Dr. Rockoff received his undergraduate degree from Yeshiva College with the distinction of Summa Cum Laude. He received his medical degree from the Albert Einstein College of Medicine. His internship and two years of Pediatric residency were at the Bronx Municipal Hospital Center, followed by training in Dermatology at the combined residency program at Tufts and Boston Universities. Dr. Rockoff is certified by both the American Board of Dermatology and the American Board of Pediatrics.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Squamous cell carcinoma is cancer that begins in the squamous cells, which are thin, flat cells that look like fish scales under the microscope. The word
squamous came from the Latin
squama, meaning "the scale of a fish or serpent" because of the appearance of the cells.
Squamous cells are found in the tissue that forms the surface of the skin,
the lining of the hollow organs of the body, and the passages of the respiratory
and digestive tracts. Thus, squamous cell carcinomas can actually arise in any
of these tissues.
Squamous cell carcinoma of the skin occurs roughly one-quarter as often as
basal cell carcinoma. Light-colored skin and a history of sun exposure are even
more important in predisposing to this kind of cancer than to basal cell
carcinoma. Men are affected more often than women. Patterns of dress and
hairstyle may play a role. Women, whose hair generally covers their ears,
develop squamous cell carcinomas far less often in this location than do men.
The earliest form of squamous cell carcinoma is called actinic (or solar) keratosis. Actinic keratoses appear as rough, red bumps on the scalp, face, ears, and backs of the hands. They often appear against a background of mottled, sun-damaged skin. They can be quite sore and tender, out of proportion to their appearance. In a patient with actinic keratoses, the rate at which one such keratosis may invade deeper in the skin to become a fully-developed squamous cell carcinoma is estimated to be in the range of 10%-20% over 10 years, though it may take less time. An actinic keratosis that becomes thicker and more tender raises the concern that it may have transformed into an invasive squamous cell carcinoma.
A rapidly-growing form of squamous cell carcinoma that forms a mound with a central crater is called a
keratoacanthoma. While some consider this not a true cancer but instead a condition that takes care of itself, most pathologists consider it to be a form of squamous cell cancer and clinicians treat is accordingly.
Other forms of squamous cell carcinoma that have not yet invaded deeper into the
skin include
actinic cheilitis, involving the lower lip with redness and scale, and blurring the border between the lip and the surrounding skin;
Bowen's disease, sometimes referred to as squamous cell carcinoma in situ. (The Latin words
in situ refer to the presence of the cancer only in the superficial epidermis, without deeper involvement.) Bowen's
disease appears as scaly patches on sun-exposed parts of the trunk and extremities; and
Bowenoid papulosis: These are genital warts that under the microscope look like Bowen's
disease but behave like warts, not like cancers.
What are risk factors for developing squamous cell carcinoma?
The single most important factor in producing squamous cell carcinomas is sun
exposure. Many such growths can develop from precancerous spots, called actinic
or solar keratoses. These lesions appear after years of sun damage on parts of
the body like the forehead and cheeks, as well as the backs of the hands. Sun
damage takes many years to promote skin cancer. It is therefore common for
people who stopped being "sun worshipers" in their 20s to develop
precancerous or cancerous spots decades later.
Several rather uncommon factors may predispose to squamous cell carcinoma.
These include exposure to arsenic, hydrocarbons, heat, or X-rays. Some squamous
cell carcinomas arise in scar tissue. Suppression of the immune system by
infection or drugs may also promote such growths. Some strains of HPV (the human
papillomavirus responsible for causing genital warts) can promote development of squamous cell carcinoma in the anogenital region.
Can squamous cell carcinoma of the skin spread (metastasize)?
Yes. Unlike basal cell carcinomas, squamous cell carcinomas can metastasize,
or spread to other parts of the body. These tumors usually begin as firm,
skin-colored or red nodules. Squamous cell cancers that start out within solar
keratoses or on sun-damaged skin are easier to cure and metastasize less often
than those that develop in traumatic or radiation scars. One location
particularly prone to metastatic spread is the lower lip. A proper diagnosis in
this location is, therefore, especially important.
How is squamous cell carcinoma diagnosed?
As with basal cell carcinoma, doctors usually
perform a biopsy to make a proper diagnosis. This involves taking a sample by injecting local anesthesia
and punching out a small piece of skin using a circular punch blade. Usually the
method used referred to as a punch biopsy. The skin that is removed is then
examined under a microscope to check for cancer cells.
How is squamous cell carcinoma treated?
Techniques for treating squamous cell carcinoma are similar to those for
basal cell carcinoma (for detailed descriptions, see above under treatment of
basal cell carcinoma):
Curettage and desiccation: Dermatologists often prefer this method, which
consists of scooping out the basal cell carcinoma by using a spoon like
instrument called a curette. Desiccation is the additional application of an
electric current to control bleeding and kill the remaining cancer cells. The
skin heals without stitching. This technique is best suited for small cancers in
non-crucial areas such as the trunk and extremities.
Surgical excision: The tumor is cut out and stitched up.
Radiation therapy: Doctors often use radiation treatments for skin cancer
occurring in areas that are difficult to treat with surgery. Obtaining a good
cosmetic result generally involves many treatment sessions, perhaps 25 to 30.
Cryosurgery: Some doctors trained in this technique achieve good results
by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the
growth to freeze and kill the abnormal cells.
Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this
technique of removing skin cancer is better termed, "microscopically
controlled excision." The surgeon meticulously removes a small piece of the
tumor and examines it under the microscope during surgery. This sequence of
cutting and microscopic examination is repeated in a painstaking fashion so that
the basal cell carcinoma can be mapped and taken out without having to estimate
or guess the width and depth of the lesion. This method removes as little of the
healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs
micrographic surgery is preferred for large basal cell carcinomas, those that
recur after previous treatment, or lesions affecting parts of the body where
experience shows that recurrence is common after treatment by other methods.
Such body parts include the scalp, forehead, ears, and the corners of the nose.
In cases where large amounts of tissue need to be removed, the Mohs surgeon
sometimes works with a plastic (reconstructive) surgeon to achieve the best
possible postsurgical appearance.
Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (Aldara). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.
The possibility of metastasis makes it especially important to diagnose
squamous cell carcinomas early and treat them adequately.
How is squamous cell carcinoma prevented?
Even more so than is the case with basal cell carcinoma, the key principles
of prevention are minimizing sun exposure and getting regular checkups.
Common-sense preventive techniques are the same as for basal cell carcinoma
and include
limiting recreational sun exposure;
avoiding unprotected exposure to the sun during peak
radiation times (the hours surrounding noon);
wearing broad-brimmed hats and tightly-woven protective
clothing while outdoors in the sun;
regularly using a waterproof or water-resistant
sunscreen with UVA protection and SPF 30 or higher;
undergoing regular checkups and bringing any suspicious-looking or
changing lesions to the attention of a doctor; and
avoiding the use of tanning beds and using a sunscreen with an SPF 30 and protection against UVA (long waves of ultraviolet light). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every
two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."
A skin tag is a small benign growth of skin that projects from the surrounding skin. Skin tags can vary in appearance (smooth, irregular, flesh colored, dark pigment, raised). Skin tags generally do not cause symptoms unless repeatedly irritated. Treatment for skin tag varies depending on the location on the body.
Melanoma is a type of skin cancer which begins in skin cells called melanocytes and affects more than 53,600 people in the United States each year. These melanocytes can grow together to form benign moles which, after a change in size, shape, or color can be a sign of melanoma. Caused by sun exposure, early detection becomes extremely important to avoid a spread to other areas of the body. Diagnosis is confirmed through a biopsy of the abnormal skin and treatment depends on the extent and characteristics of the patient.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Actinic keratoses are rough, scaly patches of skin that are considered precancerous and are due to sun exposure. Prevention is to cut sun exposure and wear sunscreen.
A pilonidal cyst is a cyst that forms near the cleft of the buttocks. The cysts are thought to be caused by the penetration of loose hairs into the skin. Symptoms and signs include pain, swelling, redness, warmth, and drainage of pus from the area of the cyst. Treatment of a pilonidal cyst involves incision and drainage.
Vitamins are organic substances that are essential for the proper growth and functioning of the body. Calcium is a mineral essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting.
Freckles are flat circular spots on the skin that may be red, yellow, tan, light brown, brown, or black in color. Lentigo is the term used to describe certain types of darker freckles. Ephelis typically appear during the sunny months. Freckles can be prevented with sunscreens, the use of wide-brimmed hats, sun-protective clothing, avoiding peak sun hours, and seeking shade and staying indoors.
Blepharitis is inflammation of the eyelids. Acne rosacea, Staphylococcal bacteria, allergies, sensitivities to makeup or contact lens solutions, head lice, or other conditions may cause blepharitis. Symptoms and signs include itchy eyelids, burning sensation in the eyes, crusting of the eyelids, light sensitivity, red, swollen eyelids, loss of eyelashes, and dandruff of the lashes and eyebrows. Proper eyelid hygiene and a regular cleaning routine controls blepharitis.
Birthmarks and other abnormal skin pigmentation is caused by the body's inability to produce enough melanin. Abnormal skin pigmentation can cause conditions such as vitiligo, pigmentation loss, melasma, albinism, port wine stains, macular stains and hemangioma.
Lichen sclerosus is a skin disease that causes white spots to form on the skin, which later grow into large, thin, and crinkled patches of skin that tear easily. Symptoms include itching, pain, blisters, and bleeding. Patches on the upper body usually go away over time, but patches in the genital region may scar if left untreated, causing problems with urination or sex. Treatment may involve surgery or the use of a very strong cortisone cream.
Moles are small skin growths that may appear flat or raised and are often tan, brown, black, reddish brown, or skin colored. They are typically about the size of a pencil eraser. There are three types of moles. Monthly skin self-exams are essential in the early detection of abnormal moles and melanomas.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Sun sensitivity (photosensitivity) is an inflammation of the skin induced by the combination of medications or substances and sunlight. The affect on the skin is redness, which looks similar to a sunburn. Generally, these reactions are either phototoxic or photoallergic. Phototoxic drugs are more common than photoallergic drugs. Symptoms of phototoxic reactions are a burning and stinging sensation and then redness. Symptoms of photoallergic reactions are itching, redness, swelling, blisters of the affected area. Treatment generally is discontinuation of the medication and topical application of creams.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.
Sunscreens are crucial for sun protection. Sun damage to the skin from exposure to ultraviolet rays is a risk factor for skin cancer and melanoma. To avoid sunburn, people should limit sun exposure during the peak hours of 10 a.m. to 3 p.m., wear protective clothing, and use a sunscreen. People with sensitive skin should use a sunscreen with an SPF of 30 or more.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
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