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Welcome to Skinside Out, where science meets beauty! We peek into skin cancer awareness and prevention in this episode, hosted by Dr. Zain alongside Courtney and Heather. Learn about the importance of sunscreen, its types, and how it protects against harmful UV rays. Discover the benefits of mole mapping and the various treatment options available for skin cancer, including surgical procedures and advanced techniques like MOHS surgery. We also discuss dietary tips to support skin health, the role of antioxidants, and how to incorporate sun-protective measures into your daily routine. Tune in to understand why sun protection is essential year-round and get practical advice on managing your skin's health.
00:00 Introduction to Skinside Out
01:00 The Importance of Sunscreen
03:58 Types of Sunscreens: Mineral vs. Chemical
06:20 Common Misconceptions About Sunscreen
11:59 Skin Cancer Prevention Tips
14:51 Healthy Skin from the Inside Out
16:19 Annual Skin Exams and Mole Mapping
20:14 Treating Skin Cancer: Surgical and Non-Surgical Options
27:24 Conclusion and Key Takeaways
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
10 Skinside Out
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[00:00:00]
Dr. Zain Husain, MD: welcome to Skin Side Out where Science Meets Beauty. I'm your host, Dr. Zane with Courtney and Heather. So today we're gonna be continuing our discussion on skin cancer awareness, talking about prevention.
I.
Heather Murray, PA-C: So just to give you an overview, we'll talk about the importance of sunscreen. We will go into skin cancer prevention, um, the benefits of mole mapping, as well as different treatment options for skin cancer.
Courtney Carroll, LE: Yep. And skin cancer is definitely on the rise. So it's important to prevent this, which is easily preventable with the use of sunscreen.[00:01:00]
Dr. Zain Husain, MD: Cool. Um, so I think that we'll first go into the obvious preventative strategy, which is sunscreen. So let's talk about that, Courtney.
Courtney Carroll, LE: Yeah. So, um, you know, I'm sure we all have used sunscreen at some point in our lives, and if you haven't, then shame on you , but why do we use sunscreen? Because the sun does, um, Amit harmful UV rays.
So those rays can lead to cellular damage, which can lead to your skin cancers. Um, not only that from a skin cancer point of view, but it can also, um, . Influence other diseases like rosacea, for example. Um, it can flare that, or some people who just have sensitivity to the sun, um, are, you know, lupus patients, things like that.
So sunscreen really is, um, not only used medically for those conditions, but cosmetically you wanna make sure you're avoiding your fine lines and wrinkles and it can help, make [00:02:00] you stay young.
Dr. Zain Husain, MD: What do they say? Like, nothing looks better in your fifties than wearing sunscreen in your twenties.
Yeah. . Yeah. . Mm-hmm .
Heather Murray, PA-C: So there are different types of ultraviolet radiation that the sun emits. So most commonly there's or mainly there's UVA and UVB. So UVA is, um, a type of UV ray that penetrates deeper. It tends to lead to the premature aging and the fine lines and wrinkles. UVB is your classic or predominant sunburn, sunburn, , UV radiation.
Either of them can contribute to skin cancer, , especially melanoma, which is the most serious type of skin cancer. So you definitely wanna be protecting yourself from both.
Dr. Zain Husain, MD: Do you know how I used to differentiate between the two when I was studying for boards?
Heather Murray, PA-C: No.
Courtney Carroll, LE: UVB is, I always heard like bur, like B for burn, burn and a for aging , smart
Dr. Zain Husain, MD: Um, so people think that [00:03:00] UV radiation, um, is only really harmful in the summertime when the sun's really strong, but that's not true. Um, the sun is constantly emitting UV radiation even in the winter months, even when it's cloudy. So sunscreen should essentially be worn all year long. And I tell my patients every single day and they're always looking at me shocked.
Like even in the winter? Yeah. Like, yes. In the winter. Um, even when you're driving, um, and you're even at working from home, you know, UV light can penetrate through windows.
Courtney Carroll, LE: I love that when they say, oh, well I don't leave the house. Oh, okay. So you don't go grocery shopping. Yeah. You don't go to the mailbox.
You don't take walks. . Yeah.
Dr. Zain Husain, MD: So I mean, I think it's really important that you just make it a part of your routine. Like you brush your teeth, yep.
Joe Woolworth: Mm-hmm . To
Dr. Zain Husain, MD: make it a habit. Wear your sunscreen, SPF 30 or higher and just call it a day and you know that you're protected. And then it's reapplying every two hours if you're gonna be out in the sun for extended periods of time.
Courtney Carroll, LE: Yeah. And so, um, you know, there [00:04:00] are mineral based sunscreens mm-hmm . And chemical based sunscreens, and we'll kind of touch on the difference between those. Typically your mineral-based sunscreens are going to be your zinc oxide and titanium dioxide. Um, these tend to be better, um, especially for more sensitive skin types like those rosacea skin types or even acne skin types.
They tend to protect better, especially ones that are tinted. Um, I think we all are pretty good about using our tinted sunscreens mineral based more than the chemical sunscreens. Um, chemical sunscreens, I think get a bad rep.
Dr. Zain Husain, MD: You think it's justified? I.
Courtney Carroll, LE: Yes and no. I think any sunscreen is better than no sunscreen.
That's right. . So in that regard, if you like your chemical sunscreen, I would rather my patients wear that than nothing. Yeah. Um, it can be harmful to the reef. In Hawaii, it's actually banned to use any chemical sunscreen because the chemicals in there. Um, [00:05:00] are destroying the reef. So those are the chemicals that, um, are your vos and your oxys avobenzone, Oxy, um, oxybenzone.
Oxybenzone. So
Joe Woolworth: ate.
Courtney Carroll, LE: Yeah. These are those, those chemicals that, um, you know, I try to avoid just because I appreciate my, my coral reefs. .
Heather Murray, PA-C: Yeah. And I think the biggest difference between mineral and chemical is their mechanism. So the way that they work. Mm-hmm . So . Mineral predominantly blocks UV rays from penetrating into the skin.
Chemical based sunscreens actually use that UV ray and converts it to heat and releases the heat. Yeah. It
Dr. Zain Husain, MD: absorbs those photons of that light energy.
Heather Murray, PA-C: Yeah. Now there's a little bit of, you know, not mineral sunscreens, don't. Only block, they do absorb and convert a little bit. So there's a little bit of leeway, but predominantly minerals will block and chemical will absorb and convert to heat.
Dr. Zain Husain, MD: Yeah. And you know, [00:06:00] some of the other benefits of those minerals, sunscreens, we talked about, you know, some patients who are more acne prone and rosacea prone, but also those that are really sensitive. Mm-hmm . Um, I feel like there's less incidents of allergic contact dermatitis. Mm-hmm . Due to some of the ingredients.
Um, controversial topic. What about I. Claims that they're hormone disruptors.
Courtney Carroll, LE: I shut it down. I hate that claim. , I quote this study all the time because people come in and are so concerned. Mm-hmm . And I think also just the word chemical people associate that with like bad chemicals, but. Ev, you know, everything's a , everything chemical.
Yeah. So I, when you look at that study, they were applying sunscreen, the chemical sunscreens seven times a day to the whole body. Now, who is applying sunscreen seven times a day? No one. And every day, you know? Yeah. I mean, maybe if you're at the beach, you're applying four or five times, but every [00:07:00] single day for, I can't remember how long the study a year or something.
Mm-hmm . So I think it's just ridiculous when . It, it makes it seem worse than it is, I would say. Yeah.
Dr. Zain Husain, MD: And I think also the whole argument about the vitamin D deficiencies. Mm-hmm . Being caused by sunscreen. Okay. You can get vitamin D from your diet, can supplement, take a supplement . Um, we know that UV light is a carcinogen.
We know that it causes skin cancer. There's so many studies that have proven that. Then when you're trying to say that, oh, like the vitamin deficiencies, or, oh, these chemicals are carcinogens themselves. I'm like, no, like that makes no sense. Like these arguments just drive me wild for why people wanna avoid using sunscreen.
It doesn't make any sense.
Courtney Carroll, LE: And then you get the people nowadays too, that are replacing sunscreen with like coconut oil, orlow. Don't get me started. I just [00:08:00] think it's so ridiculous if you really care that much. I understand, but that's when you use your zinc oxide. It is. It's used in babies for, yeah, we put them on baby's
Dr. Zain Husain, MD: bottoms.
I mean, it's gotta be safe. Yeah.
Courtney Carroll, LE: How much more safe can you get? Seriously. So as long as you don't mind a little white cast, then. Wear the zinc oxide, but hey,
Dr. Zain Husain, MD: if you're worried about the white cast, there's a micronized zinc oxide. Mm-hmm . Elegant formulations. Now we're not in the 1960s anymore. Yeah. We can get a sheer sunscreen and we have one that's in our office.
Um, it's incredible. I love it. Um, it goes on completely cast free. Like for me, like I previously did not want to use zinc based sunscreens because it would make me look like this gray ghost , um, look really awkward. So I used to use more of the chemical sunscreen, but with the micronized zinc, I've completely changed.
I. I really like the way that it looks on my skin. Um, I don't have the sensitivities and I'm acne prone to, so it's a win-win.
Courtney Carroll, LE: Yeah. And you know, for a long time too, [00:09:00] I think there was this huge misconception, , that only fair skin people need to wear sunscreen. And part of that I blame, you know, that zinc or maybe the lack, the lack of attention that these companies have put towards people of color because of course they're not, people who have skin of color are not gonna wanna wear this white
Zinc that makes them look almost grayish or, or like ghost-like. So, um, you know, not only fair-skinned people can benefit from sunscreen, both medically speaking, and again, cosmetically speaking, when we think of other conditions,
Dr. Zain Husain, MD: that point reminds me of my journey with sunscreen. So I will admit I did not use sunscreen at all until I was in residency
So until my mid twenties, um, I would just go outside. You know, those were the days where kids actually went outside and played , so we would be outside all day at the pool. Okay. Grandpa , . Well, everyone, like all my, my pediatric patients are on their phones are like, you know, they're playing like Minecraft [00:10:00] or whatever and they don't even play outside anymore.
So, you know, I would be going outside playing sports, um, and never wore sunscreen. And I remember when I studied abroad in Europe, um, I went to Greece for a week. And I'm like, okay, whatever. It's just sunny like everywhere else. I got burned for the first time and literally my skin turned so dark you could not tell the difference between my hair and my skin.
my eyes, lighting on my teeth, I was burned. I'm like, I didn't think this was possible. So after that, you know, I'm like, okay, so I can burn. , . Um, and then when I got into residency and kind of really learned about the dangers of . UV light exposure, um, and skin cancer. And just also its effects on photo aging.
You know, that's when I started using sunscreen consistently. So it's never too late. Um, and I wish I had known a bad sunscreen, but I thought that I was protected, you know, like my skin is darker. Mm-hmm . Um, I don't burn really [00:11:00] until I went to Greece. . Yeah. So.
Courtney Carroll, LE: Yeah, I have a lot of my, um, darker skin patients.
Um, in fact, I had one this week where she has, um, some hyperpigmentation mm-hmm . From old acne, um, that she was experiencing. And when I told her that she should be wearing her daily sunscreen, she looked at me like I was crazy and she said, why? Um, and then I explained to her that even those pigmented spots can be influenced by the sun.
So even from a cosmetic standpoint, um, it can be helpful to wear the sunscreen to help limit how long those spots stay around for. Yeah. And that's really important to a lot of people too. So. Yeah.
Dr. Zain Husain, MD: And I think the cosmetic point is something that I hone in on with the younger patients. Mm-hmm . Like. You know, you wanna prevent wrinkles.
Mm-hmm . Sunspots, you know, they kind of gravitate more that they're thinking about skin cancers. Like
Joe Woolworth: Yeah. A lifetime
Dr. Zain Husain, MD: away is not gonna happen to them. Like, who cares? They're invincible. Yeah. But when they're like talking about their looks and their appearance, then they kind of think about it. They wanna
Heather Murray, PA-C: prevent that.
Yeah. As much as they can.
Courtney Carroll, LE: Yeah. [00:12:00] And speaking of young people, I still cannot believe that I. Have seen patients who are still using tanning beds. Yep. So, you know, talking about skin cancer prevention and how we can, you know, really help eliminate that risk. The tanning beds drive me crazy. I can't even believe really, that they're still legal.
It's spring break season. Everyone's trying to get their base tans,
Dr. Zain Husain, MD: get 'em ready. Yeah, I know. And that drives me crazy.
Courtney Carroll, LE: I see it all over TikTok and mm-hmm . You know, um, the, the girl I saw one girl, her dad got her a tanning bed for her birthday. And I just like, I just, if I could drill it into their heads, you know, it just, it increases your risk of, um, skin cancer, specifically melanoma.
Um, we've . Have that patient who was, you know, a longtime tanner and Yeah. Has had that melanoma. So it is just, it's not worth the risk. And that's why they make things like self tanners now. Yeah. Um, where you can go get your nice glow . Yeah. I'd
Heather Murray, PA-C: much rather you go get tanning, um mm-hmm . Oil or [00:13:00] tanning lotion or spray tan than to go to a tanning bed.
Dr. Zain Husain, MD: Yeah. And like they've come a long way. You're not gonna look like an MPA lumpa, um, with some of these new formulations. So some of them look like really, really elegant and you can't really tell. Yeah.
Courtney Carroll, LE: So another, um, way to prevent that sun exposure or that skin damage is limiting what hours you're outside.
So of course those peak hours you always hear doctors and, um, you know, internet saying to avoid what is it like between 10 and two mm-hmm . Um, really just to avoid tanning in general, I think is the Yeah. The key takeaway.
Dr. Zain Husain, MD: Yeah. I mean, I try to . Make sure that my kids are out playing, like, you know, later on in the day when the, or in the shade.
In the shade. Exactly. Wearing, you know, sun Protective clothing. Mm-hmm . That is huge. Oh yeah. Um, and that's something that I've embraced recently. Um, I started wearing UPF clothing. . I'm a huge Love it. I like it. It's so much easier. They're
Courtney Carroll, LE: cute now. It's not like back in the day, you know, you, [00:14:00] but it's like so much
Dr. Zain Husain, MD: easier.
Like, I don't have to like, have, like I'm gonna put on sunscreen on my back. Yeah. And like it's cold, . Yeah, I just put on a shirt and, you know, wear my hat.
Courtney Carroll, LE: And they're breathable too. Yeah. Yeah. I remember before I started in dermatology, I, I had taken a cruise with my parents and we had went snorkeling and I had applied my sunscreen, but you're out there for hours on the boat and when you're snorkeling, your whole back is still exposed.
And so of course I get back on the ship and. My whole back is burnt and it was just a terrible feeling. Well, after that, the boat, I was a catamaran. Um, they said that they had SPF shirts for sale. Of course, they were like $60. Oh yeah. I instantly bought one and I said, I'll never go in another catamaran or go snorkeling again without my sun shirt because I just do not want to risk it.
Heather Murray, PA-C: Yeah. Yeah. I think in addition to sun protection, it's important to, um, incorporate healthy, um, diet to help support your skin. [00:15:00] So these are like diets rich in an rich in antioxidants, like fruits and vegetables to, um, help protect your skin from the inside out. Also water plays a huge role. Um, drinking plenty of water, keeping your skin hydrated and elastic, and just overall keeping your skin healthy.
Um, there's a supplement that I love, um, called heliocare, not sponsored, but I wish I was . Um, it is actually, um, an antioxidant derived from a fern. So it's called Odium Loma. Leco. Mm-hmm . Um, and it really helps to protect the skin from harmful effects from, um, radiation or any sort of damage.
Dr. Zain Husain, MD: Yeah. What about niacinamide?
Heather Murray, PA-C: Niacinamide is great. Yeah. I think, you know, um, systemic as well as topical can help protect the skin. Yeah. There
Dr. Zain Husain, MD: have been studies with nicotinamide and how they've shown improvement, um, in reducing [00:16:00] actin keratosis, which are precancerous and . I think that's interesting. It's something that, you know, we talk about with our patients.
Courtney Carroll, LE: Yeah. And I think it's important to note that. This is an adjunct treatment. I think sometimes people get the misconception that they can just take the helia hair. Right. But you still wear your sunscreen .
Dr. Zain Husain, MD: Yeah. There's no substitute for that. Yeah. . Um, and then let's not forget about getting your annual skin exams, making sure that you're getting.
Screen from head to toe with a board certified dermatologist or a provider who is really skilled at looking at, you know, these moles and other growths on the skin. So I think that's really important.
Heather Murray, PA-C: Yeah. Yeah.
Courtney Carroll, LE: So with those, um, skin checks, you might hear of the term mole mapping, um, which is something that is done to help kind of track the mole.
So I'll let Dr. Sain speak a little bit on that.
Dr. Zain Husain, MD: Yeah, it's a, it's a great, um. Option for patients who tend to have a lot of moles, um, [00:17:00] high risk skin cancers, and basically there are very . High quality digital photographs that are taken to track changes, um, amongst moles and other skin growths. And it's very helpful, especially with routine skin exams, reviewing that with what we're seeing on the patient in real time.
And that has been helpful, especially when I was working in a melanoma clinic, um, during residency. . It was really helpful to detect some of those subtle changes, um, between exams, and I think that that can be a very valuable tool for patients who A either have melanoma. History of dysplastic nevi or atypical moles, or are just nervous and want that extra reassurance.
Heather Murray, PA-C: Yeah. And I think it's, um, a game changer because it's not just taking photos of your skin, like, um, you can do that at home . Um, but this is [00:18:00] really getting in and taking a magnified photo, something, you know, like what we use with our dermatoscope, so our little handheld mm-hmm . Magnifier tools to help really see the structure of those moles and those lesions, and to know if something is almost like microscopically changing.
Courtney Carroll, LE: It's really like a visual diary of your moles and which can be I like that. Yeah. Visual diary. Yeah. Poetic , . Um, but it's extremely important, especially when it comes to things like melanoma, because the earlier you're able to catch that, the much better that outcome is. And so, um, I think that's where the mole mapping really shines in preventative care.
Dr. Zain Husain, MD: Yeah. Heather, um, . Who needs a skin check and how often should they be happening?
Heather Murray, PA-C: So, um, I recommend skin checks, um, annually for those who are over 20. For most people, I mean, you could, you could span that out to maybe 25 or [00:19:00] 30, but I think for most individuals, 20 is a good age, 18 to 20. Um, there are some people obviously who like have a strong family history of melanoma that might go a lot sooner for skin checks.
Um. Even skin of color or darker skin types, I do still recommend, um, depending on their risk, either an annual skin exam or maybe every three years depending. But, um, for most people it's annual. Now, if you have a history of . Skin cancer, um, there's this kind of algorithm we go off of. Mm-hmm. So if you've had melanoma recently, you're likely getting skin checks, um, every three months for at least two years.
If you've had a basal cell carcinoma or squamous cell carcinoma, you're likely getting skin checks every six months for at least two years. And so it kind of depends on the person. But typically annually for most people.
Dr. Zain Husain, MD: Yeah. It doesn't mean that you have to wait until your next exam, right. If you notice something new or suspicious.
So if you are worried about something, just make sure you just call your dermatologist [00:20:00] and you know, we'll see you right away and evaluate it. I think it's better to be cautious then, you know, potentially have a skin cancer that can have devastating consequences.
Courtney Carroll, LE: Agreed. So what happens when you do have a skin cancer?
How do we treat that ?
Heather Murray, PA-C: So I think the, the good thing is if we detect it early, um, the . Cure rate is very high. Um, so like Dr. Zane mentioned, anytime you do notice a spot that you're worried about, the sooner we evaluate it, the sooner we biopsy it, the the better chance that we have.
Dr. Zain Husain, MD: Yeah, and the nice thing is many of these skin cancers can be cured surgically.
Um, so you know, your basal cells, your squamous cells. In melanomas, we often treat these with a surgical excision or mos micrographic surgery, so I'll explain what both of those are. So a surgical excision is where we cut out a skin cancer with, um, [00:21:00] prescribed margins to make sure that we are removing the skin cancer as well as a margin of normal skin so that we can ensure a high cure rate.
That is sent to the pathologist to examine the margins to make sure that all the skin cancer has been removed. And that's, you know, more for like basal cell, squamous cells, um, low risk tumors, and you know, also for melanomas. However, in higher risk areas or highly cosmetically sensitive areas, then I often recommend most micrographic surgery.
So MOH surgery is actually a very specialized form of skin cancer treatment. It was named after Frederick Moss, who was a surgeon. It's not mole surgery , it's MOH surgery, MOHS. Um, so basically what we do in the office is at the site of the biopsy, we mark the, you know, the margins that we see clinically and [00:22:00] we try to take a small, narrow margin around it.
And remove a small layer of skin, that tissue gets processed into frozen section slides in real time. So I have actually a histo technologist who is preparing the slides for me, staining them, and then I serve as the pathologist as well. So I am looking under the microscope. I'm looking at the peripheral and deep margins of the tissue to see if there's any skin cancer there.
If there is skin cancer at any of those margins, I carefully mark it on a map. And go back and we repeated again, and we take another small layer and very conservative therapy. However, if we're all clear at those margins, that means you're cured. So there is a 99% cure rate for most surgery and is considered the gold standard.
And it's especially helpful for high risk tumors, um, such as on the face, um, things that are behaving a little bit more aggressively with a more [00:23:00] aggressive histology. Um, and it just provides us with the best cure rate. With preserving the amount, the most amount of healthy tissue. So that's really important.
So that's the first part. The second part is the reconstruction. So as a most micrographic surgeon, um, I'm trained in plastic and reconstructive surgery techniques to help give you the best cosmetic and functional outcome the same day. So what we do is, um. We go over the different options that you have.
You can either leave the wound to heal and on its own. That's called second intent healing. We can do a linear repair where we're putting in two layers of sutures. Internal, external typically have a straight line for more advanced or complex, um, locations or sites or tumors. Um, you know, we may employ, um, more advanced techniques such as a skin flap where we cut adjacent skin, rearrange the tissue so [00:24:00] that it covers a defect, while also having a good cosmetic outcome.
We can also do a skin graft where we take skin from another part of the body, we remove it from there, and we actually sew it into place in the defect. So there are a lot of different options that we can use and we can also use tissue substitutes as well to help promote healing. Quickly. So there are a lot of different options that we have, um, to reconstruct the tumors, and that's all happening the same day.
So your most surgeon is not only curing of your skin cancer, but also putting you back together again.
Heather Murray, PA-C: I have a question for you. Yeah. What's your favorite type of reconstruction? After most,
Dr. Zain Husain, MD: I find flaps to be the most fun. What type of
Heather Murray, PA-C: flap?
Dr. Zain Husain, MD: My favorite flap. I love my, I love the O to Z flap. Yeah. 'cause it looks really cool and it makes a z and I love Zplasty.
Yeah.
Joe Woolworth: after me .
Dr. Zain Husain, MD: So, but you know, there's a lot of different cool flaps that are out there. Um, there's a really cool one called the flip flop flap.
Heather Murray, PA-C: Really? I haven't heard of that one. Yeah. So
Dr. Zain Husain, MD: actually I wrote a little paper [00:25:00] on that, um, from a case that I did when I was in fellowship. So basically we . When you have a large, um, defect involving the cartilage of the ear, like this part of the ear mm-hmm.
Like the concha and other parts. So you're essentially like have a through and through defect, you can actually take skin from behind the ear mm-hmm. On the scalp. Size it and actually sew it into place so that it forms like this little, oh my gosh. Skin splat. Oh gosh. Like you pull it through, you pull it through, its a pull through flap.
Courtney Carroll, LE: Yeah.
Dr. Zain Husain, MD: So, and then later on, three weeks later, you kind of separate it and that becomes part of your ear and nobody sees the defect behind it. 'cause your ears iss covering it. So it's
Heather Murray, PA-C: kind of like a graft, sort of. But you, it's
Dr. Zain Husain, MD: a flap. It's an interpolation flap. It's technically a flap. Yeah. Because it's still attached to the skin.
Oh, I see. But then we, um, separate it weeks later. Interesting. Kinda like a forehead flap, you know, like, you know, you separate it three weeks later once you connect it to the nose. Yeah. From the forehead. So it's kind of fun. Interesting. [00:26:00] I
Courtney Carroll, LE: like that. And I think, you know, a lot of people tend to be nervous about the MOS surgeries or any surgery for, for that matter.
Um, because their biggest question is always, what is the scar going to look like? Yeah. And I think that's where MOS shines because, um, you are, it's a, it is a tissue sparing procedure and you are keeping intact the, the healthy skin. And, um, if you're going to a provider that is both, um, you know,
Cosmetically trained as well. Mm-hmm . I, I think that's always a nice, um, situation for a patient who is worried about that cosmetic outcome as well.
Dr. Zain Husain, MD: Yeah. And the nice thing is also we have all the technologies mm-hmm . In our office. Um, so being a comprehensive practice, um, practicing cosmetic dermatology, we have a lot of lasers and other
Devices that can help improve the appearance of scars, whether it's the redness. So we have a vascular laser that can help, um, or the texture where we can use like a CO2 to kind of blend it in or [00:27:00] microneedling. And we often, you know, don't have to use these, um, thankfully, 'cause our, you know, reconstructions turn out really well, but.
If we need to, we have those tools available.
Heather Murray, PA-C: Yeah. And MOS micrographic surgery is typically for skin cancer, non-melanoma skin cancers like basal cell and squamous cell. But there's also this term called slow mos, which we use mm-hmm . For, um, like melanoma sometimes. Yeah. Which is. Not tech technically moss, but it's where we're taking that specimen.
We send it off to the pathologist, but we make sure the margins are clear. Mm-hmm . Before doing that. Reconstructive or, um, any sort of simple closure.
Dr. Zain Husain, MD: It's called staged excision. And it is a great option, especially for practices that don't have immunostains. Um, so immunostains can also be used. Um, so you can technically do moss on some of these melanoma in situ twos.
Um. Using these specialty, but not everyone has access to them. So large academic centers, they typically have access to it, but smaller [00:28:00] offices often don't. So slow mos is the way to go
Courtney Carroll, LE: in
Dr. Zain Husain, MD: spaces.
Courtney Carroll, LE: Um, I wanted to touch on some of the other procedures that people might hear of, or I know, um, previous offices I've worked at have done some of these, so,
For example, um, the ED and CS or some offices call them Cnds, scrape
Joe Woolworth: and Burn The
Courtney Carroll, LE: Scrape. Yeah. Scrape and burn. Um, which stands for Electrodesiccation and Tage. So that's a procedure that I know, um, offices that I've previously worked at. The provider will numb the skin similar to the biopsy, and they use this little curette to essentially scrape the skin cancer off.
And then they use a device called the cautery. Tose off that skin. So they do it usually about three times. Um, kind of repeat that process, scrape and burn. Um, and with that, it typically will leave this circular scar. Now the problem with that procedure is that you're not rebiopsying or sending anything off to the pathologist [00:29:00] to confirm that that skin cancer has been completely removed.
So there is a higher risk of recurrence with that, and that's why you do wanna be mindful of . Um, how you're treating those skin cancers. And those aren't pretty scars. No. , they're not.
Heather Murray, PA-C: I don't love an EDNC, but I will say the reason for the cartage is actually that skin cancer has a different feel. Mm-hmm
When you're using that tool, you feels like butter, right? Yeah. You're doing that kind of scrape. It has a more buttery, smooth feel. Mm-hmm . Compared to normal skin and so that kind of helps the provider know . How far to go, but I, I still don't love it. 'cause you don't have that confirmation of clearance.
Yeah.
Dr. Zain Husain, MD: I really always love having pathology confirmation. Yeah. Because I've seen such bad recurrences. Mm-hmm . Um, with. Patients who've been treated with E, D and C. Mm-hmm . Topical chemotherapy, um, and other methods. And these recurrences are horrible and they're harder to treat. They're really hard to treat.
Mm-hmm . 'cause there's scar tissue involved. Yeah. [00:30:00] And then there's just, it just becomes a big mess. So I really like, you know, tissue confirmation like mos. Gives that to you. Um, why local excisions give that to you. So, um, I'm just not a huge fan of, you know, these other options. And that also brings us to radiation.
Yep. Mm-hmm . So Right. That is an option. You know, it can have good outcomes. But I still don't know whether all the skin cancer has been treated.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: I'm just hoping. Yeah. Praying to God, . Yeah, it's gone.
Heather Murray, PA-C: And there are also like, especially for the advanced melanomas or invasive melanomas mm-hmm . There are other treatment options like immunotherapy.
Um, sentinel lymph, lymph node biopsies, which is where we're actually, um, biopsying a lymph node to see if that melanoma has traveled to mm-hmm . Um, the lymphatic system. So there are definitely different options, chemotherapy, depending on what type of skin cancer you have and how advanced it is.
Courtney Carroll, LE: Yeah, [00:31:00] so it's skin cancer.
I think, um, if you haven't had it, most people know someone who has had a skin cancer. So, you know, you're not alone in that realm. You have the support of your providers. Um, there's so many resources online for, um, people who have gone through things like that. I know for sure there's, um, a. I talk about Reddit all the time, , but there is like a Reddit group for people who have had melanoma.
Mm-hmm . Um, so there's a lot of, I think, resources out there so that you don't feel like so afraid of what's going on and, um, so nervous about your cancer?
Dr. Zain Husain, MD: Yeah. I mean the a a D. Mm-hmm . A SDS, the melanoma research Foundation. American College of Most Surgery, they have great resources on their websites.
All free. Yeah. So, you know, I always encourage my patients to check it out. Um, there's a wealth of knowledge there.
Joe Woolworth: Yeah.
Dr. Zain Husain, MD: So I think that we had a great discussion about prevention, um, as well as treatment. [00:32:00] Um, so some takeaways from today's discussion. Prevention is key. Wear your sunscreen. Um, be smart. Wear protective clothing.
Don't go out picking out in the sun. Don't use tanning beds. Um, and then just make sure that you get your annual skin checks. Um, it's really important, um, just to just have knowledge of what's going on with your body and you can't see all of your body sometimes, and you just need to train professional to take a look at it.
Heather Murray, PA-C: Yeah. And trying to avoid those. Um, the middle of the day, like between 10 and two or 10 and four. Some people say, um, wearing, like Dr. Zane said, the Sun Protective clothing, and also seeing your dermatology provider. If you're worried about a spot, maybe consider mole mapping.
Courtney Carroll, LE: I mean, the skin is your largest organ, so it requires the most attention.
Um, so you know, things like the sunscreen, the Sun Protective clothing, your prevention is really gonna make the biggest difference in, deterring [00:33:00] skin cancer, um, overall. So, yeah.
Dr. Zain Husain, MD: Thanks for joining us and this month long discussion on skin cancer awareness. I think it's a really important message to get out there and if you have any questions, feel free to reach out to any of us.
We're happy to answer any questions. Hopefully you like this episode. Please subscribe and like, and until next time, skin side out, out,
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