Skin Cancer, from a Dermatologist's Perspective (Introducing Dr. Emily Keller)
I’m going to say this upfront – I love my dermatologist. I think having a good doctor-patient relationship is extremely beneficial in one’s skin cancer journey. That is why I was thrilled when someone recommended Dr. Keller to me. You can imagine my excitement when I saw that the first item on the list of services she provides was “Skin Cancer Treatment.” I wish everyone had a Dr. Keller. She’s not only an excellent doctor, but she listens to my preferences regarding my treatment. She may not always agree with me, but at least she considers what I’m saying.
I asked Dr. Keller if she would be willing to answer some questions I presented her regarding dermatology and skin cancer, and she graciously agreed.
The inside scoop from my dermatologist
Q: What is the benefit of seeing a dermatologist instead of a family doctor for skin concerns?
A: A dermatologist has specialized in all things related to the skin, so they are well educated and trained in this specific field.
Q: At what age should people start having skin checks?
A: The age at which a person should get a skin check differs based upon family history and amount of sun exposure. Someone with no significant family history and no significant history of sun exposure should begin skin checks around 40 years of age. Someone with family history or history of excessive sun exposure may want to start skin checks earlier.
(I’m going to add that I made my daughter get her first skin check at the age of 20 with Dr. Keller because my daughter loved going to the tanning bed. Even though she is already showing signs of skin damage, thankfully she had no skin cancer or areas of concern, and I had the peace of mind that she went. If you are a tanner, get your skin checked!)
Q: What is your recommendation for the frequency of skin checks?
A: The frequency is dependent upon personal history. A patient with history of melanoma may have skin checks every 3-6 months. A patient with history of squamous cell carcinoma or basal cell carcinoma may have skin checks every 6 months. A patient with no significant skin cancer history (but sun exposure history) may have skin checks once yearly.
Q: What is the best way people can prepare for a visit with you for a skin check?
A: When a patient is coming in for a skin check, I recommend showering the night before, no makeup, no lotion. Patients should be prepared to get undressed and have all of their skin examined. If they have specific spots of concern, they can circle them on the body or write a list.
Q: What do you specifically look for when you do a skin exam?
A: When performing a skin exam, I am looking for a plethora of lesions. Of most concern are those lesions that are changing, non-healing, or new within a short amount of time.
Q: How do you determine which course of action (Efudex cream, blue light therapy, cryotheraphy, excision, etc.) to use on a patient?
A: The decision on what course of action needs to be performed is based upon the specific diagnosis.
(I do have a feeling that Dr. Keller is fond of torturing me when freezing my actinic keratosis areas. There have been several times I’ve told her to stop and she says ‘just one more spray.’ I’m thinking this is one way dermatologists amuse themselves.)
Q: What is one thing you wish people knew about skin cancer?
A: That we do a majority of our sun damage before the age of 18. Starting sun avoidance and sunblock is essential from a young age.
Q: What is the most common area you find skin cancer on a patient?
A: The most common areas are the face, chest, and back.
Q: What is the most uncommon place you’ve found skin cancer?
A: The places that people do not often think about getting skin cancer, which are the penis, vagina, and on the bottom of the feet.
(This is scary, and all the more reason for the "up close and personal" skin checks that make people uncomfortable.)
Q: What do you recommend people do to help prevent getting skin cancer?
A: I recommend the strict use of sunblock that contains titanium dioxide and zinc oxide, as these provide better protection than do chemical sunscreens. I also encourage wide-brimmed hats and sun protective clothing.
There you have it. If you won’t listen to your mom, your sister, or your friend about sun protection and skin cancer, maybe you’ll listen to your doctor. Or in this instance, my doctor. Pay your dermatologist a visit soon, and take good care of your skin!
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