What Is a Nurse Practitioner and What Do They Do?
Medical Review By: Dr. Ted Schiff
Many dermatology practices are staffed with multiple types of providers, including board-certified dermatologists, physician assistants, and nurse practitioners. What exactly is a nurse practitioner, and what are they qualified to do?
Unlike a registered nurse (RN), a nurse practitioner can diagnose and manage health conditions. RNs have an associate degree or bachelor’s degree in nursing, but NPs complete additional training and get an advanced degree — either a Master of Science in Nursing or a Doctor of Nursing Practice. They can prescribe medication and, depending on the state, work without a doctor’s supervision.
A nurse practitioner is a type of advanced practice registered nurse, or APRN. Water’s Edge Dermatology is proud to have many APRNs who specialize in dermatology on staff. They play an invaluable role in treating and educating patients.
Types of nurse practitioners
Nurse practitioners get one of several specialty certifications. Most NPs are family nurse practitioners, who care for patients of all ages. Other specialties include acute care, adult health, geriatric health, neonatal health, pediatric/child health, psychiatric/mental health, and women’s health.
Once they are licensed, NPs can pursue extra training in a sub-specialty if they want to focus on a particular area of medicine, such as dermatology, endocrinology, orthopedics, gastroenterology, or cardiovascular health.
Services nurse practitioners provide
Nurse practitioners can diagnose and treat acute and chronic medical conditions. For dermatology nurse practitioners, these might include severe sunburns, boils, acne, rosacea, eczema, psoriasis, cysts, warts, atypical moles, and skin cancer. They can order, perform and interpret tests. A dermatology nurse practitioner might order skin biopsies, for example, as well as screen patients for skin cancer.
NPs can also perform treatments. A nurse practitioner in a dermatology practice might perform minor skin excisions (for mole removal, for example), extractions and cryotherapy, and/or administer cosmetic treatments such as Botox injections, dermal fillers, laser treatments, and peels.
Finally, nurse practitioners teach patients healthy lifestyle practices, such as proper skincare, and educate them about disease prevention.
How to become a nurse practitioner
In most cases, candidates must have a bachelor of science in nursing (BSN) and then complete a Master of Science in Nursing (MSN) program or a Doctor of Nursing Practice (DNP) program to become an NP. People who have an Associate’s Degree in Nursing (ADN) but not a bachelor’s degree can enroll in an accelerated RN-BSN program or an ADN-to-MSN program.
Advanced nursing degree students take classes in subjects such as advanced health evaluation, ethics, and pharmacology, and they participate in clinical rotations to gain hundreds of hours of patient care experience. Candidates then take an exam administered by an accredited certifying body such as the American Academy of Nurse Practitioners Certification Board to become a nationally certified NP.
Nurse practitioners who want to specialize in dermatology can pursue a certified nurse practitioner (DCNP) credential. There are a few ways to do this — by entering a post-master’s-degree program, taking continuing education courses, or training on the job under a board-certified dermatologist or a highly skilled dermatology NP. To take the Dermatology Nurse Practitioner Certification Exam and earn a DCNP, nurses must have at least 3,000 hours of general dermatology practice. DCNPs must earn continuing education credits and be recertified every three years.
: Jessica Brown, a health and science writer/editor based in Nanuet, New York. She has written for Prevention magazine, jnj.com, BCRF.org, and many other outlets
Medical Review By: Dr. Ted Schiff
Radiation Therapy for Skin Cancer
Medical review by David Herold, MD, MBA
Learning you have skin cancer can be a shock. The disease is rarely fatal, but many people worry about the effects treatment could have on their appearance, particularly if they have skin cancer on the face.
Scars from skin cancer surgery can be very noticeable and even disfiguring in some cases. But radiation therapy can remove many skin cancers just as effectively as surgery, without the risk of scarring.
“Unfortunately, patients who are diagnosed with some of the most common forms of skin cancer, such as basal cell and squamous cell carcinoma, are often told they need surgery and aren’t informed that there are other options,” said David Herold, MD, MBA, a board-certified radiation oncologist at Water’s Edge Dermatology. “Many of these patients could get better cosmetic results with radiation therapy, particularly if the lesions are on their face.”
What is radiation therapy?
When you undergo radiation therapy for skin cancer, a beam of low-energy rays (such as x-rays) or particles such as electrons is aimed at the treatment area for a set period time. These rays or particles break apart the DNA in cancer cells, ultimately killing the cells. While some healthy surrounding cells may be damaged in the process, it isn’t a cause for concern.
“Healthy cells have incredible repair mechanisms, and they start healing themselves seconds after treatment,” Dr. Herold said. “Cancer cells die because they’re unable to repair themselves from the effects of radiation.”
Radiation therapy is sometimes confused with chemotherapy, but the two treatments are nothing alike. Radiation therapy is delivered externally and penetrates only as far as the skin, so there are few or no side effects. Chemotherapy is administered internally, either intravenously or orally. It affects the whole body and can lead to side effects such as nausea and hair loss.
Types of radiation therapy for skin cancer
Superficial radiation therapy (SRT) uses a beam of low-energy x-rays to destroy cancer cells. A newer, more versatile type of radiation therapy is electron beam therapy (EBT), which uses a very thin, non-penetrating electron beam.
Dr. Herold specializes in EBT. Water’s Edge Dermatology is one of the few dermatology practices in Florida that offer it.
Advantages of electron beam therapy
EBT for skin cancer offers several advantages over SRT for skin cancer.
“Electron beam therapy can treat larger skin cancer lesions on the face and head compared to SRT, such as big lesions that appear on the scalp,” said Dr. Herold. “It also treats deeper skin cancers without causing irritation or pain in the cartilage or bone beneath the lesion, which happens sometimes if you use a higher dose of SRT to treat a deeper skin cancer.”
Another major advantage of EBT is that it more effectively treats lesions on irregular skin surfaces, such as the tip of the nose or curved areas of the ear. “SRT uses a flat beam that doesn’t work as well on areas like these,” Dr. Herold said.
EBT is the better radiation therapy for basal cell carcinoma of the nose as well as squamous cell carcinoma of the nose.
Who can get electron beam therapy?
This form of radiation therapy is most often used to treat basal cell carcinoma (the most common type of skin cancer) and squamous cell carcinoma (the second most common type of skin cancer).
According to Dr. Herold, EBT is used as a stand-alone treatment in 95% of cases but is occasionally used after surgery to clear any margins (the border of the tissue removed during surgery) that contain cancer cells. The cure rate of EBT for skin cancer — 90% to 98%, depending on the location of the lesion — is equivalent to that of skin cancer surgery, he added.
EBT isn’t recommended as a standalone treatment for melanoma except in some cases of melanoma in situ (stage 0). Stage 0 means the cancer hasn’t spread beyond the outermost layer of skin. EBT can also be used to treat a rare type of cancer called cutaneous lymphoma, a group of lymphomas that start in the lymph system and affect the skin.
While EBT can treat skin cancer lesions on any area of the body, it’s most commonly used to treat skin cancer on the face to avoid serious scarring and resulting complications.
“Surgically removing lesions on the face can sometimes lead to terrible outcomes,” Dr. Herold said. “I’ve seen patients who had surgery on their nose or eyelid who are now missing the tip of their nose or who can’t close their eye completely, which wouldn’t have happened if they’d had radiation therapy.”
What happens during an EBT session
Undergoing EBT for skin cancer on the face is quite simple. Before your treatment sessions start, your doctor will make a mold of your face and the sides and top of your head to create a plastic mesh mask you’ll wear during each session to keep your head and neck stationary. A piece of lead in the shape of the lesion is placed on the lesion to prevent electrons from scattering to nearby healthy skin.
You’ll be instructed to lie down on a table beneath the machine that delivers the electron beam, called a linear accelerator. The beam is aimed at the lesion for about 90 seconds. All told, the appointment takes less than 5 minutes.
“EBT is painless, so there’s no need to numb the skin beforehand,” Dr. Herold explained. “Patients may experience some redness in the treated area after a session, so I advise them to apply Aquaphor or a prescription cream to help with healing.” Patients can resume their normal activities (working, swimming, exercising) immediately after treatment.
While sessions are very quick, you do have to get them five days a week for anywhere from two weeks to six weeks. How long you undergo treatment depends on several factors, such as the location of the cancer:
- Small lesion on the cheek: two weeks
- Lesion on the ear: four or six weeks, depending on the size
- Large scalp lesion: four or six weeks
- Tip of the nose: six weeks
Once you’ve completed your sessions, the treated area will heal in one to three weeks. In some cases, radiation therapy for skin cancer can lead to loss of pigment in the area, but the effect is subtle (if it occurs at all) with EBT because the doses of radiation are so low.
“Most people who receive EBT look like they never got any kind of treatment,” Dr. Herold said.
“I’m very dedicated to educating patients about the procedure because they should be able to make an informed decision about how they want to be treated, and surgery isn’t always the best choice,” he added.
Written by Jessica Brown, a health and science writer/editor based in Brooklyn, New York. She has written for Prevention magazine, jnj.com, BCRF.org, and many other outlets.
The Surprising Link Between Breast Cancer and Skin Cancer
Medical Review By: Dr. Ted Schiff
Anyone who’s had breast cancer or skin cancer should know the unfortunate truth: Having one of these diseases seems to increase the likelihood of developing the other.
The risk for getting hit with this double whammy appears to be highest among younger women. And unfortunately, the form of skin cancer most closely associated with breast cancer also happens to be the most dangerous, melanoma.
Here’s a summary of what the science says.
Young breast cancer survivors at increased melanoma risk
A 2004 study looked at a large database of health records for women in nine regions of the United States. Breast cancer survivors age 50 and younger had a 46% increased risk for later being diagnosed with melanoma. Women who’d had melanoma were more likely than others to develop breast cancer, though the increase in risk was much lower.
In a 2011 study, female breast cancer survivors under age 45 had a 38% increased risk for developing melanoma compared to the general population. Among women over 45 who survived breast cancer, the increased risk for melanoma was 12%.
A weaker link between other skin cancers and breast cancer
Any association between breast cancer and non-melanoma forms of skin cancer, which include basal cell and squamous cell cancers, is less clear. Study have yielded mixed results.
A 2013 study found that women (average age 66) who’d had non-melanoma skin cancer had a 19% increased risk for eventually being diagnosed with breast cancer. A study of more than 70,000 postmenopausal women published the same year found no link between non-melanoma skin cancers and breast cancer, but it discovered that women with a history of basal cell or squamous cell cancer who developed breast cancer were more likely to have an advanced case of breast cancer.
Are BRCA genes a double threat?
If your mom or sister had both breast cancer and skin cancer, does that mean a similar fate may await you? Research offers clues that a risk for both conditions could be inherited in your genes, though whether that’s true remains unclear.
Genes called BRCA1 and BRCA2 increase the risk for breast cancer. Some research has linked them, especially BRCA2, to melanoma, too. But the authors of a 2021 scientific review of the current evidence called that association “relatively weak” and argued that neither gene is likely to have much influence over whether or not a person develops melanoma.
What you can do
Researchers still have a lot to learn about the link between breast cancer and skin cancer, but early diagnosis of either disease is critical no matter what, as are skin cancer prevention measures.
Mammograms
Most women should consider having annual mammograms when they turn 40, according to the American Cancer Society, and make mammograms a yearly event at age 45 (then consider reducing the frequency at age 55). Women who have a family history of breast cancer or who know they carry genetic mutations such as the BRCA gene that increase their risk should begin screening earlier.
The benefits of having a doctor physically examine your breasts, or examining your own breasts regularly, has recently come into question, but the American Cancer Society suggests at least being familiar with your breasts and reporting any changes to a doctor.
Skin checks and self-exams
Frequent skin self-exams, on the other hand, are essential. Your dermatologist can advise on how often to perform them, though monthly is a common rule of thumb. The American Cancer Society has a guide on how to do a skin self-exam.
Most people should also have an annual full-body skin exam at their dermatologist’s office.
Sun protection
Everyone should protect their skin from the damaging effects of the sun, but double down on those efforts if you’re a breast cancer survivor or if you’re undergoing treatment for breast cancer or any other malignancy. Chemotherapy may make skin more vulnerable to the harms of UV rays, and radiation may have already caused skin redness or burns.
You know the rules: Use a broad-spectrum sunscreen with an SPF of 30 or higher on any day that you’ll be outside, and cover up with protective clothing.
Article Written By: Timothy Gower, an award-winning journalist who writes about medicine and health. His work has appeared in more than two dozen national magazines.
What Does Lip Cancer Look Like?
Medical Review By: Thomas Pham, MD
Your lips are important for lots of things, including chewing and kissing. While the occasional cold sore or cause of chapped lips is annoying, lip cancer is another story entirely.
Lip cancer in its early stages is hard to notice, but that’s when it’s most treatable. By the time a lip tumor becomes obvious, cancer requires more invasive treatment, and it may spread to other parts of your body.
If you get a lot of sun exposure, or you smoke, chew tobacco, or drink heavily, it’s time to learn how to spot it.
Types of lip cancer
Lip cancer usually takes the form of squamous cell carcinoma. This type of cancer occurs in the squamous cells, which are thin, flat cells found in the middle and outer layers of the skin. Squamous cell cancer of the lip is much more aggressive than squamous cell cancer found in other places of the skin. It’s more likely to spread to the head and neck and harder to treat.
Much less frequently, lip cancer is melanoma, one of the deadliest types of cancer.
Lip cancer symptoms
The lower lip is more vulnerable to lip cancer because it gets more sun exposure than the upper lip. Symptoms to watch for include:
- A sore, ulcer or lesion on your lip that doesn’t heal (a cold sore, unlike lip cancer, does heal)
- A lump or thickened area on the lip
- Whitish or reddish patches on the lip
- Lip pain, bleeding or numbness
- A lump in your neck or swollen glands
- Jaw swelling or tightness
A precancerous condition that can lead to squamous cell cancer of the lip is actinic cheilitis. Symptoms include:
- Scaly whitish patches on the lip
- Dryness or peeling that won’t heal
- A rough, sandpapery texture
- Blurring of the border between the lip and the adjacent skin
- Loss of color in the skin of the lip
- Swelling or redness of the lip
Who gets lip cancer?
UV radiation from spending a lot of time in the sun or using tanning beds is the leading cause of lip cancer. Certain habits, such as smoking or chewing tobacco and excessive drinking, also increase the risk.
Other risk factors for lip cancer include having a weakened immune system, having fair skin, being over 40 years old, and being infected with certain strains of human papillomavirus (particularly strains 16 and 18). Lip cancer is more common in men, possibly because they are more likely to work outdoors and less likely to use lip balm with SPF. They may also be more likely to have smoked or consumed too much alcohol in the past.
Recent research suggests that taking hydrochlorothiazide, a diuretic, is strongly associated with an increased risk of developing lip cancer. This drug is used alone or in combination with other medications to treat high blood pressure.
Lip cancer treatment
Lip cancer is usually curable; most people survive it and have a good outcome after treatment.
The doctor may recommend Mohs surgery to remove the tumor. In this procedure, the surgeon gradually removes layers of the tumor and a small amount of tissue surrounding it, checking each layer for cancer cells. The surgery ends when cancer cells can no longer be detected under a microscope. Mohs surgery lets surgeons identify and remove tiny roots of cancer, which helps prevent it from spreading to other parts of the body.
Advanced cases are usually treated by an ear, nose, and throat doctor (ENT). Radiation and/or chemotherapy may be used in conjunction with surgery. In rare cases, radiation “seed” therapy is used to treat patients who opt out of surgery. Reconstructive surgery may be necessary to repair the lip.
Protect your lips by following these tips:
Wear lip balm with SPF. Choose a lip balm with an SPF of at least 30 and wear it whenever you go outside. A wide-brimmed hat is also a good idea.
Don’t use tanning beds. Indoor tanning isn’t any safer for your skin than lying in the sun.
Limit or quit smoking and drinking. This is especially important if you drink and also smoke. These habits together put you at much higher risk for lip cancer than either habit alone.
See your dentist regularly. Dentists are often the ones to detect lip cancer, so keep up with routine cleanings and exams.
If you notice any unusual changes in your lip when you look in the mirror, don’t panic. But if something looks or feels different and the problem doesn’t resolve quickly, call your dermatologist ASAP. Treating lip cancer early means less risk of spoiling your smile.
Article Written By: Jessica Brown, a health and science writer/editor based in Brooklyn, New York. She has written for Prevention magazine, jnj.com, BCRF.org, and many other outlets.