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The bleaching agent is somewhat helpful. The big thing is to prevent them from going out in the sun by using sunscreens that prevent hyperpigmentation. Vitiligo, not much we can do for vitiligo chloasma, cloasma, closma, chlosma PUVA therapy has been useful but not that useful. Here’s a man who came in because he had a sore here from a basal cell, he had a previous basal cell here. He recognized this but he also had a second basal cell on the side of the nose. Always examine these patients completely when they’ve had more than one. If they’ve had a basal cell, always strip them to the waist because I’ve found very often they may have a big one on their back. Here is a patient with an ulcer, with a squamous cell carcinoma sitting on top with an ulceration which needs surgical excision, of 

So does the basal cell which is locally destructive, but the squamous cell can be important in that it metastasizes. Here is a patient who has actinic keratosis from long years of sunlight exposure. Cryotherapy for these lesions or using topical Efudex for one month. When I use Efudex I always have them put it on in the morning, not at night. And then I always have them put it on once a day to all their face, their spots, their forearm. They will get a burn a primary burn almost from the Efudex for one month. I have them use grease, Vaseline or water washable Aquaphor many times a day to keep it from getting fissured and cracked and sore and prevent secondary infection. At the end of one month I have them stop the therapy and then use topical hydrocortisone ointment to get it better and clearer. What doesn’t clear, I do biopsies chloasma, cloasma, closma, chlosma