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Michael E. DeBakey VA Medical Center - Houston, Texas

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VA Dermatologist Battles Skin Cancer

March 11, 2009

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Listed as one of the best doctors in the nation in the field of dermatology, Ida F. Orengo, M.D., Dermatology assistant chief at the Michael E. DeBakey VA Medical Center, examines U.S. Army Veteran Robert Nowlin during a recent appointment. Orengo is also the director of the Mohs Surgery Center, a professor in the Department of Dermatology, and an assistant professor in the Department of Otorhinolaryngology at Baylor College of Medicine. She is board certified by the American Board of Dermatology.


HOUSTON – Dermatologists at the Michael E. DeBakey VA Medical Center (MEDVAMC) have a wide variety of treatments, valuable information, and technology at their fingertips to keep veterans from developing skin cancer and treat those who are suffering from the disease.

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands, and arms. Another type of skin cancer, melanoma, is more dangerous but less common.

Anyone can get skin cancer, but it is more common in people who spend a lot of time in the sun or have been sunburned, have light-colored skin, hair, and eyes, have a family member with skin cancer, or are over age 50.

Whether your scalp is covered with a full head of hair or not, MEDVAMC dermatologists say play it safe when it comes to skin cancer on the scalp. “While most cases of skin cancer on the scalp are found in balding men, a full head of hair does not mean you are fully protected,” said Ida Orengo, M.D., Dermatology assistant chief.

Dark thick hair gives more protection compared to blond wispy locks, but some type of extra protection should be used at all times. Drug stores now carry shampoo or leave-in conditioners that include sunscreen. However, the best prevention method is to wear a hat with at least a three-inch brim around the entire head. If not a hat, which can be uncomfortable in the heat, then carry an umbrella for shade.

The most common forms of skin cancer found on the scalp are basal, squamous and melanoma, which can be deadly.

“Early detection is important, so if you have a regular hair dresser you might want to ask him or her to keep an eye out for any new moles or bumps,” Orengo said. “Most patients say their hair dresser or barber find the skin cancer first.”

Those at risk for skin cancer should also have an annual full-body skin check, which includes the scalp, the skin along the hairline, and the ears.

Orengo has worked with dermatologists at Baylor College of Medicine (BCM) to test a topical treatment for certain types of skin cancer. While a topical treatment for precancerous cells has been around for more than 30 years, it was only in the last five to 10 years a topical cream was developed for cancerous lesions.

“The cream, called Aldara™, only works for certain types of skin cancer,” said Orengo, who is also a professor of dermatology at BCM and director of the Mohs Surgery Center at the Baylor Clinic.  “You simply rub it on the area, usually at night, and after about four to six weeks, the cancer is gone in about 80 percent of the cases.”

It is FDA-approved for superficial basal cell and actinic keratosis, but has shown good results for squamous cell carcinoma in situ.

“It works by turning on the body’s immune system,” said Orengo. “Your body starts to recognize those cancer cells are not normal and kills them off.”

Skin cancer is typically removed by scraping and burning or cutting the area. This can leave a scar or even multiple scars since superficial basal cell carcinomas can appear in several spots close together, but not connected. The cream allows for a larger area of coverage and usually heals without leaving behind scars.               

 “While the cream works the area can look raw and begin to scab,” she said. “But when treatment is over it heals beautifully.”

A small area of redness or discoloration can be left behind initially but that will eventually fade. Some side affects include a risk of bacterial infection. Daily cleansing is important to counter that risk. Since the cream affects the immune system, those who have autoimmune disorders might see those symptoms increase in severity and should probably not be used in these patients.

“This might not work for everyone,” Orengo said. “But for those who have superficial basal cell carinoma on visible areas like the face or chest where you don’t want scars, it is a good treatment option to talk to your doctor about.”