's, behaving in certain ways, located in special areas, merit special attention. When any growth has even the uncommon potential to cause significant harm by invading locally or spreading distantly, that growth (in this case, KA) should be classified as skin cancer to alert doctors and the general public to be vigilant. Experts with thousands of cases of experience, however, many times can split hairs and predict which KA will cause trouble and which will not with about 98% accuracy. There is also a hereditary form of KA, as well as the eruptive form that can pop up with many KA lesions, especially on the arms and legs.

Lentigo - A freckle. Lentigos are very rarely malignant, only when they are a form of melanoma. Otherwise, most maturity (age-induced) lentigos are known as senile (old-age) lentigos. Senile lentigos are usually flat, light brown, very uniformly colored "liver spots" that are present on the arms, legs and hands of more mature patients. Other benign lentigos can be solar-induced (caused by the sun) in younger patients.

Lesion - A very non-specific term that can be used in many ways. This ambiguous term encompasses almost every process occurring on the skin, from allergy spots to skin cancers to moles. The author considers "lesion" a "wastebasket" or all-encompassing term because it describes almost any blemish on the skin. Medical practitioners who cannot accurately diagnose the true problem, e.g., some Board Certified Plastic Surgeons, frequently use the term "lesion" on the lab paperwork when they submit skin biopsies to labs for testing.

Liquid nitrogen - Liquid nitrogen, also known as LN2, is liquefied-nitrogen gas. It is the greatest component of the natural air we breathe. It exists at a temperature of -196 C. When a skin lesion is "frozen" with liquid nitrogen, the skin may reach extremely cold temperatures. It is usually the thawing process that damages the cells to be reduced or removed. Liquid nitrogen may be applied to the skin by spray bottle (canister), by cotton swab or by an intermediate transfer object other than swab to bring a low temperature to the skin lesion. Liquid nitrogen is commonly used to treat precancers, benign growths and skin cancers. It has varying degrees of failure and success depending upon the skill of the treating doctor.

Malignancy - A growth that has become malignant. See Malignant in the glossary.

Malignant - The tendency of a cancer or tumor either to invade the surrounding tissues, to destroy or replace the tissues previously present or to metastasize (spread to other parts of the body). Not all malignant tumors kill patients.

Melanocyte - A type of pigment cell located in the lower epidermis. The melanocyte usually provides tanning and sun protection as well as ultraviolet-radiation protection to the remainder of the skin. Melanocyte cells can become abnormal to varying degrees. The highest degree of abnormality in a melanocyte cell results in the deadly skin cancer melanoma.

Melanoma - A tumor derived from the melanocyte cells in the lower epidermis. Melanomas are graded according to the deepest depth to which they penetrate the skin tissue. The depth may be described in terms of millimeters (Breslow) or by the depth level of various structures in the skin tissue to which the melanoma has penetrated. Melanoma is a cancer/tumor that may spread not only locally, but also to distant sites in the body via the blood and the lymph-drainage systems. Melanoma is very curable in its earliest phases. Melanoma may arise on its own or from an atypical or unusual mole. More than 90% of melanomas occur on the visible portions of the body (skin); this shows the importance of clinical skin examinations in detecting, preventing and/or aiding in early removal of melanoma.

Metastasis - The spread of a cancer/tumor to another part of the body, not by the formation of a root, but by releasing bad cells into the blood streams or lymph streams that carry the cell(s) to a new location of invasion or growth.

Microscope - A viewing tool used by doctors to look at stained or unstained thinly cut or thinly placed specimens (samples or pieces) of biopsied tissue at powers of ten, hundreds, etc. The microscope is used to see deep into the centers of tissue that has been removed and is dead. Individual cells and parts of cells may be seen.

Misnomer - Wrong name. An improper, although perhaps scientific, name that was used in the past and will continue to be used in the future, merely for convenience. It's just too difficult to change to another term.

MOHS Surgery - MOHS Surgery is a form of excisional surgery that acts as a "perpetual biopsy," a term coined by the author. MOHS Surgery is the most accurate form of skin-cancer removal and spares more normal tissue than any other method. It is, unfortunately, expensive and requires proper training and precision in order to assure that it is being done properly. MOHS Surgery was developed by a dermatologist, Dr. Frederick E. Mohs, at the University of Wisconsin in the early half of this century. Mohs Surgery was recently used to treat skin cancers on both President Reagan and President Bush. Mohs Surgery is a form of horizontal section analysis and involves the removal of a bowl-shaped tissue specimen. MOHS is different from excisional surgery or excisional biopsy removal, which usually implies vertical sectioning. Vertical sections have an inherent failure rate. See Excisional biopsy.

Mole - A term understood by most dermatologists to represent a NEVUS. See Nevus. Unfortunately, many of the public use the term "mole" very loosely, sometimes including nevi (the plural of nevus), seborrheic keratoses and skin tags, among other growths. The public usually understands moles to be "good" or "bad." A "good" mole may best be thought of as a benign (common) nevus or an only slightly dysplastic nevus. See Dysplastic Nevus. A "bad" mole may best be thought of as a severely dysplastic nevus. See Atypical Mole. A mole on the skin does not necessarily mean that the growth will burrow like the animal.

Nevi - More than one nevus, plural of nevus.

Nevo-melanocyte - The cells existing along the spectrum between nevus or mole cells and melanocytes. These cells can be totally benign in nature or they may be more atypical, resulting in dysplastic moles and even melanoma. The true behavior of a nevo-melanocytic lesion can usually be determined by biopsying it and examining it under the microscope, rather than the doctor "eye-balling" it in the clinic. Nevertheless, the clinical examination sets up the more-definitive biopsy.

Nevus - A group of cells commonly referred to by the lay public as a "mole." A nevus may be congenital, meaning the mole probably existed at birth, or finally arose to the surface and became noticeable within the first year or so of life. Other nevi are considered acquired, which is probably best thought of as not being congenital or occurring sometime after the first years of life. The author believes that even acquired nevi are pre-programmed into a patient's genes just as a congenital nevus is. Both types may, in the future, be found to be genetically related. (The author seriously doubts that any external event like poison, radiation or trauma actually causes a nevus and, therefore, considers the term "acquired" to be a misnomer.) Another type of acquired mole is the dysplastic (atypical) mole.

Nevus recurrens - A mole of any type that has grown back after it was partly removed from the body by a surgical biopsy or surgery. Also, trauma such as cutting, tearing, etc., can cause part of a mole to look like nevus recurrens under the microscope and therefore cause concern that it might be melanoma. It helps for the patient to tell the doctor that a mole was previously cut or traumatized so that the doctor can advise the dermatopathologist who will examine the biopsy specimens(s) of the all-important history that may help determine a nevus recurrens.

Nucleus - The genetic control center of a cell, made of DNA. The nucleus is composed of chromosome genes that are tightly packed and pick up the dark purple stain hematoxylin. Cancer or abnormal cells often show irregularities in the nucleus.

Photodynamic therapy (PDT) - The use of a chemical, given orally (by mouth), intravenously (through the blood vessels) or topically (directly to the skin), that can be activated or energized by light to destroy a target tissue. This activation causes the formation of new molecules and free radicals that form other chemicals that, in turn, may destroy the targeted material to a varying extent. PDT is less effective for thick lesions. Skin cancers are usually thicker than precancers and respond less well. PDT has been only modestly successful in treating the simplest forms of skin cancer. Precancers are usually thinner and have a better response to PDT. The author foresees a significant role in the use of PDT to treat actinic keratoses and other extremely superficial skin growths.

Plastic surgeon - See also Board certified and Plastic surgery. A doctor who will surgically change, mold or shape a portion of a human being. A plastic surgeon rarely uses plastic. Plastic surgery is practiced by many different branches of medicine including Ear, Nose and Throat Surgeons, General Surgeons, Dermatologists, Ophthalmologists, Oculoplastic (a branch of Ophthalmology) Surgeons and Plastic Surgeons (common, usual variety) Board certification of a Plastic and Reconstructive Surgeon means that an individual has passed a test given by a "board" of "authoritative" individuals. Some board-certification tests may examine only memory by a paper test or computer exam, some tests are oral and some tests are physical, involving the doctor’s treatment or examination of a patient. Board examinations in plastic surgery were originally meant to restrict the practice of a certain portion of medicine to doctors who are "qualified" and have studied at an "approved training center" to perform plastic surgery. A plastic surgeon may sit for the board certification examination after completing 5 years of general surgery (cutting bowels, etc.) followed by just 2 years of plastic surgery training. Some boards have been used as tools to restrain trade or limit other specialists).

Plastic surgery - Surgery to change, mold or shape. It rarely has anything to do with the use of plastic. Plastic surgery is practiced by many different branches of medicine including Ear, Nose and Throat Surgeons, General Surgeons, Dermatologists, Ophthalmologists, Oculoplastic (a branch of Ophthalmology) Surgeons and Plastic Surgeons (common, usual variety). Plastic surgery is also used when doctors repair a defect. It should be performed in a meticulous and fine fashion by whatever type of doctor is doing the work. It was not until the middle of the last century that certain doctors felt that is would be desirable for them to break away as a group from other surgical specialties and form the American Society of Plastic and Reconstructive Surgeons with a TWO year training period (shorter than almost any other specialty). Thus about 50 years ago, the American Board of Plastic and Reconstructive Surgery was formed by many of the same doctors and only allowed doctors who were "grandfathered-in" and doctors completing the TWO year training period just mentioned to sit the board. Unfortunately, passing a board examination does not guarantee that a doctor is gifted with a scalpel, laser, liposuction device or sewing needle.

Prognosis - The predicted outcome of a disease or condition following either treatment or no treatment. Usually for potentially lethal skin cancers, like squamous-cell carcinoma and melanoma, prognosis is often measured in the five-year survival rate, i.e., the percent of patients who will be alive at the end of five years. For skin cancers known to destroy skin and structures locally, like basal-cell cancer, prognosis is usually measured in chances for the tumor to return following either treatment or no treatment, e.g., the recurrence rate at five years.

Process - A natural happening, usually marked by gradual changes, that ends in an expected result. A process may also be a series of actions or operations. As used in this text, a process may be a growth or the way cells are growing, be it normal or abnormal.

Protoporphryn IX - A photoactive (light-active) compound naturally occurring in the human body as a result of the conversion of aminolevulinic acid. Protoporphryn IX may collect in especially actively growing cells that are usually a sign of disorder, like precancer or cancer. Certain wave lengths of light cause Protoporphryn IX to absorb the light energy and to kill cells in which the protoporphryn is present in excess. This is the basis for photodynamic therapy, a highly promising treatment for precancers that will likely be available in the not-too-distant future.

Radiation therapy - The use of x-rays, ultraviolet rays and/or any electromagnetic radiation, possibly even light, in order to treat skin cancer or skin disease. An example of radiation therapy is the use of x-radiation to treat acne in children decades ago, which now causes those same patients to grow skin cancers wildly and aggressively. Another example would be the use of x-radiation or other radiation to destroy a skin cancer, such as a cancer growing into the ear of an 85-year-old patient, in whom major reconstructive surgery could cause a problem with bleeding, stress or heart disease.

Recurrence or Recurrent - A description of a tumor that, having FAILED previous medically acceptable and properly performed treatment(s), has re-grown.

Repair - The closing, fixing or covering of a defect (hole in the skin, fat, muscle or bone) where a skin tumor, cancer or growth has been removed, usually using the patient's own natural skin. In the future, skin repair may be accomplished using cloned or grown skin. The term could be loosely applied to repairing the skin with synthetic materials, as well.

Scar - Fibrous tissue, composed of collagen, formed by fibroblasts or other cells. Scars are usually the result of damage to the body and are readily visible on the skin. Collagen and scarring are the glue by which the human body heals wounds. Without the formation of deep scars, almost all skin wounds would split apart. Gland or surface tissue has little or no binding capability; therefore, scar tissue is important to all skin-surgery results. When sewing or closing wounds, the author prefers to create a deep, hidden, strong scar for permanent binding because the deep scar takes the pressure off the surface tissues. The surface scar can then be minimized by proper tension and stitch techniques. Any surgery or wounding of the skin results in some scar formation. The key to good surgical results is how easily the final scar can be seen or how well it is hidden in pre-existing wrinkle lines or natural anatomy lines.

SCC - An abbreviation for squamous-cell carcinoma. See Squamous-cell carcinoma.

Scraping & Burning - Also known as curettage and electrodesiccation or C&D. See Curettage.

Screening - Looking at large numbers of people in the hope of detecting some disorder. In dermatology, screening is usually used to detect skin cancer.

Sebaceous hyperplasia - Benign hair oil-gland overgrowth. These growths are genetically preprogrammed and usually range in size from that of a pinhead to that of a pencil eraser. "Seb hypes," as they are sometimes called, usually look like a tiny, yellow donut just above the skin surface of the face. A tiny blood vessel may be present on the seb hype. They rarely go away and usually continue to grow and multiply throughout time. Sometimes they may cause significant cosmetic deformity. They can be treated best with electrosurgery, but some lasers have shown promise.

Seborrheic keratosis - A greasy, oily wart. They are benign but occasionally a squamous cancer has been reported to develop within a seborrheic keratosis. Therefore, careful, close examination is necessary to be sure that all is well. Seborrheic keratosis may arise from lentigos (age freckles) or may start on their own, growing usually as a greasy, stuck-on brown, tan or black wart-like growth. If examined very closely under a magnifying glass, miniature white or light horn pearls (tiny, white beads of keratin that can fit on the tip of a pen) may be noticed within the seborrheic keratosis. Very rarely will seborrheic keratosis develop a malignancy within. Because seborrheic keratoses are so common, there is also a possibility that one or more may collide merely by chance with a skin cancer growing nearby. Many times patients confuse seborrheic keratosis with melanoma and go to a doctor for examination. A thorough examination by an experienced doctor is usually a reliable way to tell the difference. Unfortunately, there is a type of melanoma known as verrucous melanoma that can mimic seborrheic keratosis. Fortunately, however, this is an extremely rare event.

Secondary procedure - Doing something a second time, usually surgery, e.g., for touching up, to make more nearly perfect or to repair a treatment failure.

Skin - The largest organ of the body. Skin is composed of living and dead layers. The dead layers include the surface scale, outside hair and nail plate. The living layers include the epidermis, dermis, subcutaneous and all of the structures found within those layers, including blood vessels, sweat glands, etc.

Squamous-cell carcinoma (SCC) - A skin tumor or cancer likely derived from the keratinocytes (skin- surface cells) closer to the surface of the skin. There are several grades of squamous-cell carcinoma, depending on how unusual the tumor's cells are. The less normal (and less natural) the cells are, the more aggressively (badly) they usually behave. For example, poorly differentiated (not looking much like any normal tissue found in the skin) squamous-cell carcinoma has a much greater tendency to spread unchecked and kill a patient than well-differentiated SCC.

Standard surgical excision - Also known as routine excision, it has the same net effect as an excisional biopsy. The doctor guesses how wide the lesion is, then cuts a wider specimen than it appears to him/her that the lesion occupies. The apparent excess is taken in order, he/she hopes, to clear away all of the abnormal cells of the skin cancer or skin process. This form of therapy (treatment) has an inherent failure rate that varies with the amount of normal tissue the doctor cuts around the edge. Excisional biopsy usually implies the process of vertical sectioning, which carries with it an inherent failure rate. See Vertical sections.

Stratum corneum - Usually the outermost layer of the epidermis on most exposed tissue, also known as the horny layer. It is composed of tightly packed, scale-like dead keratinocyte cells, which are constantly being replaced by new cells from the lower epidermis below. It is dead tissue (cells) that contributes to the physical outer barrier of the skin. The keratinocytes consist mostly of keratin, a protein. The outermost stratum corneum is relatively acidic and is therefore also called the acid mantle.

Subcutaneous - Lying below or under the cutaneous (dermis, leather) tissue. This tissue is usually composed of fat cells and the structures that run through it, i.e., blood vessels, nerves, etc. Fat is a soft, shock-absorbing barrier that acts as a conduit for the nerves and blood vessels. As well, subcutaneous tissue is an energy-storage device. See Fat in the glossary. The sebaceous glands of the hair follicle arise in the subcutaneous layer and are in high concentration on the face and scalp. There are no sebaceous glands on the palms or soles.

Surgery - A procedure that permanently manipulates or changes the body, usually by tool or instrument, with the expectation of some beneficial effect. Most skin surgery results in scarring (fiber tissue formation). However, if an incision is minor enough or well placed, the resulting scar may be difficult for the casual observer to detect. Signs of scarring include thickened skin, the loss of surface lines, redness and permanent whiteness.

Surgical biopsy - A fancy term that means the same thing as just plain old "biopsy." See Biopsy.

Syndrome - A group of signs or symptoms that, occuring together, characterize a particular abnormality (Webster). A collection of things that happen together in a patient that spell-out a special disease or problem that is usually given a particular name. Some, but not all, syndromes can hereditary in families.

Therapy - Treatment. Medical treatment does not involve cutting or phsically damaging the skin with electricity, acids, lasers or knives like surgical treatment does. Medical treatment may involve topicals, pills, injections, elixirs or the like.

Topical - Applicable to the surface, or on top of the skin. Ointments (greasy), creams (water and grease mixed), lotions (some water and oil mixed), solutions (water or alcohol based) or gels (usually alcohol based) are topically applied to the skin. Topical agents usually carry something of purpose if used to treat skin cancers or precancers. For example, topical fluorouracil (5-FU) is a chemotherapy drug used to treat precancers on the skin's surface. Topical 5-FU may be applied as either a cream or lotion.

Tumor - A growth that may be malignant or nonmalignant, good or bad, fast- or slow-growing. The term indicates the unusual presence of a type of tissue (group of cells) in an area in which it is not commonly found in most individuals. The word tumor is another term the author considers a "wastebasket" term. For example, melanoma, a tumor, may kill a person. As well, a benign mole on the tip of the nose or the on the front of the knee can be considered a tumor, although it will not harm anyone. It is important to know that the word tumor does not necessarily mean something is deadly or even harmful to life.

Vein - Blood vessel that takes blood back to the heart from the capillaries, where oxygen has been released from the red blood cells for use by the body.

Verruca - The technical term for wart. Verrucous refers mainly to the visibly roughened ridge-like surface of a wart or other skin growth. See Wart.

Vertical sections - Usually made by the "breadloafing" method of testing a specimen to see if a tumor or another process still involves the edges of the sample taken from the body. If a process involves the edges of the tested specimen, then it is highly likely that the process (benign or malignant) involves the edges of the tissue that remain behind in the body from where the specimen was taken. Unfortunately, vertical sections test only a small segment (portion) of the edge of a specimen and, therefore, have an inherent failure or uncertainty rate. Most surgeons do not know this important fact, as you will see if they are questioned. Vertical sections were the cause of the plastic surgeons' failing to cure the basal-cell skin cancer on President Reagan's nose the first time. Horizontal section testing does not have this inherent failure rate.

Wart - Otherwise known as a verruca. A wart is almost always a benign growth found on humans caused by the human papilloma (wart) virus (HPV). Warts are contagious (spreadable) but many people just have a weak immunity to wart and fungus infection to which they are, therefore, more susceptible than other people. Some wart virus infections have been shown to develop into cancer, although this is fairly rare event.