Dealing with Suspicious Lesions

If you’re into crime fiction, you’re all too familiar with suspicious persons or persons of interest. At Deschutes, Dr. Carter is more concerned with suspicious lesions.

OK, most lesions don’t fall into the “suspicious” category. It’s not like they’ve been hanging around the crime scene, have definite motives, or have been known to use aliases. Most of them don’t require any special treatment. But Dr. Carter will weigh the evidence against said lesion, considering how long it’s been there, if it has changed in some way, if it has started bleeding, or is tender.

What are the signs of a lesion being “suspicious?”

A skin lesion is a part of the skin that has an abnormal growth or appearance compared with the skin surrounding it. They are broken into two categories: primary or secondary. Primary skin lesions are abnormal skin conditions that are either present at birth (a birthmark, for instance) or are acquired during a person’s life. Secondary skin lesions are the result of irritated or manipulated primary skin lesions. Crusting and scaling are common secondary skin lesions.

Dr. Carter usually is suspicious of skin lesions that are showing signs of skin cancer

  • Basal cell carcinomas will show signs of bleeding, ulceration, and will be locally destructive. They don’t usually spread, but are removed for the patient’s safety.
  • Squamous cell carcinomas occur mainly on the areas of the skin that receive tons of sun: the head, arms, back of the hands, and the back of the neck. Squamous cell carcinomas can spread to other parts of the body, so their diagnosis and removal is key.
  • Melanoma doesn’t necessarily occur on areas of enduring sun exposure. Research shows that the risks of melanoma rise dramatically due to the number of “extreme” sunburns a person has had. They also have a genetic trend, and occur in people with large numbers of moles. Melanoma is the most dangerous skin cancer, as it can spread to all parts of the body and metastasize there.

How does Dr. Carter interrogate “suspicious lesions?”

We’ve covered this in another blog on melanoma, but the ABCDs are important for diagnosing precancerous or cancers lesions.

A — Asymmetry: Does half of the lesion look different from the other half?

B — Border irregularity: Are the edges of the lesion uneven, ragged, or blurred?

C — Color: Does the lesion have a variety of colors?

D — Diameter: With is the size of the lesion?

Removing suspicious lesions

If Dr. Carter is wary of a particular lesion, she will excise it along with 2mm of healthy tissue surrounding it. This tissue will then be biopsied.

Do you have a suspicious skin lesion? Don’t call Harry Bosch; call Dr. Carter at 541-330-0900.

How Does Sunscreen Work?

Everyone knows that the sun’s ultraviolet rays and human skin don’t get along. That’s even more so at the 3,623-foot altitude of Bend. With less atmosphere to get in the way, the UV rays are even more intense.

Sunscreens are a given today. We know that if we’re going to be out for a hike on the Sisters, skiing at Bachelor, or playing golf at Sunriver that putting on sunscreen is as important as the equipment such as hiking boots or a sand wedge.

But it wasn’t always that way. If you’re in your upper 50s or 60s now, you probably remember when the first sunscreens were introduced. The first true sunscreen was called Glacier Cream and later became Piz Buin (which still makes sunscreen lotions today), and it was developed in 1946 by a Swiss chemist. But when Coppertone (the name says it all) came on the market in the 50s, sunscreen lotion began to grow. Of course, it’s estimated now that the early Glacier Cream and Coppertone products had an SPF of 2! Not much protection there.

Today’s sunscreens have come a long way. Now they’re waterproof (for awhile) with effective SPFs of 50 (it’s thought that any SPF over that doesn’t provide any more protection).

Since we’re big fans of protecting your skin at Deschutes, here’s a little primer on how your sunscreen blocks the sun from damaging your skin.

Inorganic versus organic

Sunscreens come in sprays, lotions, gels, or waxes, and are made of a mix of chemicals. Inorganic chemicals in sunscreen can reflect or scatter the light away from the skin. Organic (carbon-based) chemicals can absorb UV rays so that your skin doesn’t.

Some of the early inorganic chemicals included minerals such as zinc oxide and titanium dioxide, and they acted as physical sunblocks. To be effective, they had to be covering the skin, hence the white noses of people on the beach in the 80s and 90s. The minerals reflected the sun’s UV rays back off the skin just as white paint reflects light. Today’s inorganic particles are much smaller, so users don’t have to look as if they’re covered with white frosting.

Organic chemicals used in sunscreens have names such as avobenzone and oxybenzone. These chemicals don’t reflect or deflect the UV rays; they absorb them. They do this with chemical bonds. As the bonds absorb UV radiation, the components of the sunscreen slowly break down and release heat. This is why these sunscreens have an effective time limit at which point the user would need to reapply.


The sun is delivering two types of ultraviolet rays onto your skin, UVA and UVB rays. UVB rays cause sunburns. For a long time, these were the only rays that sunscreens protected against, as their effects were obvious on the lobster-red skin. UVB rays affect the epidermis, the skin’s outer layer.

More recently, the effects of UVA rays have come into focus. UVA rays penetrate the epidermis into the dermis, the skin’s second layer. It’s thought that UVA rays damage the skin longer term with premature wrinkling, age spots, and other issues. UVA rays don’t cause sunburn, though, so they’re not as obvious.

SPF is how you can judge the protection level of a sunscreen. It stands for Sun Protection Factor, and it refers to how well the sunscreen protects the user against UVB rays. Obviously, SPF came before UVA rays were understood. Now, any sunscreen worth a thing is labeled “broad spectrum,” and it protects against both UVB and UVA rays.

It’s recommended to use the broad-spectrum sunscreen with SPF between 15 and 50. A sunscreen with SPF 15 protects against about 93 percent of the sun’s UVB rays; SPF 30 blocks 97 percent. No sunscreen provides a 100 percent block.

So, there’s some sunscreen information from your friends at Deschutes Dermatology. Put on that sunscreen and get out there in our beautiful Oregon outdoors. But remember to get your skin checked for skin cancer with Dr. Carter here once a year. Call us at 541-330-0900 to make your appointment.