Dear Dr. Roach: At about four to six years old, I got chickenpox and, of course, had a lot of itchy bumps on my body.
One bump in particular did not heal right. I scratched it so much that it formed into a small (smaller than a dime) keloid on my inner thigh. This did not happen anywhere else.
This was confirmed by my former pediatrician, who told my parents and I that I should never get my ears pierced.
Ever since then, I have never attempted to have anything pierced on my body, nor get any tattoos.
I am now 30, and I was really wanting to pierce my ears and cartilage. I have never had any major surgeries or huge cuts, so I鈥檓 not sure how my skin will react if I decide to get my ears pierced.
I played sports my entire life, so I have had floor burns, minor cuts and bruises, and a gash on my face without developing a keloid.
I would really appreciate your insight on this matter, as this has been bothering me for a long time.
I have always wanted my ears pierced, but I also don鈥檛 want to risk my appearance changing because of a decision that could have been avoided.
A.C.
Because of your previous keloid, you are going to be at higher-than-average risk for developing a keloid, but I can鈥檛 even offer a guess on what the likelihood might be of getting one. The advice not to get your ears pierced remains the most conservative option, and the only one to guarantee you won鈥檛 get a keloid from piercing.
However, if you choose to try piercing, I can offer some advice on how to minimize your risk.
Keeping the area meticulously clean with alcohol and sterile cotton and never touching it with your bare hands are good ideas. Pressure earrings reduce the risk, but they need to be worn at least 16 hours a day for six to 12聽months for maximum effectiveness. Age seems to be important 鈥� getting ears pierced between 11 and 30 may have lower risk.
Dear Dr. Roach: I have a small but persistent scab on my thumb, and my primary-care doctor referred me to a dermatologist. A biopsy showed squamous cell cancer and I was scheduled for Mohs surgery.
A friend recommended I see a radiation oncologist. He read the biopsy and told me the treatment with radiation would be a 鈥減iece of cake,鈥� and no surgery is necessary. He also advised that radiation would be easier than surgery for a person of my age, 68. The dermatologist said the recurrence rate is higher for radiation than for surgery, but the radiation oncologist said that was 鈥減atently untrue.鈥� Is there a correct answer?
R.B.
Both surgery and radiation treatment are considered reasonable for squamous cell cancer on the skin. The recurrence rate in a large series of pooled studies was similar 鈥� 5.4 per cent for surgery and 6.4 per cent for radiation.
There are certain situations in which one would be preferred over the other. Radiation may have better cosmetic results. However, most authorities recommend surgery as the first choice for squamous cell cancer on the hand.
Radiation can damage blood vessels, and the wear and tear on the skin of the hand makes it more likely to have skin breakdown with radiation. Radiation should be avoided in people under 40, due to the risk of secondary cancers years later. Radiation is much more expensive and requires numerous visits.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@ med.cornell.edu.
