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. The author believes that 5-year cure rates for many types of skin cancer treatments are far too short to be a reliable indicator of a treatment choice for younger patient (<50 years old). 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. The ACGME, the recognized official governing body for all specialties medical training in the United States has officially voted and recognized dermatologic surgery under the new heading "Procedural Dermatology."

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 average dermatologists and average 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 (dermatoscope) - 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 level or 10% unsurety level) by taking 3 millimeters (1/8 inch, or small pencil eraser in size) 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% of squamous cell cancers will be missed and left in the body with anything less. 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. Failure rates are usually classified for skin cancer purposes along the same time intervals that cure rates are classified, i.e.. 5 year. The author believes that 5 year cure rates/failure rates are an unreliable indicator of which treatment a younger skin cancer patient should be seeking. Unfortunately, very little data exists for 10 year cure rates, and most "evidence" is anecdotal "doctors reminiscing about cases."

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 website: www.Lipoinfo.com.