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Chichester's TAKEN AT MIDNIGHT Heads to the West End This Winter; Penelope Wilton to Reprise Role (Oct 22, 2014)
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BWW TV: Judy Kuhn, Chip Zien, Kelli O'Hara, Matthew Broderick & More Sing with Seth Rudetsky at SETH'S BROADWAY DIARY Book Launch!STAGE TUBE: Miss Tony Bennett & Lady Gaga's CHEEK TO CHEEK: LIVE? Watch it Here!BWW TV: Chatting with the Company of DISGRACED on Opening Night- Pittman, Radnor, Dhillon, Mol & More!STAGE TUBE: Lady Gaga & Tony Bennett Rehearse 'Bewitched, Bothered, Bewildered'BWW TV Exclusive: CUTTING-EDGE COMPOSERS CORNER- In the Studio with Alexander Sage Oyen and Caissie Levy!BWW TV: That's Entertainment! In Rehearsal with Brian Stokes Mitchell, Laura Osnes, Tracey Ullman and More for Encores! THE BAND WAGONVIDEO: Alan Cumming & Victor Garber Reveal Most Embarrassing Broadway Moments & More on BravoSTAGE TUBE: Josh Young Performs 'Testimony' from Broadway-Bound AMAZING GRACEUpdate: Kristin Chenoweth & Peter Gallagher in Promo Shoot for ON THE TWENTIETH CENTURY; Plus First Photo!BWW TV: On the Opening Night Red Carpet for DISGRACED with Judith Light, Tony Danza & More!VIDEO: John Lithgow Talks Return to Broadway: 'I Feel Like a Kid Again!'BWW TV: Watch Highlights from Signature Theatre's ELMER GANTRYBWW TV Exclusive: CHEWING THE SCENERY- Randy Returns to the Newsdesk to Talk PETER PAN, Emma Stone & More!VIDEO: Watch Official Lyric Video for 'Shadowland' from Broadway's THE LION KINGFIRST LISTEN: Bette Midler's New Single 'Waterfalls' from Upcoming Album 'It's The Girls'
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Photo Coverage: Mol, Radnor, Pittman, Dhillon & More Celebrate Opening Night of DISGRACED!
BWW Reviews: Volatile, Discomforting DISGRACED Earns Its Pulitzer
Photo Coverage: DISGRACED Company Takes Opening Night Bows at the Lyceum Theatre!
SOUND OFF: Lady Gaga & Tony Bennett's CHEEK TO CHEEK: LIVE! Is A Big Wet Kiss


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The Skin
Cancer Cells
Types of Skin Cancer
Risk Factors
Symptoms of Melanoma
Symptoms of Basal Cell and Squamous Cell Skin Cancers
Second Opinion
Taking Part in Cancer Research
Follow-up Care
How To Check Your Skin
Sources of Support
About This Booklet
This National Cancer Institute (NCI) booklet (NIH Publication No. 10-7625) is for people diagnosed with the most common types of skin cancer:
- Melanoma
- Basal cell skin cancer
- Squamous cell skin cancer
Skin cancer is the most common type of cancer in the United States. Each year, more than 68,000 Americans are diagnosed with melanoma, and another 48,000 are diagnosed with an early form of the disease that involves only the top layer of skin. Also, more than 2 million people are treated for basal cell or squamous cell skin cancer each year. Basal cell skin cancer is several times more common than squamous cell skin cancer.
Learning about medical care for skin cancer can help you take an active part in making choices about your care. This booklet tells about:
- Diagnosis and staging
- Treatment
- Follow-up care
- How to prevent another skin cancer from forming
- How to do a skin self-exam
This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes.
You may also want to have a family member or friend go with you when you talk with the doctor—to take notes, ask questions, or just listen.
This booklet does not describe rare types of skin cancer, such as Merkel cell carcinoma. Also, this booklet does not discuss melanoma that begins in the eye, the digestive tract, or other areas of the body. NCI's Cancer Information Service can provide information about rare skin cancers and melanoma that begins in areas other than the skin. Call 1–800–4–CANCER (1–800–422–6237) or chat with us online using LiveHelp (https://livehelp.cancer.gov/), NCI's instant messaging service.
The Skin
Your skin protects your body from heat, injury, and infection. It also protects your body from damage caused by ultraviolet (UV) radiation (such as from the sun or sunlamps).
Your skin stores water and fat. It helps control body heat. Also, your skin makes vitamin D.
The picture shows the two main layers of the skin:
- Epidermis: The epidermis is the top layer of your skin. It's mostly made of flat cells called squamous cells.
Below the squamous cells deeper in the epidermis are round cells called basal cells.
Cells called melanocytes are scattered among the basal cells. They are in the deepest part of the epidermis. Melanocytes make the pigment (color) found in skin. When skin is exposed to UV radiation, melanocytes make more pigment, causing the skin to darken, or tan.
- Dermis: The dermis is the layer under the epidermis. The dermis contains many types of cells and structures, such as blood vessels, lymph vessels, and glands. Some of these glands make sweat, which helps cool your body. Other glands make sebum. Sebum is an oily substance that helps keep your skin from drying out. Sweat and sebum reach the surface of your skin through tiny openings called pores.
This picture shows the layers of the skin -- the epidermis and dermis. At the top, the close-up shows a squamous cell, basal cell, and melanocyte.
Cancer Cells
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the skin and other organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they usually die, and new cells take their place.
But sometimes this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Growths on the skin can be benign (not cancer) or malignant (cancer). Benign growths are not as harmful as malignant growths.
- Benign growths (such as moles):
- Are rarely a threat to life
- Generally can be removed and usually don't grow back
- Don't invade the tissues around them
- Don't spread to other parts of the body
- Malignant growths (such as melanoma, basal cell cancer, or squamous cell cancer):
- May be a threat to life
- Often can be removed but sometimes grow back
- May invade and damage nearby organs and tissues
- May spread to other parts of the body
Types of Skin Cancer
Skin cancers are named for the type of cells that become malignant (cancer). The three most common types are:
- Melanoma: Melanoma begins in melanocytes (pigment cells). Most melanocytes are in the skin. See the picture of a melanocyte and other skin cells.
Melanoma can occur on any skin surface. In men, it's often found on the skin on the head, on the neck, or between the shoulders and the hips. In women, it's often found on the skin on the lower legs or between the shoulders and the hips.
Melanoma is rare in people with dark skin. When it does develop in people with dark skin, it's usually found under the fingernails, under the toenails, on the palms of the hands, or on the soles of the feet.
Basal cell skin cancer: Basal cell skin cancer begins in the basal cell layer of the skin. It usually occurs in places that have been in the sun. For example, the face is the most common place to find basal cell skin cancer.In people with fair skin, basal cell skin cancer is the most common type of skin cancer.
- Squamous cell skin cancer: Squamous cell skin cancer begins in squamous cells. In people with dark skin, squamous cell skin cancer is the most common type of skin cancer, and it's usually found in places that are not in the sun, such as the legs or feet.
However, in people with fair skin, squamous cell skin cancer usually occurs on parts of the skin that have been in the sun, such as the head, face, ears, and neck.
Unlike moles, skin cancer can invade the normal tissue nearby. Also, skin cancer can spread throughout the body. Melanoma is more likely than other skin cancers to spread to other parts of the body. Squamous cell skin cancer sometimes spreads to other parts of the body, but basal cell skin cancer rarely does.
When skin cancer cells do spread, they break away from the original growth and enter blood vessels or lymph vessels. The cancer cells may be found in nearby lymph nodes. The cancer cells can also spread to other tissues and attach there to form new tumors that may damage those tissues.
The spread of cancer is called metastasis. See the Staging section for information about skin cancer that has spread.
Risk Factors
When you're told that you have skin cancer, it's natural to wonder what may have caused the disease. The main risk factor for skin cancer is exposure to sunlight (UV radiation), but there are also other risk factors. A risk factor is something that may increase the chance of getting a disease.
People with certain risk factors are more likely than others to develop skin cancer. Some risk factors vary for the different types of skin cancer.
Risks for Any Type of Skin Cancer
Studies have shown that the following are risk factors for the three most common types of skin cancer:
- Sunlight: Sunlight is a source of UV radiation. It's the most important risk factor for any type of skin cancer. The sun's rays cause skin damage that can lead to cancer.
- Severe, blistering sunburns: People who have had at least one severe, blistering sunburn are at increased risk of skin cancer. Although people who burn easily are more likely to have had sunburns as a child, sunburns during adulthood also increase the risk of skin cancer.
- Lifetime sun exposure: The total amount of sun exposure over a lifetime is a risk factor for skin cancer.
- Tanning: Although a tan slightly lowers the risk of sunburn, even people who tan well without sunburning have a higher risk of skin cancer because of more lifetime sun exposure.
Sunlight can be reflected by sand, water, snow, ice, and pavement. The sun's rays can get through clouds, windshields, windows, and light clothing.
In the United States, skin cancer is more common where the sun is strong. For example, more people in Texas than Minnesota get skin cancer. Also, the sun is stronger at higher elevations, such as in the mountains.
Doctors encourage people to limit their exposure to sunlight. See the Prevention section for ways to protect your skin from the sun.
- Sunlamps and tanning booths: Artificial sources of UV radiation, such as sunlamps and tanning booths, can cause skin damage and skin cancer. Health care providers strongly encourage people, especially young people, to avoid using sunlamps and tanning booths. The risk of skin cancer is greatly increased by using sunlamps and tanning booths before age 30.
- Personal history: People who have had melanoma have an increased risk of developing other melanomas. Also, people who have had basal cell or squamous cell skin cancer have an increased risk of developing another skin cancer of any type.
- Family history: Melanoma sometimes runs in families. Having two or more close relatives (mother, father, sister, brother, or child) who have had this disease is a risk factor for developing melanoma. Other types of skin cancer also sometimes run in families. Rarely, members of a family will have an inherited disorder, such as xeroderma pigmentosum or nevoid basal cell carcinoma syndrome, that makes the skin more sensitive to the sun and increases the risk of skin cancer.
- Skin that burns easily: Having fair (pale) skin that burns in the sun easily, blue or gray eyes, red or blond hair, or many freckles increases the risk of skin cancer.
- Certain medical conditions or medicines: Medical conditions or medicines (such as some antibiotics, hormones, or antidepressants) that make your skin more sensitive to the sun increase the risk of skin cancer. Also, medical conditions or medicines that suppress the immune system increase the risk of skin cancer.
Other Risk Factors for Melanoma
The following risk factors increase the risk of melanoma:
- Dysplastic nevus: A dysplastic nevus is a type of mole that looks different from a common mole. A dysplastic nevus may be bigger than a common mole, and its color, surface, and border may be different. It's usually wider than a pea and may be longer than a peanut. A dysplastic nevus can have a mixture of several colors, from pink to dark brown. Usually, it's flat with a smooth, slightly scaly or pebbly surface, and it has an irregular edge that may fade into the surrounding skin.
A dysplastic nevus is more likely than a common mole to turn into cancer. However, most do not change into melanoma. A doctor will remove a dysplastic nevus if it looks like it might have changed into melanoma.
- More than 50 common moles: Usually, a common mole is smaller than a pea, has an even color (pink, tan, or brown), and is round or oval with a smooth surface. Having many common moles increases the risk of developing melanoma.
Other Risk Factors for Both Basal Cell and Squamous Cell Skin Cancers
The following risk factors increase the risk of basal cell and squamous cell skin cancers:
- Old scars, burns, ulcers, or areas of inflammation on the skin
- Exposure to arsenic at work
- Radiation therapy
Other Risk Factors for Squamous Cell Cancer
The risk of squamous cell skin cancer is increased by the following:
- Actinic keratosis: Actinic keratosis is a type of flat, scaly growth on the skin. It is most often found on areas exposed to the sun, especially the face and the backs of the hands. The growth may appear as a rough red or brown patch on the skin. It may also appear as cracking or peeling of the lower lip that does not heal. Without treatment, this scaly growth may turn into squamous cell skin cancer.
- HPV (human papillomavirus): Certain types of HPV can infect the skin and may increase the risk of squamous cell skin cancer. These HPVs are different from the HPV types that cause cervical cancer and other cancers in the female and male genital areas.
Symptoms of Melanoma
Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole. Melanoma may also appear as a new mole. Thinking of "ABCDE" can help you remember what to look for:
- Asymmetry: The shape of one half does not match the other half.
- Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
- Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
- Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch).
- Evolving: The mole has changed over the past few weeks or months.
Melanomas can vary greatly in how they look. Many show all of the ABCDE features. However, some may show changes or abnormal areas in only one or two of the ABCDE features.
In more advanced melanoma, the texture of the mole may change. The skin on the surface may break down and look scraped. It may become hard or lumpy. The surface may ooze or bleed. Sometimes the melanoma is itchy, tender, or painful.
This photo shows an asymmetic melanoma with irregular and scalloped borders. The color varies from gray to brown to black. The melanoma is about 1.2 centimeters.
This photo shows a dysplastic nevus with an arrow pointing to a new black bump that was not there 18 months earlier. The black bump is a melanoma that is about 3 millimeters.
Symptoms of Basal Cell and Squamous Cell Skin Cancers
A change on the skin is the most common sign of skin cancer. This may be a new growth, a sore that doesn't heal, or a change in an old growth. Not all skin cancers look the same. Usually, skin cancer is not painful.
Common symptoms of basal cell or squamous cell skin cancer include:
|A lump that is small, smooth, shiny, pale, or waxy
|A lump that is firm and red
|A sore or lump that bleeds or develops a crust or a scab
|A flat red spot that is rough, dry, or scaly and may become itchy or tender
|A red or brown patch that is rough and scaly
If you have a change on your skin, your doctor must find out whether or not the problem is from cancer. You may need to see a dermatologist, a doctor who has special training in the diagnosis and treatment of skin problems.
Your doctor will check the skin all over your body to see if other unusual growths are present.
If your doctor suspects that a spot on the skin is cancer, you may need a biopsy. For a biopsy, your doctor may remove all or part of the skin that does not look normal. The sample goes to a lab. A pathologist checks the sample under a microscope. Sometimes it's helpful for more than one pathologist to check the tissue for cancer cells.
You may have the biopsy in a doctor's office or as an outpatient in a clinic or hospital. You'll probably have local anesthesia.
There are four common types of skin biopsies:
- Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth
- Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area
- Incisional biopsy: The doctor uses a scalpel to remove part of the growth
- Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it. This type of biopsy is most commonly used for growths that appear to be melanoma.
You may want to ask your doctor these questions before having a biopsy:
- Which type of biopsy do you suggest for me?
- How will the biopsy be done?
- Will I have to go to the hospital?
- How long will it take? Will I be awake? Will it hurt?
- Will the entire growth be removed?
- Are there any risks? What are the chances of infection or bleeding after the biopsy?
- Will there be a scar? If so, what will it look like?
- How soon will I know the results?
- If I do have cancer, who will talk with me about treatment?
If the biopsy shows that you have skin cancer, your doctor needs to learn the stage (extent) of the disease to help you choose the best treatment.
The stage is based on:
- The size (width) of the growth
- How deeply it has grown beneath the top layer of skin
- Whether cancer cells have spread to nearby lymph nodes or to other parts of the body
When skin cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if skin cancer spreads to the lung, the cancer cells in the lung are actually skin cancer cells. The disease is metastatic skin cancer, not lung cancer. For that reason, it's treated as skin cancer, not as lung cancer. Doctors sometimes call the new tumor "distant" disease.
Blood tests and an imaging test such as a chest x-ray, a CT scan, an MRI, or a PET scan may be used to check for the spread of skin cancer. For example, if a melanoma growth is thick, your doctor may order blood tests and an imaging test.
For squamous cell skin cancer or melanoma, the doctor will also check the lymph nodes near the cancer on the skin. If one or more lymph nodes near the skin cancer are enlarged (or if the lymph node looks enlarged on an imaging test), your doctor may use a thin needle to remove a sample of cells from the lymph node (fine-needle aspiration biopsy). A pathologist will check the sample for cancer cells.
Even if the nearby lymph nodes are not enlarged, the nodes may contain cancer cells. The stage is sometimes not known until after surgery to remove the growth and one or more nearby lymph nodes. For thick melanoma, surgeons may use a method called sentinel lymph node biopsy to remove the lymph node most likely to have cancer cells. Cancer cells may appear first in the sentinel node before spreading to other lymph nodes and other places in the body.
Stages of Melanoma
These are the stages of melanoma:
- Stage 0: The melanoma involves only the top layer of skin. It is called melanoma in situ.
- Stage I: The tumor is no more than 1 millimeter thick (about the width of the tip of a sharpened pencil.) The surface may appear broken down. Or, the tumor is between 1 and 2 millimeters thick, and the surface is not broken down.
- Stage II: The tumor is between 1 and 2 millimeters thick, and the surface appears broken down. Or, the thickness of the tumor is more than 2 millimeters, and the surface may appear broken down.
- Stage III: The melanoma cells have spread to at least one nearby lymph node. Or, the melanoma cells have spread from the original tumor to tissues nearby.
- Stage IV: Cancer cells have spread to the lung or other organs, skin areas, or lymph nodes far away from the original growth. Melanoma commonly spreads to other parts of the skin, tissue under the skin, lymph nodes, and lungs. It can also spread to the liver, brain, bones, and other organs.
Stages of Other Skin Cancers
These are the stages of basal cell and squamous cell skin cancers:
- Stage 0: The cancer involves only the top layer of skin. It is called carcinoma in situ.
Bowen disease is an early form of squamous cell skin cancer. It usually looks like a reddish, scaly or thickened patch on the skin. If not treated, the cancer may grow deeper into the skin.
- Stage I: The growth is as large as 2 centimeters wide (more than three-quarters of an inch or about the size of a peanut).
- Stage II: The growth is larger than 2 centimeters wide.
- Stage III: The cancer has invaded below the skin to cartilage, muscle, or bone. Or, cancer cells have spread to nearby lymph nodes. Cancer cells have not spread to other places in the body.
- Stage IV: The cancer has spread to other places in the body. Basal cell cancer rarely spreads to other parts of the body, but squamous cell cancer sometimes spreads to lymph nodes and other organs.
Treatment for skin cancer depends on the type and stage of the disease, the size and place of the tumor, and your general health and medical history. In most cases, the goal of treatment is to remove or destroy the cancer completely. Most skin cancers can be cured if found and treated early.
Sometimes all of the skin cancer is removed during the biopsy. In such cases, no more treatment is needed.
If you do need more treatment, your doctor can describe your treatment choices and what to expect. You and your doctor can work together to develop a treatment plan that meets your needs.
Surgery is the usual treatment for people with skin cancer. In some cases, the doctor may suggest chemotherapy, photodynamic therapy, or radiation therapy. People with melanoma may also have biological therapy.
You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat skin cancer include dermatologists and surgeons. Some people may also need a reconstructive or plastic surgeon.
People with advanced skin cancer may be referred to a medical oncologist or radiation oncologist. Your health care team may also include an oncology nurse, a social worker, and a registered dietitian.
Because skin cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person. Before treatment starts, your health care team will tell you about possible side effects and suggest ways to help you manage them.
Many skin cancers can be removed quickly and easily. But some people may need supportive care to control pain and other symptoms, to relieve the side effects of treatment, and to help them cope with the feelings that a diagnosis of cancer can bring. Information about such care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping and from NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and at LiveHelp (https://livehelp.cancer.gov/).
You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research section.
You may want to ask your doctor these questions before you begin treatment:
- What is the stage of the disease? Has the cancer spread? Do any lymph nodes or other organs show signs of cancer?
- What are my treatment choices? Which do you suggest for me? Why?
- What are the expected benefits of each kind of treatment?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for how long?
- What are the risks and possible side effects of each treatment? How can side effects be managed?
- Will there be a scar? Will I need a skin graft or plastic surgery?
- What is the treatment likely to cost? Will my insurance cover it?
- How will treatment affect my normal activities?
- Would a research study (clinical trial) be a good choice for me?
- How often should I have checkups?
In general, the surgeon will remove the cancerous growth and some normal tissue around it. This reduces the chance that cancer cells will be left in the area.
There are several methods of surgery for skin cancer. The method your doctor uses depends mainly on the type of skin cancer, the size of the cancer, and where it was found on your body.
Your doctor can further describe these methods of surgery:
- Excisional skin surgery: This is a common treatment to remove any type of skin cancer. After numbing the area of skin, the surgeon removes the growth (tumor) with a scalpel. The surgeon also removes a border (a margin) of normal skin around the growth. The margin of skin is examined under a microscope to be certain that all the cancer cells have been removed. The thickness of the margin depends on the size of the tumor.
- Mohs surgery (also called Mohs micrographic surgery): This method is often used for basal cell and squamous cell skin cancers. After numbing the area of skin, a specially trained surgeon shaves away thin layers of the tumor. Each layer is examined under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. In this way, the surgeon can remove all the cancer and only a small bit of healthy tissue.
Some people will have radiation therapy after Mohs surgery to make sure all of the cancer cells are destroyed.
- Electrodesiccation and curettage: This method is often used to remove a small basal cell or squamous cell skin cancer. After the doctor numbs the area to be treated, the cancer is removed with a sharp tool shaped like a spoon (called a curette). The doctor then uses a needle-shaped electrode to send an electric current into the treated area to control bleeding and kill any cancer cells that may be left. This method is usually fast and simple. It may be performed up to three times to remove all of the cancer.
- Cryosurgery: This method is an option for an early-stage or a very thin basal cell or squamous cell skin cancer. Cryosurgery is often used for people who are not able to have other types of surgery. The doctor applies liquid nitrogen (which is extremely cold) directly to the skin growth to freeze and kill the cancer cells. This treatment may cause swelling. It also may damage nerves, which can cause a loss of feeling in the damaged area. The NCI fact sheet Cryosurgery in Cancer Treatment has more information.
For people with cancer that has spread to the lymph nodes, the surgeon may remove some or all of the nearby lymph nodes. Additional treatment may be needed after surgery. See the Staging section for information about finding cancer in lymph nodes.
If a large area of tissue is removed, the surgeon may do a skin graft. The doctor uses skin from another part of the body to replace the skin that was removed. After numbing the area, the surgeon removes a patch of healthy skin from another part of the body, such as the upper thigh. The patch is then used to cover the area where skin cancer was removed. If you have a skin graft, you may have to take special care of the area until it heals.
The time it takes to heal after surgery is different for each person. You may have pain for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
Surgery nearly always leaves some type of scar. The size and color of the scar depend on the size of the cancer, the type of surgery, the color of your skin, and how your skin heals.
For any type of surgery, including skin grafts or reconstructive surgery, follow your doctor's advice on bathing, shaving, exercise, or other activities.
You may want to ask your doctor these questions before having surgery:
- What kind of surgery do you recommend for me? Why?
- Will you remove lymph nodes? Why?
- Will I need a skin graft?
- What will the scar look like? Can anything be done to help reduce the scar? Will I need plastic surgery or reconstructive surgery?
- How will I feel after surgery?
- If I have pain, how will you control it?
- Will I need to stay in the hospital? If so, for how long?
- Am I likely to have infection, swelling, blistering, or bleeding, or to get a scab where the cancer was removed?
- Will I have any long-term side effects?
Chemotherapy uses drugs to kill cancer cells. Drugs for skin cancer can be given in many ways.
Put directly on the skin
A cream or lotion form of chemotherapy may be used to treat very thin, early-stage basal cell or squamous cell skin cancer (Bowen disease). It may also be used if there are several small skin cancers. The doctor will show you how to apply the cream or lotion to the skin one or two times a day for several weeks.
The cream or lotion contains a drug that kills cancer cells only in the top layer of the skin:
- Fluorouracil (another name is 5-FU): This drug is used to treat early-stage basal cell and squamous cell cancers.
- Imiquimod: This drug is used to treat early-stage basal cell cancer.
These drugs may cause your skin to turn red or swell. Your skin also may itch, ooze, or develop a rash. Your skin may be sore or sensitive to the sun after treatment. These skin changes usually go away after treatment is over.
A cream or lotion form of chemotherapy usually does not leave a scar. If healthy skin becomes too red or raw when the skin cancer is treated, your doctor may stop treatment.
Swallowed or injected
People with melanoma may receive chemotherapy by mouth or through a vein (intravenous). You may receive one or more drugs. The drugs enter the bloodstream and travel throughout the body.
If you have melanoma on an arm or leg, you may receive drugs directly into the bloodstream of that limb. The flow of blood to and from the limb is stopped for a while. This allows a high dose of drugs in the area with the melanoma. Most of the chemotherapy remains in that limb.
You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
- Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
- Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
- Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.
You may want to read the NCI booklet Chemotherapy and You.
You may want to ask your doctor these questions about chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- Do I need to take special care when I put chemotherapy on my skin? What do I need to do? Will I be sensitive to the sun?
- When will treatment start? When will it end?
- Will I have any long-term side effects?
Photodynamic Therapy
Photodynamic therapy (PDT) uses a drug along with a special light source, such as a laser light, to kill cancer cells. PDT may be used to treat very thin, early-stage basal cell or squamous cell skin cancer (Bowen disease).
The drug is either rubbed into the skin or injected intravenously. The drug is absorbed by cancer cells. It stays in cancer cells longer than in normal cells. Several hours or days later, a special light is focused on the cancer. The drug becomes active and destroys the cancer cells.
The side effects of PDT are usually not serious. PDT may cause burning or stinging pain. It also may cause burns, swelling, or redness. It may scar healthy tissue near the growth. If you have PDT, you will need to avoid direct sunlight and bright indoor light for at least 6 weeks after treatment.
The NCI fact sheet Photodynamic Therapy for Cancer has more information.
You may want to ask your doctor these questions about PDT:
- Will I need to stay in the hospital while the drug is in my body?
- Will I need to have the treatment more than once?
Biological Therapy
Some people with advanced melanoma receive a drug called biological therapy. Biological therapy for melanoma is treatment that may improve the body's natural defense (immune system response) against cancer.
One drug for melanoma is interferon. It's injected intravenously (usually at a hospital or clinic) or injected under the skin (at home or in a doctor's office). Interferon can slow the growth of melanoma cells.
Another drug used for melanoma is interleukin-2. It's given intravenously. It can help the body destroy cancer cells. Interleukin-2 is usually given at the hospital.
Other drugs may be given at the same time to prevent side effects. The side effects differ with the drug used, and from person to person. Biological therapies commonly cause a rash or swelling. You may feel very tired during treatment. These drugs may also cause a headache, muscle aches, a fever, or weakness.
You may find it helpful to read the NCI booklet Biological Therapy. You may also wish to read the NCI fact sheet Biological Therapies for Cancer.
You may want to ask your doctor these questions about biological therapy:
- What is the goal of treatment?
- When will treatment start? When will it end?
- Will I need to stay in the hospital for treatment? If so, how long will I be in the hospital?
Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. The radiation comes from a large machine outside the body. It affects cells only in the treated area. You will go to a hospital or clinic several times for this treatment.
Radiation therapy is not a common treatment for skin cancer. But it may be used for skin cancer in areas where surgery could be difficult or leave a bad scar. For example, you may have radiation therapy if you have a growth on your eyelid, ear, or nose. Radiation therapy may also be used after surgery for squamous cell carcinoma that can't be completely removed or that has spread to the lymph nodes. And it may be used for melanoma that has spread to the lymph nodes, brain, bones, or other parts of the body.
Although radiation therapy is painless, it may cause other side effects. The side effects depend mainly on the dose of radiation and the part of your body that is treated. It's common for the skin in the treated area to become red, dry, tender, and itchy. Your health care team can suggest ways to relieve the side effects of radiation therapy.
You may find it helpful to read the NCI booklet Radiation Therapy and You.
You may want to ask your doctor these questions about radiation therapy:
- How will I feel after treatment?
- Am I likely to have infection, swelling, blistering, or bleeding after radiation therapy?
- Will I get a scar on the treated area?
- How should I take care of the treated area?
Second Opinion
Before starting treatment, you might want a second opinion from another doctor about your diagnosis and treatment plan. Some people worry that their doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.
If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you'll have more information and perhaps a greater sense of control. You may also feel more confident about the decisions you make, knowing that you've looked carefully at all of your options.
It may take some time and effort to gather your medical records and see another doctor. Usually it's not a problem if it takes you several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this possible delay with your doctor. Some people with skin cancer need treatment right away.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, or a nearby hospital or a medical school for names of specialists.
Also, you can get information about treatment centers near you from NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and at LiveHelp. Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.
Taking Part in Cancer Research
Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Clinical trials are designed to find out whether new treatments are safe and effective.
Doctors are trying to find better ways to care for people with skin cancer. They are studying many types of treatment, such as surgery, chemotherapy, biological therapy, and combinations of treatment. For example, doctors are studying the use of a cancer treatment vaccine after surgery for people with advanced melanoma. For more information about cancer vaccines, you may want to read the NCI fact sheet Cancer Vaccines.
Even if the people in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about skin cancer and how to control it. Although clinical trials may pose some risks, doctors do all they can to protect their patients.
If you're interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It describes how treatment studies are carried out and explains their possible benefits and risks.
NCI's Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of skin cancer. Information specialists at 1–800–4–CANCER (1–800–422–6237) and at LiveHelp can answer questions and provide information about clinical trials.
Follow-up Care
After treatment for skin cancer, you'll need regular checkups (such as every 3 to 6 months for the first year or two). Your doctor will monitor your recovery and check for any new skin cancers. Regular checkups help ensure that any changes in your health are noted and treated if needed.
During a checkup, you'll have a physical exam. People with melanoma may have x-rays, blood tests, and scans of the chest, liver, bones, and brain.
People who have had melanoma have an increased risk of developing a new melanoma, and people with basal or squamous cell skin cancers have a risk of developing another skin cancer of any type. It's a good idea to get in a routine for checking your skin for new growths or other changes. Keep in mind that changes are not a sure sign of skin cancer. Still, you should tell your doctor about any changes right away. You'll find a guide for checking your skin in the How To Check Your Skin section.
Follow your doctor's advice about how to reduce your risk of developing skin cancer again.
You may find it helpful to read the NCI booklet Facing Forward: Life After Cancer Treatment. You may also want to read the NCI fact sheet Follow-up Care After Cancer Treatment.
People with skin cancer are at risk of developing another skin cancer. Limit your time in the sun and stay away from sunlamps and tanning booths. Keep in mind that getting a tan may increase your risk of developing another skin cancer.
The best way to prevent skin cancer is to protect yourself from the sun:
- Avoid outdoor activities during the middle of the day. The sun's rays are the strongest between 10 a.m. and 4 p.m. When you must be outdoors, seek shade when you can.
- Protect yourself from the sun's rays reflected by sand, water, snow, ice, and pavement. The sun's rays can go through light clothing, windshields, windows, and clouds.
- Wear long sleeves and long pants. Tightly woven fabrics are best.
- Wear a hat with a wide brim all around that shades your face, neck, and ears. Keep in mind that baseball caps and some sun visors protect only parts of your skin.
- Wear sunglasses that absorb UV radiation to protect the skin around your eyes.
- Use sunscreen lotions with a sun protection factor (SPF) of at least 15. (Some doctors will suggest using a lotion with an SPF of at least 30.) Apply the product's recommended amount to uncovered skin 30 minutes before going outside, and apply again every two hours or after swimming or sweating.
Sunscreen lotions may help prevent some skin cancers. It's important to use a broad-spectrum sunscreen lotion that filters both UVB and UVA radiation. But you still need to avoid the sun during the middle of the day and wear clothing to protect your skin.
How To Check Your Skin
Your doctor or nurse may suggest that you do a regular skin self-exam to check for the development of a new skin cancer.
The best time to do this exam is after a shower or bath. Check your skin in a room with plenty of light. Use a full-length mirror and a hand-held mirror.
It's best to begin by learning where your birthmarks, moles, and other marks are and their usual look and feel.
Check for anything new:
- A new mole (that looks different from your other moles)
- A new red or darker color flaky patch that may be a little raised
- A new flesh-colored firm bump
- A change in the size, shape, color, or feel of a mole
- A sore that doesn't heal
Check yourself from head to toe:
- Look at your face, neck, ears, and scalp. You may want to use a comb or a blow dryer to move your hair so that you can see better. You also may want to have a relative or friend check through your hair. It may be hard to check your scalp by yourself.
- Look at the front and back of your body in the mirror. Then, raise your arms and look at your left and right sides.
- Bend your elbows. Look carefully at your fingernails, palms, forearms (including the undersides), and upper arms.
- Examine the back, front, and sides of your legs. Also look around your genital area and between your buttocks.
- Sit and closely examine your feet, including your toenails, your soles, and the spaces between your toes.
By checking your skin regularly, you'll learn what is normal for you. It may be helpful to record the dates of your skin exams and to write notes about the way your skin looks. If your doctor has taken photos of your skin, you can compare your skin to the photos to help check for changes. If you find anything unusual, see your doctor.
Sources of Support
Learning that you have skin cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to need help coping with the feelings that such a diagnosis can bring.
Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.
Here's where you can go for support:
- Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.
- Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
- Support groups also can help. In these groups, people with skin cancer or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
- NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and at LiveHelp can help you locate programs, services, and NCI publications. They can send you a list of organizations that offer services to people with cancer.
For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer.


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Categories Food, Groceries Baking Aids
Categories Food, Groceries Gluten Free Foods
Prohibited, Countries Prohibited, Japan
Bob's Red Mill, Baking Powder, Gluten Free, 16 oz (453 g)
- Shipping Weight: 1.24 lbs (0.56kg)
- Product Code: BRM-00392
- UPC Code: 039978003928
- Package Quantity: 16 oz (453 g)
- Dimensions: 1.2 x 3.4 x 5 in, 1.05 lbs (0.48kg)
- Expiration Date: Sep 2016
Madre Labs, CocoCardio, 7.93 oz (225 g)
Priced together: $16.61 Priced separately: $19.61
Product Overview
- Double Acting
- Aluminum Free
- Gluten Free
- Kosher
- All Natural
Bob's Red Mill Double Action Baking Powder releases carbon dioxide when exposed to moisture and heat, causing doughs and batters to rise. It is all natural and contains no aluminum. Baking powder is perishable and should be kept cool and dry.
Bob's Red Mill products labeled Gluten Free are batch tested in our quality control laboratory. We use an ELISA Gluten Assay test to determine that a product is gluten free.
Suggested Use
Buttermilk Biscuits
2/3 cup Buttermilk
1/3 cup Canola Oil
2 cups Unbleached White Flour
1/2 tsp Salt
3 tsp Baking Powder
Preheat oven to 400ºF.
In a small bowl, stir together buttermilk and oil. In a medium bowl, combine flour, salt and baking powder. Gradually add the milk mixture to the flour mixture, combine until well blended. Shape into a ball, place on a floured surface and knead 4 or 5 times. Roll dough out flat, with a cookie cutter, cut out biscuits. Place 1 inch apart on a baking sheet. Bake on rack in center of oven for 12 to 15 minutes or until light brown. Serve with butter and jam.
Dear Friends,
Since starting this company over thirty years ago, our mission has always been to offer the most diverse array of stone ground, whole grain products. About ten years ago, we noticed that some folks were exclusively buying gluten free grains like brown rice, sorghum and quinoa. Soon after that, we learned all about celiac disease and gluten intolerance and how serious they are to millions of people like you.
We've also learned that "naturally gluten free" just isn't good enough. Over the years we have introduced a variety of measures to ensure purity in our line of gluten free products that have become industry standard. We inspect all farm deliveries, use dedicated gluten free production facilities and employ batch testing in our quality control laboratory. Knowing that we're providing safe and delicious gluten free foods that you and your family can trust makes it all worth the effort.
To your good health,
Bob Moore
Other Ingredients
Sodium acid pyrophosphate, sodium bicarbonate, corn starch and monocalcium phosphate.
Manufactured in a facility that uses tree nuts and soy.
Keeps best refrigerated or frozen.
|Supplement Facts
|Serving Size: 1 tsp (4 g)
|Servings Per Container: 113 (per 16 oz)
|Amount Per Serving
|% Daily Value*
|Calories from Fat
|Total Fat
|0 g
|Saturated Fat
|0 g
|Trans Fat
|0 g
|0 mg
|590 mg
|Total Carbohydrate
|1 g
|Dietary Fiber
|0 g
|0 g
|0 g
|Vitamin A
|Vitamin C
|*Percent Daily Values (DV) are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.


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Make a Gift to the Salvation Army
Youngstown Temple
The Salvation Army in Youngstown Temple is dedicated to serving the men, women, and children who are at-risk and in need of financial, social service, and spiritual support. We work everyday to elevate individuals up from despair to provide hope and assistance. In teaching life skills, we provide individuals with an opportunity to maximize their physical, emotional, and spiritual being to effect life change. Questions or Comments? For more information, please contact us using the information below.
Address: 1501 Glenwood Ave. Youngstown, OH 44501 (click to view map)Ph. (330) 270-5999 | Fax: (330) 746-0002 | Informacion en Espanol: (330) 559-3406web: www.SalvationArmyOhio.org/YoungstownTemple
Officers: Lieutenant Gretchen & Jorge Munoz
firstname.lastname@example.com |
The Salvation Army is an evangelical part of the universal Christian church that provides opportunity for spiritual growth and development. Our services are designed for the entire family and there is always a friendly welcome. Bible studies are offered with a concentration on real-life issues that confront so many of us today. The Salvation Army offers opportunities to provide worship and Christian service. All are welcome.
The Salvation Army is a non-profit organization wholly funded by private and public donations. Your gift, of any amount, is needed to support our important community programs. Please take this opportunity to make a donation now to help those in Youngstown Temple who are in need. Your gift is tax-deductible to the extent provided by law. Thank you!Mailing in a Check? Please make checks to (memo: Youngstown Temple Salvation Army):
With 'heart to God and hand to man', The Salvation Army strives to meet the basic needs of all who come seeking help. Taking immediate care of the basic human needs of food, shelter, clothing and safety is an important first step in the development of a more positive and permanent life change in the people we help. It is essential to note that at no time the participation in spiritual activities be required as a condition for receiving needed services. All service given in the name of Jesus for meeting human needs and caring for hurting persons is in and of itself valued and is a spiritual ministry.For more information about the following programs and services, please call (330) 270-5999.Current List of Programs and Services
SunbeamsGirl GuardsBoy's AdventureTeen GroupMime & DanceDrama & Choir
The Advisory Board stands in service to the mission of The Salvation Army and is an essential component to its success. The purpose of the Advisory Board is to be a liaison between The Salvation Army and the community at large. The board represents The Salvation Army to the community through advocacy, access, and fundraising. The Board also ratifies all major initiatives and monitors operations in light of community realities, property matters, budgets, and related items.The Board stays informed through its regular meetings, and through its committees and Advisory Councils. Executive and AdHoc committees meet intermittently to take up specific issues, and make recommendations.
The development committee of the Board is directly responsible for fundraising alongside our Development staff. Our Board members help identify new prospective funders, they cultivate relationships, serve as natural partners, make introductions for Development staff to meet with new prospective donors, and they solicit gifts for our annual campaign, benefit events and any special initiatives and/or seasonal programs. They help leverage significant dollars each year.
Interested in learning more about the Advisory Board or becoming a member? Please call (330) 270-5999 or email email@example.com
Youngstown Temple Advisory Board Roster
For more than 135 years The Salvation Army has worked tirelessly to improve the quality of life for people in need in Northeast Ohio. The Salvation Army works every day to elevate men, women and children up from despair to provide hope and assistance through programs that work. In teaching life skills, The Salvation Army provides individuals with an opportunity to maximize their physical, emotional and spiritual being to effect permanent change.
Throughout the year, the demand for services is great. While the ultimate goal is to help people change their lives permanently, The Salvation Army services support those in need as they work to improve their lives.
support The Salvation Army in your community as we work everyday for change.
The Salvation Army, an international movement, is an evangelical part of the universal Christian church.
Its message is based on the Bible. Its ministry is motivated by the love of God. Its mission is to preach the gospel of Jesus Christ and to meet human needs in His name without discrimination.
The Salvation Army, Northeast Ohio Division
2507 E. 22nd Street Cleveland, Ohio 44115 (map)
ph. (216) 861-8185 | web: www.SalvationArmyOhio.org


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Havanese Puppies for Sale
Henry, WWW.AFFORDABLEPUP.COM
• Male • $495
Mittens, WWW.AFFORDABLEPUP.COM
• Female • $495
Sophie - Female AKC Havanese
• Female • $699
• Male • $1,299
View More Puppies for Sale
Breed Group: Toy
Weight: 7-13 lbs
Height: 8-11 inches
Color(s): cream, gold, silver, champagne, tan, blue, black, parti-color and tri-colored
The Havanese is a small breed that is happy and affectionate.
They are true companions who love to be part of the family. They are
extremely social and will lavish attention on those who lavish attention on
them. Since this breed is odorless and low shedding they are popular
choices for allergy sufferers.
The Havanese is a true delight. They are intelligent, curious,
and playful. This breed thrives on companionship and adores children. The
Havanese are good watch dogs who will alert their family to danger or
visitors. They will look to their family for reassurance before welcoming
strangers. Once they befriend someone they are friends for life.
The Havanese is a highly devoted breed. They are at their
best in the family environment and do not like to be left alone for extended
periods of time. They get along very well with children and other pets.
The Havanese are neither aggressive nor timid, and do not exhibit a
possessive nature. They truly have an endearing personality that makes them
a lovely house pet.
The Havanese require brushing and combing a minimum of two times per
week although the coat may be clipped for easier care. It is important to
check the eyes and ears regularly and keep them clean. They are susceptible
to genetic eye disease and ear infections. The Havanese need to have their
teeth brushed weekly so early tooth loss is prevented.
The Havanese is a double-coated breed that is low shedding. The hair
is soft in texture, very long and in great abundance. The Havanese coat has
different types from straight to curly. They come in many colors such as
pure white to cream, black, silver, chocolate, or parti-colored. In the
adult Havanese the coat reaches a length of 6-8 inches.
The Havanese is always eager to learn. They do well in both
agility and obedience. They also love to swim and enjoy many water sports.
They take great delight in being the center of attention and with their
quick wit are easily trained to perform tricks. Their sweet and loving
dispositions make them great therapy dogs. The Havanese, like many toy
breeds, may be difficult to housebreak. It is important to train this breed using firm, fair, consistent and loving direction.
The Havanese has an energetic nature that requires walking, a
play session, or a swim. However, they do not require an inordinate amount
of exercise. They do well in apartments and also homes with small yards.
Since they are adept at learning tricks, they benefit from this activity.
The Havanese are moderately active indoors but do need toys and social
stimulation so as not to become bored and irritable.
If you are looking for Havanese puppies for sale from reputable Havanese breeders or to adopt Havaneses from a Havanese rescue then make sure you understand as much about the dog breeds you are interested in as you can. Every puppy breed is different. Begin your research by reading the breed information about the Havanese puppy above. Search our dog breeds section to find Havanese puppies that make great pets.
Are you knowledgeable about a certain breed? Share what you know!
We provide the only safe marketplace for Havanese dog breeders to list and rehome their purebred Havanese puppies. Havanese dog breeders listing puppies on Next Day Pets are required to verify their identity for your protection. Most dog breeders with Havaneses for sale offer health guarantees and may be shipped worldwide. With over 100,000 active dog breeders, we can assure you you'll find the perfect puppy for your family.


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INGLEWOOD, Calif. (August 11, 2011)—Trainer Jerry Hollendorfer, whose current stable includes Horse of the Year candidate Blind Luck, will be inducted into Racing's Hall of Fame Friday in Saratoga Springs, N.Y.
Hollendorfer, who turned 65 in June, is one of seven inductees, joined by trainer Matthew Byrnes, jockey Shelby Barnes and horses Sky Beauty, Safely Kept, Open Mind and Duke of Magenta.
Hollendorfer, whose graded stakes wins at Hollywood Park include the 2011 Vanity (Blind Luck), 2010 Gamely Stakes (Tuscan Evening), 2008 Californian (Heatseeker) and the 2010 Bayakoa (Washington Bridge), is among the all-time leaders in both wins and purse earnings.
Through Aug. 10, Hollendorfer has 5,990 victories, leaving him fourth behind Dale Baird, Jack Van Berg and King Leatherbury. Horses trained by Hollendorfer have earnings of $123,563,330, placing him seventh all time.
Copyright © 2009-2014, Hollywood Park. All rights reserved.


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To answer some comments by other reviewers:
No, this is not a cream as you'd expect, it's an ointment. Your mother or grandmother would have known how to make this with oil and wax. The wax is what keeps it solid and, as the wax melts the oil is 'released' as it were. And no, you can't park some on your arm or the back of your hand, since the very thing that keeps it solid [the wax] is what melts at body temperature and allows the product to liquefy completely. And lastly, yes you can surely make this at home, the problem is the shelf life - unless you know what you're doing you may end up with nasties growing in the product. Also there might be issues of liability, since now you're not just the applier of the product, but you're also the manufacturer. The scents are mild and lasting - my clients love that the scent is noticeable, but not so strong as to interfere if they return to work. A little really, really does go a long way, so be careful with application [the upside to that is it justifies the price]. And it works great on hairy clients without getting gunky or slick. This is not a product for everybody however. Balms like this have been used since ancient times as medicinal products, and they still work as well now as they did then. The downside is that they don't work like modern products, so there is definitely a learning curve involved if you're going to get any real versatility out of them. The bottom line is, if you don't like putting synthetic chemicals on your clients [regardless of how many times they might print 'organic' on the label], and you're willing to spend a little time learning how to use something that was designed in a kitchen and not engineered in a lab, then I don't think you'll be disappointed. I think this is going to turn out to by my go-to product.
I was very pleased with my order for 3 containers of massage cream. The price was below competitors, and they arrived well before they were promised.
I have been a massage therapist for 20 years. I have never cared for manmade massage creams and have always used oils. I was thrilled to learn of this product through another massage therapist friend. It is completely natural and gives the perfect amount of glide. I wish it came in an organic version but am otherwise 100% pleased. it will be the only thing I use in the future - I also bought the unscented version for my clients who prefer no scent.
I have been using this product for a few years. It is all natural and I love that it glides so well without being greasy. I have used only this product since I tried it a few years ago. It is great for use on both men and women.
Above average product. Similar performing products can be had for a fraction of the price.
The Occupational Safety and Health Administration requires that MSDS be available to employees for potentially harmful substances handled in the workplace under the Hazard Communication regulation.
Material Safety Data Sheet


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Colorectal Cancer Health Center
Caring for a Continent Ileostomy or K-Pouch
General Guidelines for Draining the K-Pouch continued...
If you still think pouch drainage has stopped, remove the catheter in case food particles or debris have blocked it. Flush the catheter with cool tap water then reinsert it.
After the first three to four weeks, you can stop the continuous draining and start draining several times per day or as instructed by your health care provider. Though you usually make this change after seeing your doctor for the first time after the operation, sometimes your doctor will tell you to start doing the following earlier:
- Drain the pouch every two hours during the day while you are awake.
- Drain at bedtime and first thing in the morning.
- Do not drink or eat within two hours of bedtime.
- During the night, you will usually set the catheter to constant drainage. You may also choose to set your alarm clock to wake you to empty the pouch.
Over the next several weeks, the time interval between pouch drainages will increase. At night, you may be able to stop the constant drainage and go for longer periods without waking to drain the pouch.
Three months after surgery, there are usually no specific restrictions. Sound practice is to empty the pouch four to six times per day and use irrigation on two of these times. However, any time you feel full, bloated, or distended, drain the pouch. Just as you would empty your bladder before engaging in physical activity or going to bed, so should you empty the continent ileostomy.
How Do I Care for the Continuous Draining Catheter and My Skin?
Good skin and catheter care need to be continued after you go home from the hospital. It is important to keep the skin around the catheter clean and protected, as well as make sure the catheter is open and draining. The following guidelines will help you properly care for your catheter.
1. Gather the following supplies
- Washcloths or paper towels
- Non-oily soap (Ivory and Dial are recommended brands)
- Plastic bag or newspaper
- Dressing
- Irrigation supplies: tap water, bulb syringe, and basin
2. Wash your hands with soap and warm water and dry them with a clean towel.
3. Irrigate the catheter.
- Remove the dressing over the stoma and discard it.
- Separate the catheter from the drainage bag and drain the contents of the catheter into the basin.
- Collect 30 cc (1 ounce) of tap water into the bulb syringe. Tip: Highlight the 30 cc mark on the bulb syringe with permanent marker or nail polish for accurate, easy measurement.
- Insert the 30 cc of tap water into the catheter by slowly squeezing the bulb syringe to release the water.
- While holding the syringe bulb down with your thumb, pinch the catheter and separate the bulb syringe from the catheter.
- Unpinch the catheter and drain its contents into the basin. Do not withdraw the fluid from the catheter into the syringe.
- If the fluid you just put in seems to be taking a long time to come back out, or if mucus blocks the catheter, repeat the previous irrigation steps as needed until stool flows freely through the catheter. If water doesn't go in or come back out, the tube may be blocked. You may have to remove the catheter from the stoma and rinse it with cool tap water to clean any mucus built up inside the catheter. Then reinsert the catheter. Do not put in more than 60cc (or 2 ounces) of water without the pouch contents emptying.
- When the stool flow has stopped, continue to step four.
4. Reconnect the catheter.
5. Cleanse the skin around the stoma and catheter.
- Wash the skin around the stoma and catheter with non-oily soap and warm water.
- Rinse the skin thoroughly with warm water.
- Pat the skin dry with a soft towel or paper towel.
- Apply two layers of "split" dry gauze dressing around the catheter and over the stoma. Secure with tape as needed.
- Discard the waste.
- Wash the basin and the bulb syringe with soap and warm water. Let the supplies air dry, or dry with a clean towel.
- Wash, rinse, and dry your hands.


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Blocks hackers so you can shop safely
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Computer Hardware
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AVG's LinkScanner® technology is compatible with:
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Where can I go to see a Revolutionary War fort or battlefield?
New York State Office of Parks, Recreation and Historic Preservation manages a number of historic battlefields, forts, headquarters and homes that played a significant role in the birth of our nation. Perform a search with the keyword 'revolution' when you visit the Historic Preservation Bureau.
More Info
Historic Sites - Office of Parks, Recreation and Historic Preservation
Historic Sites Bureau
URL: http://www.nysparks.state.ny.us/sites/


text:
Alessandro Ballan of the BMC Racing Team finished eighth in Saturday's Queen Stage of the Santos Tour Down Under to remain in 11th place overall with one day of racing remaining.
A Hard Stage
Ballan, who has twice finished in the top 10 in five stages, said he hopes to climb into the top 10 with a strong finish Sunday. "Today was very, very hard," the former world champion said. "I made the first group and hoped to do a good sprint but my legs are still not the best." Early in the 131-kilometer race, John Murphy represented the BMC Racing Team in an eight-rider breakaway that gained a lead of 2:36 before being reeled in on the first of two ascents of Old Willunga Hill. Francisco Ventoso (Movistar) won the sprint finish while Cameron Meyer (Garmin-Cervelo) kept the overall lead.


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First spotted on the runway in petal, these chandelier earrings are crafted using custom hand-poured resin stones. Set in Russian gold, made exclusively for the house, these earrings will add modern sophistication to any look.
• 3.625" long
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Used Ford Dealership in Ellisville, MO | Serving Chesterfield, O'Fallon, Fenton, Eureka & St. Louis
Bo Beuckman Quality Ford is dedicated to providing the finest used cars in Ellisville, MO. The chances are good that you will find that pre-owned Ford Escape, Explorer, F-150, Focus, or Fusion you have been searching for. Use our up-to-date online vehicle inventory to shop for a used car day or night. Before a used vehicle is added to our current inventory it must first pass a rigorous inspection. You get peace of mind knowing that each and every vehicle that we sell will provide thousands of miles of trouble-free driving. Please feel free to give us a call at (800) 401-6441 or stop by our Ellisville, Missouri Ford dealership to speak with an automotive sales' professional. Drivers from St. Louis, Chesterfield, O'Fallon, Eureka, Fenton, and all across Missouri, have used our services to find their perfect used Ford.


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Granite Quarry Elementary celebrates different cultures
Hola! Guten Tag! Bonjour!
Granite Quarry Elementary School welcomed all on March 7 for its annual Multi-Cultural Night. Parents, students and teachers lined the hallways to learn about cultures around the world.
Kindergarten's fiesta made guests feel a little closer to Mexico, especially with spicy chips and salsa. First grade flew visitors to beautiful Germany for May poles and pretzels. The luck of the Irish was with second grade as they searched for that elusive pot of gold at the end of the rainbow.
Third grade took a trip to merry old England just in time for tea. Exotic Brazil welcomed visitors on the fourth grade hall while fifth grade entertained with facts about Spain. Guests had to be careful not to get drenched by Niagara Falls as they toured the 200 hall and learned about Canada.
If all those travels made guests feel homesick for the USA, Mrs. Booker and her crew were more than willing to give them a taste of home with barbecue and hotdogs.
Students in each grade level have been hard at work exploring these different cultures and finding out they have more in common than they realize. Thanks go out to all visitors who helped with this night of learning and fun.


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Europe has a vibrant and alive cultural scene, and that is due to its extraordinary history and extremely complicated cultural set-up which has built up over the centuries to produce the diverse continent we know today. Populations shifted, climates changed and cultural themes appeared only to be absorbed into other cultures. Europe is more richly diverse and has a longer history than virtually anywhere else in the world, and it celebrates that fact.
Celtic culture is fascinating to many people. Tantalizingly little is known about daily Celtic life during the Bronze and Iron Ages, yet modern Celtic language and arts are alive and well in the United Kingdom, Ireland, and northern France. The Celtic legacy is visible to a lesser extent in many other European countries as well.
The Celts were a widespread group of tribes that flourished between the 8th and 1st centuries BC. The Greeks called them "Keltoi", hence the word "Celt", and the Romans named them "Galli", whence the name "Gaul". At the height of their civilization, the Celts lived in an area stretching from the Black Sea to the Atlantic Ocean and north to the Baltic Sea! As the Romans colonized Celtic territory, some of the population and customs were assimilated, but much was destroyed. By the time of the Roman Conquest in the 3rd century A.D., Celtic culture survived only in large parts of Britain and northern Europe. Because Ireland and northern Scotland were never Roman colonies, they remained entirely Celtic.
It's well-known that the Romans were great builders; in Europe they constructed an immense network of roads (approximately 100,000 km, more than 62,000 miles) during the 800 years of the Empire, and sprinkled Europe with cities and monuments that still attract great numbers of visitors today, often in the heart of areas rich in other tourist attractions.
Some 2,000 years ago, the Roman Empire needed a way to maintain a firm hold on its conquests: it was imperative to build a main road for military use that would allow communication among the provinces.
Originally a military route, the Via Domitia, the first road to be built in Gaul (France), rapidly became a conduit for communication and commerce, facilitating the settlement of all of southern Gaul. The road begins in Italy, crosses the south of France and over the Pyrenees all the way to Spain, where the Via Augusta takes over and continues on into Andalucía.
In the Languedoc you'll find the majestic Pont Du Gard, the best-preserved aqueduct in the world, and considered to be the symbol of Roman genius.
Europe's oldest palaces are Roman villas. Villa Romana del Casale in Sicily is a 4th century B.C. villa decorated with splendid mosaics of hunting scenes, luscious fruits, geometric patterns—and female gymnasts wearing what may be Europe's earliest bikini! Diocletian's Palace in Split was built for the emperor's retirement; Diocletian may have stopped working, but parts of the palace are still going strong today, part of the city's current architecture.
Germany Castle Route, for cyclists and motorists alike, includes over 70 medieval, baroque, and rococo castles and palaces. Historic pageants bring the drama of past eras to life at many sites. Mad King Ludwig was definitely mad for building; his best known project is Neuschwanstein, which inspired Disney's Magic Kingdom castle.
Spain's history harkens to the struggle between Moors and Christians vying to control the rich Iberian Peninsula. 10,000 castles once dotted the landscape; today, thousands still stand, reflecting the contributions of many civilizations to Spanish culture. Seville is the oldest royal palace in Europe still in use.
In Greece visit ancient acropolises and medieval Greece Castles, such as hilltop Byzantine fortresses at Platamon and Trikala. The Franks constructed strongholds in the Peloponnese; the Knights Hospitalier built the famous Palace of the Grand Master in medieval Rhodes, and imposing Venetian strongholds still stand in Crete, Corfu, and Nafplion. The 19th century Achilleion Palace in Corfu incarnates the Hapsburg's passion for Greek mythology.
European Heritage Days (EHD) offers opportunities to visit buildings, monuments and sites, many of which are not normally accessible to the public. It aims to widen access and foster care for architectural and environmental heritage. These events are also known as Doors Open Days and Open Doors Days in English-speaking countries.
The Carpathian Mountains form the largest mountain range in Europe.
The North Sea region brings a body of water famous for fiercely beautiful coastal areas.
The Rhine, one of Europe's great rivers, brings to mind wine and beautiful landscapes.


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Academy Sketchbox Set
Manufacturer: Grumbacher
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Academy Sketchbox Set
An excellent value for beginning or advanced painters, this set includes twelve .25 oz. tubes of Academy watercolors, a red sable brush, a flat wash brush, an instruction booklet and a palette, packed in a handy portable carrying case. Colors include: alizarin crimson, burnt sienna, cadmium red light hue, cadmium yellow deep hue, cadmium yellow pale, Chinese white, Payne' s gray, sap green, thalo blue, ultramarine blue, viridian and yellow ochre.
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The word theatre means a "place for seeing." The first known theatrical event was in 2500 BC in Egypt.
The ancient Greeks began formalizing theatre as an art, developing strict definitions of tragedy and comedy as well as other forms, including satyr plays. Like the religious plays of ancient Egypt, Greek plays made use of mythological characters. The Greeks also developed the concepts of dramatic criticism, acting as a career, and theatre architecture.
Western theatre continued to develop under the Roman Empire, in medieval England, and continued to thrive, taking on many alternate forms in Spain, Italy, France, and Russia in the 16th, 17th and 18th centuries. The general trend over the centuries was away from the poetic drama of the Greeks and the Renaissance and toward a more realistic style, especially following the Industrial Revolution.
Ireland likes to think of itself as a rather cultural spot, and with good reason, too. Ireland has a lively theatre scene, the most famous of which could be the Abbey Theatre.
In Mainland Europe theatre has a long tradition.
In Iceland the Reykjavík City Theatre has been performing repertory since 1897. It stages 6-10 plays per year on two stages. The state-run National Theatre has operated since 1950 and stages 10-15 productions a year on three stages.
In Portugal Casa da Musica, Avenida Da Boavista opened in 2005 and has already established itself as the musical heart of the city. It is home to the Orquestra Nacional do Porto and has a hugely impressive concert hall, but it also has lots of other halls and rooms for a wide variety of musical events and genres. In addition, it has two restaurants and three bars, so it's a nice venue to spend an evening.
In Spain the main opera house is the Gran Teatre del Liceu in Barcelona, opened in 1847, and one of the world's finest and largest settings for opera. Since its complete refurbishment in 1997, the Teatro Real in Madrid, originally opened in 1850, has become one of the most avant-garde opera venues in Europe and stages many world premieres.
In Paris, marvel at the sumptuous Opéra Garnier, an amazing example of neo-Baroque architecture. For a magnificent combination of classic Italian and modern architecture, you must see the opera house in Lyon. Marseille, Rouen, Nice, and Bordeaux are just a few of the other cities in France graced with opera houses.
On to Germany and the question is: where to start? Berlin has the modern Deutsche Oper Berlin, the 19th century Comic Opera, and the reconstructed 18th century Staatsoper to choose from. The award-winning Stuttgart State Opera is another beautiful building well worth a visit. The Dresden Semper is a superb example of Baroque architecture, stunning and filled with art from the original building. There are lovely opera houses in so many other cities in Germany – Cologne, Düsseldorf, Frankfurt, Leipzig, and more – seize the opportunity to take a tour or enjoy a performance!
In the Czech Republic it was at the Prague Estates Theatre that Mozart conducted the very first performance of Don Giovanni; the Prague State Opera is an equally magnificent building.
In Hungary, the Hungarian State Opera awaits its visitors at the opera house on world famous Andrássy Avenue.
To see some of the most contemporary and striking opera houses, visit Copenhagen (Denmark), or Gothenburg (Sweden). Norway will have a new opera house opening in Bjørvika, a harbor area in Oslo area, in 2008.
The Pyrenees Mountains straddle the border between Spain and France.
Who put the "Be" in Benelux? Belgium, the Netherlands, and Luxembourg!
The Mediterranean Region defies description; so rich is it in dramatic history and bewitching scenery.