What is your background and what inspired you to become a dermatologist?
When I began medical school, I opened my first dermatology textbook to figure out a skin finding that I noticed on a family member. The photographs of various skin diseases were fascinating to me and the healing properties of skin were as well. As I had used tanning beds in the past (but had since quit), I became inspired to help others with skin cancer prevention and treatment. I ultimately pursued a fellowship in Mohs surgery (skin cancer removal). It is very satisfying to confirm that a skin cancer is removed under the microscope and to reconstruct the skin all in one visit. Patients are very appreciative.
What is a board-certified dermatologist and why is it so important for people to seek regular skin exams from one?
A board-certified dermatologist has undergone extensive training and passed a rigorous board examination. Training includes four years of medical school (after four years of undergraduate studies), one general internship year, and three years of dermatology residency, at a minimum. Many dermatologists spend additional years performing clinical and/or basic science research, and many also pursue specialized training after residency in the form of fellowships.
There is an incredible number of skin disease that exist – more than 3,000, in fact. Board-certified dermatologists are trained to recognize and treat the common conditions and are also trained to tackle the rare conditions. It truly does take several years of training and experience to learn the subtleties of skin disease and to recognize skin cancers at an early stage. Full body skin examinations are important to detect skin cancers that many not look obvious or follow the “rules” (asymmetrical, irregular border, different colors, etc.). Studies have shown that full body skin exams will find incidental skin cancers.A Studies have also shown that board-certified dermatologists have a higher yield with each biopsy in detecting a skin cancer as compared to other providers in dermatology, and to other non-dermatology physicians.B,C Early detection is key to saving lives in patients with skin cancer.
You posted on Instagram that your patients are surprised when you tell them to wear sunscreen and hats in the winter. Why does this surprise people?
Many people assume that cold weather or a cloudy day offer adequate protection from the sun. While the sun (or UV index) may be less strong during these times, the risk of skin damage is far from zero. We need to educate the public about the additive damage of small doses of UV radiation. These small amounts over several years will ultimately increase the risk of skin cancer. Education is challenging because UV radiation is invisible (unless a massive amount gives you a sunburn!). It is somewhat similar to high blood pressure, which often does not cause symptoms until it has been left untreated for several years.
What do you think influences people when it comes to tanning and their skin health?
I find that people are influenced by their social circles. Patients will often come in for their first skin check after hearing about one of their friends, family, or co-workers who were recently diagnosed with skin cancer. Not surprisingly, it is the stories of advanced melanoma (the deadliest form of skin cancer) that seem to have the most substantial and immediate impact.
Overall, more and more people are becoming educated about the dangers of tanning and ways to protect their skin. Celebrities who have shared their skin cancer stories, such as Hugh Jackman and Ali Fedotowsky (Bachelorette contestant), also seem to have a positive influence and garner awareness.
What advice would you give to people about enjoying life yet still being mindful of their sun exposure?
The good news is that, nowadays, MANY tools and techniques exist to protect your skin while enjoying outdoor activities.
I would recommend that you make sunscreen application part of your daily morning routine. This seems to be more difficult for men, who may not apply any skincare products at baseline. The best sunscreen is the one you will use, so finding a formulation that you can tolerate (and may even like) is important.
Investing in hats – the wider the brim, the better – and sun protective clothing (look for UPF 50) are easy, hassle-free ways to protect your skin.
Additionally, there are oral supplements, such as nicatinomide (a type of B vitamin) and polypodium leucotomos (an herbal supplement), that confer some additional protection (but should not be the sole method of sun protection).
Avoiding the outdoors during peak UV index hours of 10am to 3pm is another way to reduce exposure.
A: Hanson JL, Kingsley-Loso JL, Grey KR, et al. Incidental melanomas detected in veterans referred to dermatology. J Am Acad Dermatol. 2016;74(3):462–469. doi:10.1016/j.jaad.2015.09.057
B: Privalle A, Havighurst T, Kim K, Bennett DD, Xu YG. Number of skin biopsies needed per malignancy: Comparing the use of skin biopsies among dermatologists and nondermatologist clinicians. J Am Acad Dermatol. 2020;82(1):110–116. doi:10.1016/j.jaad.2019.08.012
C: Anderson AM, Matsumoto M, Saul MI, Secrest AM, Ferris LK. Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System [published correction appears in JAMA Dermatol. 2018 Jun 1;154(6):739]. JAMA Dermatol. 2018;154(5):569–573. doi:10.1001/jamadermatol.2018.0212