James J. Romano, MD
CLOTHING AND SKIN PROTECTION FACTS
- A light T-shirt has a sun protection factor (SPF) of only 6 or 7, not even close to the 15 or 30 in a good sunscreen.
- Bleached cotton clothing offers less protection than unbleached cotton, wool, or polyester.
- Darker colors block more sunlight than lighter colors.
- Loose-fitting apparel is more protective than stretch fabrics that hug the skin.
- Consider using an excellent hat designed specially to protect against the sun. This is available at: www.sundayafternoons.com.
Skin Cancer Facts
- There are three different types of skin cancer: basal cell, squamous cell, and melanoma. Each is easily recognized on the skin surface.
- Basal cell carcinoma is the most common and presents as crusty, scaly lesions that bleed easily and never seem to heal. It grows very slowly. It is easily treated and cured if removed in the early stages. It is very, very destructive if allowed to spread into the surrounding tissues.
- Squamous cell carcinoma is the second most common, and is similar to basal cell carcinoma at times but usually starts off as a red painful area and grows much more rapidly. Unlike basal cell carcinoma, it can break off and spread into the bloodstream and then can become fatal.
- Melanoma is the least common but most deadly. It arises in the pigment-bearing cells and for this reason is usually colored. See the typical photos and ABCD warning signs below. Any suspicious areas should be biopsied.
Melanoma Images
ABCD’s of Melanoma
- Non-malignant lesions can be suspicious looking and deserve evaluation by your doctor. These include actinic keratoses and seborrheic keratoses. These are sun spots and age spots and raised areas that can usually be treated by shaving, peels, or creams.
- For more information on skin cancer, visit the Skin Cancer Foundation at www.skincancer.org.
SKINCARE
Proper care and maintenance of the skin parallels much of the same things we do for our body as a whole. These are our basic recommendations, which are customized to your skin and lifestyle and expectations during a full-hour intensive consultation with our skincare specialist.
- First is the avoidance of environmental pollutants, especially the sun, cigarette smoke, and improper diet.
- Skin cancer surveillance.
- Emphasis on hydration with two quarts of water intake daily.
- Cleansing of the skin. This is not only with specific medical-grade products, but also through periodic hands-on treatments with our specialists for deeper cleansing.
- The skincare specialist. Skin cleansing, care, and maintenance definitely require the skill and expertise of a dedicated highly qualified specialist who can squeeze the pores, treat the skin, and educate you in ways you simply cannot do yourself.
- Topical products. There are many products and nutraceuticals and cosmeceuticals that provide specific medical-grade benefits to the skin and should be used under the supervision and recommendation of your doctor or skincare specialist. These include:
- Vitamin C
- Bleaching creams
- Topical growth factors
- Retin-A
- Copper peptides
- Aloe vera
- Textural interventions. This relates to the procedures designed to treat smoothness, light scars, wrinkles, blemishes, pigmentation, blotchiness, and mild skin laxity.
- Chemical interventions such as peels. These can be light (glycolic or alpha hydroxy peels), medium (TCA or Blue peel), or deep (Phenol). The healing time, permanency, and level of improvement increases as you go up the scale.
- Mechanical interventions. This includes microdermabrasion and dermabrasion. An abrasive substance or rotary device is used to remove the upper skin cell layers, usually after a period of skincare pre-treatment or in combination with other interventions.
- Systemic products. Most of the nutrients, supplements, and dietary interventions you utilize in our program will have a direct effect on improvement and maintenance of the skin.
- Education. There are many products and interventions, and this needs to be an ongoing evaluation, recommendation, and treatment process with constant learning by the patient and education by your supervising doctor and skincare specialist.
EXERCISE
Do not think of this just as a means to lose weight, which it affects the least. It is mostly beneficial in protecting the heart, strengthening bones, improving sleep and memory, reducing cancer risk, and retaining muscle mass.
- Obtain a consultation from a personal trainer to know what exercises to do, and develop a program that is safe and fun and will not harm your body.
- Exercise at least 20 minutes as day with the endpoint of raising your heartbeat (breaking into a sweat).
SPIRITUALITY AND RELATIONSHIPS
Do not ignore or underemphasize this. A sound marriage is one of the strongest positive factors in prolonged life and longevity. These place great emphasis on your basic human and loving needs and need for fulfillment. The approach is very personal but can be evaluated and improved greatly with reading, resources, and professional evaluation and interventions.
STRESS
Management of stress and relaxation is important.
- Learn relaxation techniques and spend ten minutes daily purposely and consciously doing nothing in an effort to rest your brain activity and relax your mind.
- Meditation is very powerful. Your brain is a very active organ that needs relaxation and rest besides just sleep. Learn these techniques and use them daily.
- Consider yoga, tai chi, or other practices.
- Relaxation treatments work on your body and your mind and state of well-being. Massage, hydrotherapy, and sauna are excellent examples of this. Personal nail and hair treatments can contain many of these relaxing elements.
RISK FACTOR AND ENVIRONMENT POLLUTANT ANALYSIS
- No cigarette smoking. Also avoid secondhand cigarette smoke, which is more harmful that actually smoking. This is because the pollutants are unfiltered, unlike when you are smoking.
- Be careful of the sun, especially through its role of conversion in the skin of pre-Vitamin D to its active form. Sunlight can be an important factor in the prevention of rickets (vitamin D deficiency). For all this essential good, sunlight can be our enemy, especially to the skin and vitality of the skin. It is the singular harshest aging factor to our skin. We need some sun, but do not overdo it.
- Avoidance of sun exposure. Not just sun-tanning. This also means excess in casual sun activities like biking, hiking, and gardening.
- Use sunscreen. This means using the proper product and using it properly. Use at least an SPF 30. Make sure it contains a physical sun block, such as zinc oxide and titanium dioxide. Use at least a generous two tablespoons on sun-exposed areas every two to four hours while in the sun and after getting wet or sweating.
- Proper clothing. Not all clothes shield damaging sun rays.
- Consider using a bronzing or tanning cream for your color.
- Minimize alcohol intake.
PLASTIC SURGERY EXAM
These are all features that can be improved with plastic surgery and can decrease the appearance of aging:
- Skin exam. Look for loose skin, folds, wrinkles, creases, pigmentation, skin lesions, blotchiness, and spots.
- Facial exam. Look for drooping eyebrows, excess skin, and fat of the eyelids and face. Notice if the eyelids are loose and lack elasticity. Note jowls, drooping to the corners of the mouth and nose. See if there are loose hanging folds of skin and muscles in the neck.
- Breast exam. Notice if there are stretch marks and looseness of unevenness from one side to the other or an unusual shape (tubular) to the breasts. Note that sagging is defined by nipples below the level of the fold beneath the breasts. Note if the breasts are enlarged and uncomfortable, numb, or painful and associated with rashes and deep bra-strap grooves. See if the nipples are inverted, enlarged, or uneven. Notice if the areolae are large or puffy.
- Body exam. Note abnormal large fat accumulations, especially those unresponsive to diet and exercise. Note excess skin and looseness in the arms, thighs, or abdomen. Note if there is an abdominal pouch or protuberance or weakness (hernia). Notice the contours of the calves, ankles, and knees.
