fileAge spots (lentigo) are a common, usually benign skin condition in older people. Age spots are also called liver spots, but that has everything to do with the color. The term therefore does not refer to a poorly functioning liver. About 80% of Dutch and Belgians aged 65 and older have one or more lentigo spots.

What do age spots look like?

A lentigo is typically a uniformly brown, sharply defined oval or irregularly defined flat spot of a few millimeters to a few centimeters in size. The spots are mainly seen on the face and on the backs of the hands, sometimes also on the décolleté.

A condition that is sometimes confused with age spots is purpura senilis. These are also dark spots that mainly occur in older people, but they are not caused by too much pigment. They are small bruises that occur because the skin becomes less elastic with age.

Types of age spots

1. Lentigo solaris (liver spots): These age spots are the most common. They are also called liver spots or sun spots.
2. Verruca seborrhoica (age warts): These age spots usually look wart-like or cauliflower-shaped and often become slightly larger than the other age spots, up to several centimeters in diameter. However, some age warts look like liver spots or moles.
3. Senile angiomas (blood blisters): These age spots are characterized by a red or purple color. That is why they are also called blood blisters or ruby ​​spots.
4. Idopathic guttate hypomelanosis (white age spots): These spots are white and round, and on average half a centimeter in size.

Also read: White spots on the skin: what types are there?

Cause of age spots

There is a clear connection between the development of lentigo and the amount of sunlight to which the skin is exposed during life. They are most commonly found in lighter skin types (people with red hair who have difficulty tanning). They also occur in people who have been treated with PUVA therapy for a long time due to a skin disease (e.g. or ).

Also read: SPF sunscreen: can you stay in the sun longer with a high factor?

Sometimes malignant: lentigo maligna

Lentigo is usually completely benign. However, sometimes malignant pigment cells can develop. This is then referred to as lentigo maligna (or Dubreuilh’s disease). In fact, lentigo maligna is the last stage before melanoma, the most malignant form of skin cancer. It is still unknown how long it takes for a lentigo maligna melanoma to develop. The chance of malignant degeneration is estimated at 25 to 50%.

A lentigo maligna is distinguished from a normal lentigo by varying and erratic pigmentation. The pigment is no longer even, but there are some dark brown to almost black spots.
If lentigo spots change or cause symptoms, the doctor should be consulted.

Remove age spots

Because a lentigo is benign, it does not actually need to be treated. If you find the spots disturbing, you can camouflage them with makeup so that they are less noticeable.
If it is desirable to remove the lentigo for cosmetic reasons, various treatments are possible. You can opt for a chemical peeling, electrocoagulation (burn it off) or a treatment with liquid nitrogen. The more expensive, but most efficient treatment is laser therapy. Moreover, the chance of scar formation is very small. A lentigo maligna must always be treated. This treatment usually consists of surgical removal.

Also read: Types of skin cancer: which spots are possibly malignant?

Sources:
https://www.huidarts.com
https://www.mmc.nl

fileMany people with naturally dark or tanned skin think that sunscreen is not necessary thanks to their extra pigment. But that is not true: even tanned skin can unknowingly suffer damage from UV radiation.

Why you are also at risk of skin damage and skin cancer with dark skin

Do you have dark or quickly tanning skin? Then you naturally have more melanin, the pigment that partly protects your skin against the sun. This means you burn less quickly and see less redness. But make no mistake: UV rays still penetrate and can damage the DNA in your skin cells. This causes aging, pigment spots and increases the risk of skin cancer.

Although skin cancer is less common in people with darker skin, it is unfortunately often discovered late. Spots are less noticeable or appear in less visible places, such as under the soles of your feet or nails. This makes the disease more difficult to treat. For example, according to the American Cancer Society, the survival rate five years after diagnosis for black patients with melanoma is 70%, compared to 94% for white patients.

Applying a sunscreen of at least SPF 30 every day is therefore not an unnecessary luxury. It not only prevents sunburn, but also reduces the risk of various forms of skin cancer, including melanoma. In addition, it helps to prevent pigment spots and melasma (dark spots), something to which people with dark skin are often extra sensitive. Many creams also contain antioxidants and moisturizing ingredients, which keep your skin supple and protect against premature wrinkles.

In short: daily sun protection is essential, even with dark skin.

Tips for good sun protection for dark skin

• Use at least SPF30 daily; go for SPF50+ for longer exposure or on sunny days.
• Minerals such as zinc oxide and titanium dioxide offer a broad spectrum of protection and are gentle on your skin.
• Use tinted sunscreen formulas. They do not leave a white cast and also block blue light from screens.
• Apply 5–10 minutes before going into the sun so that the cream adheres well. Repeat every 2–3 hours, especially after swimming or exercising.
• Inspect your entire body every month, including the soles of your feet, under your nails and between your toes, for new or abnormal spots. If in doubt, go to your doctor or dermatologist.

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fileDCIS is an early stage of breast cancer that is confined to the milk ducts. It is usually discovered through mammography and has a small risk of becoming invasive. Treatment is important to prevent further growth.

What is ductal carcinoma in situ?

Ductal carcinoma in situ, DCIS for short, is a very early form of breast cancer. The cancer cells are located exclusively in a milk duct of the breast and have not yet penetrated the surrounding breast tissue. That is why DCIS is also called non-invasive, pre-invasive or stage 0 breast cancer.

DCIS is often discovered during a mammography, for example during a breast cancer screening or when examining a lump in the breast. The risk of DCIS spreading or becoming life-threatening is small, but careful assessment and consideration of treatment remains important.

Also read: What are the symptoms of breast cancer in women?

Grades of DCIS

The abnormal cells are compared with healthy breast cells. On this basis, a grade is assigned, which says something about how abnormal and how fast-growing the cells are:

• Grade 1 – well differentiated: cells still closely resemble healthy cells and usually grow slowly.
• Grade 2 – moderately differentiated: cells look less like healthy cells and often grow faster.
• Grade 3 – little differentiated: cells have an abnormal shape, stick together and hardly resemble healthy cells. This variant usually grows faster.

Symptoms of DCIS

Ductal carcinoma in situ usually causes no complaints. Sometimes DCIS can lead to symptoms such as:

• A lump in the breast.
• Bloody discharge from the nipple.

Make an appointment with your doctor if you notice changes in your breasts, such as:

• A lump.
• A retracted or strange looking patch of skin.
• A thickened area under the skin.
• Discharge from the nipple.

Also read: What are the symptoms of breast cancer in women?

Causes of DCIS

The exact cause of DCIS is not known. It occurs when cells in a milk duct of the breast develop changes in their DNA. Healthy cells have DNA that provides instructions to grow in a controlled manner and to die in time. In cancer cells, DNA changes ensure that cells divide more quickly and uncontrollably and do not die when they should. In DCIS, the cancer cells do not yet have the ability to leave the milk duct and invade the surrounding breast tissue. Possible contributing factors are lifestyle, environmental factors and hereditary DNA changes.

Who is more at risk for DCIS?

• Family history of breast cancer, especially in young age or multiple family members.
• Previous breast cancer or certain benign breast abnormalities such as LCIS or atypical hyperplasia.
• Menstruation before age 12 or menopause after age 55.
• Being a woman (but men can get breast cancer too).
• Dense breast tissue.
• Alcohol consumption.
• First pregnancy after 30 years or never been pregnant.
• Older age.
• Hereditary DNA mutations such as BRCA1 or BRCA2.
• Hormone therapy during menopause (estrogen + progesterone).
• Overweight.
• Exposure to thoracic radiation at a young age.

How can you reduce your risk of DCIS?

You may be able to lower your risk by:

• Discuss with your doctor when and how often you should screen.
• Check your breasts yourself to notice changes faster.
• Limit or abstain from drinking alcohol.
• Exercise regularly (at least 30 minutes a day, several days a week).
• Limit hormone therapy during menopause.
• Maintain a healthy weight.

Diagnosis DCIS

DCIS is usually discovered through a mammography and can almost never be felt. When the number of cells in the milk ducts increases, some cells may die due to lack of oxygen. These dead cells can calcify and clump together to form microcalcifications. These calcifications are visible on mammography. Depending on the result, the doctor may decide to perform a puncture. Such a puncture is often done stereotactically: the breast is precisely imaged during mammography to locate the small calcifications, because these are usually not visible on an ultrasound scan.

DCIS treatment

With ductal carcinoma in situ (DCIS), the chance is small, but there, that it will develop into an invasive breast cancer. Therefore, the abnormal tissue is usually removed via breast surgery.

Two surgical options

1. Breast-conserving surgery: the DCIS is removed together with a border of healthy tissue. Because DCIS is often not palpable, the radiologist places a thin metal wire (harpoon) in advance to pinpoint the spot. The removed tissue is examined to check whether all abnormal cells are gone (negative cutting edge) or whether there are still cells at the edge (positive cutting edge). A positive incision edge sometimes requires a second operation.
2. Mastectomy: If the DCIS is too extensive, the entire mammary gland with skin and nipple is removed.

Sometimes the sentinel node (first lymph node near the tumor) is removed and examined during the operation. If this is clean, the other armpit glands are usually also free of cancer cells.

Possible after-treatment

• Radiation: breast-conserving surgery is often followed by radiotherapy to destroy remaining cells.
• Antihormonal therapy: If the tumor is hormone sensitive, a daily pill may be prescribed for at least five years.
• After the operation, there is a schedule of regular check-ups: first every three months, then less often. A mammography and ultrasound are performed annually.

DCIS survival rates

With ductal carcinoma in situ, the chances of survival are very high. Worldwide, with adequate treatment, long-term survival is more than 97%. In addition, the chance that DCIS will develop into invasive breast cancer per year is small. In short, with timely and appropriate treatment, the risk of death from DCIS is very small.

Also read: What are the survival rates for breast cancer?

Emotional impact of the diagnosis and treatment

Hearing that you have cancer is emotionally devastating. DCIS is technically a preliminary stage, but the treatment can still be drastic. It can be difficult to comprehend it all. You may experience a variety of feelings, such as sadness, uncertainty, powerlessness, misunderstanding and anger. These feelings can be intense and confusing, but they are completely normal. Support from partner, children, family and friends often helps. Sometimes extra help is needed to process everything. Do not hesitate to contact a doctor or psychologist.

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