Q:  Does smoking make skin cancer worse? I have a friend with basal cell carcinoma who smokes.  I need to show her as many reasons as I can to quit this terrible habit. Can you help?

A: Although cigarette smoking, by itself, does not worsen basal cell carcinoma (BCC) or any other skin cancer, it does significantly affect the healing of any surgery to treat the cancer. In numerous scientific studies, smoking has been shown to reduce significantly the blood flow that is necessary for wound healing to proceed in a normal manner. Nicotine in cigarette smoke causes blood vessels to constrict; this reduces blood flow and, in the case of a freshly healing wound, can starve the wound healing site of oxygen and life-sustaining nutrients. The nicotine absorbed from smoking just two cigarettes reduces blood flow to the bottom of the feet by 40 percent! There is also a much higher risk of healing complications — wound breakdown, localized tissue death and infection — in patients who smoke. In short, if your friend stops smoking, the treatment of the BCC and the healing after her surgery will be swifter and have fewer complications.

If that isn't enough to convince your friend to quit (along with the heightened risk of lung cancer, heart disease and other life-threatening illnesses), let her know that smoking greatly accelerates wrinkling, leathering and skin aging in general.

Robert H. Gotkin, M.D., F.A.C.S., Director of Plastic Surgery at Cosmetique Dermatology, Laser & Plastic Surgery, LLP, is a board-certified plastic surgeon specializing in cosmetic and reconstructive facial surgery and breast and body contouring.  On the staff of prestigious hospitals  in Manhattan and Long Island, NY, Dr. Gotkin is a member of the American Society for Aesthetic Plastic Surgery, the American Society of Plastic Surgeons and is a Fellow of the American College of Surgeons.  He is the co-author, along with his wife, Deborah S. Sarnoff, M.D., of a the best-selling book Instant Beauty: Getting Gorgeous on Your Lunch Break.

Dr.Gotkin is an Amonette Circle member of The Skin Cancer Foundation.