A biopsied skin cancer that resurfaces before definitive treatment is common and is evidence that the cancer is still present. However, some squamous cell carcinomas can be aggressive and grow quickly. If this seems to be the case with your skin cancer, I would suggest moving your Mohs appointment to an earlier date. The smaller the skin cancer is when it is treated, the better your surgical outcome.
It is safe to use those products together, however you may not be optimizing your rejuvination regimen. Retin-A really only needs to be used at night, as sunlight can inactivate the retinoid. Antioxidants work best during the day when free radicals are being generated. Furthermore, layering products will dilute the active ingredients. Sometimes my patients want to dilute their Retin-A because it is too drying or irritating, especially when they first start using it. My recommendation to you to get the most out of your products without wasting them, is to use your antioxidant and sunscreen in the morning, waiting as long as possible between the two, and use your Retin-A by itself in the evenings.
I frequently recommend that patients use the highest strength of Retin-A that they can tolerate. However, I have seen a study that showed that although Retin-A shows significant improvement in photoaging there was no difference between the lower and higher strengths of Retin-A. Retin-A gel allows for better penetration of the retinoid into the skin. Because of this, there is a lower percentage of the active ingredient in Retin-a gel. Retin-a cream comes in .025%, .05% and .1% and Retin-A gel comes in .01% and .025%. Some patient with very oily skin prefer the gel because they find the cream too greasy. However, in my experience, the majority of patients find the gel too drying. Unless your skin is very oily, I would recommend staying with the cream, but increasing the strength to .1%.
Accutane is usually dosed at 1mg/kg/day. Typically, I would prescribe 40 mg twice daily for someone your size. At this dose most patients complete treatment in 5 or 6 months. If I use a lower dose, most patients will have to be on the medication for a longer period of time. I like for my patients to be totally clear for one month before stopping the medication. Accutane's effectiveness is usually determined by the total cummulative dose. Some doctors start at a lower dose for very severe cases so they don't get the initial flare. I hope this helps. Good luck.
Melasma can be prevented if you practice strict ultraviolet light avoidence. You should never leave the house without a sunscreen that contains adequate UVA protection. The SPF measures only the UVB protection and melasma is primarily caused by UVA exposure. The best UVA blockers are zinc, titanium, avobenzone and mexoryl. Check the active ingredients on your moisturizers, sunscreens and/or makeups to make sure it contains one of the above ingredients. UVA rays can pass through glass, so make sure you have adequate protection when sitting next to a window or driving in a car as well. Seeking shade whenever possible and wearing a hat will also help prevent melasma. IPL results will last for years if you do not have unprotected ultraviolet light exposure. Having had IPL should not have any effect on whether you develop melasma. You should focus on having a healthy pregnancy. Although necessary hormonal drugs may predispose you to melasma, if you utilize safe sun practices it should not be an issue. Keep also in mind that if you do develop melasma it can be treated successfully after your pregnancy with bleaching agents and chemical peels. Best of luck with your IVF!
