Several years ago, I was telling a patient about the importance of doing routine screening for skin cancer – by far the most common type of cancer in the U.S., affecting over a million people a year. She volunteered that she was covered, that she was seeing a dermatologist routinely for Botox injections. “Does he do a complete head-to-toe exam?” I asked. Her pause and sheepish expression told me all I needed to know. She wasn’t at all covered – because she was never uncovered.
Fortunately, the majority of skin cancers found each year are basal cell or squamous cell – the types that have a very high chance of being cured. The National Cancer Institute estimated that fewer than 1,000 people died from these “non-melanoma” cancers in 2008. Melanoma is another story, affecting over 62,000 Americans a year and causing over 8,400 deaths. The majority of melanomas occur in older patients but almost 1 percent are diagnosed under age 20 and almost 8 percent are found between ages 20 and 34. So you’re never too young to start thinking about ways to prevent skin cancer and ways to keep track of what’s happening with your skin.
Since I was in medical school in the mid-’70s, the number of yearly cases in the U.S. has more than doubled. Early detection is likely one reason for the increase but nobody is exactly sure what has been causing the dramatic rise. What is clear, however, is that early detection is the name of the game when it comes to curing melanoma. The earlier a lesion is found, the better the chance of cure – which brings us to the main point of this blog. Everybody should be getting routine head-to-toe skin exams. This means looking from head to toe at every millimeter of your body, including where the sun doesn’t shine. Skin cancers can occur in any location of the body, including the armpits, scalp, between the toes, in the groin or anogenital area – anywhere! Routine self-exam should be part of your screening regimen. If a partner is available who can examine hard to see areas such as the small of the back – all the better.
In addition, I feel that routine screening should include a well-trained health professional who is interested in performing a careful skin exam. This is where it can get tricky. We live in a time when sub-specialists abound – even among dermatologists. A patient may see a cosmetic dermatologist several times a year for Botox injections. The dermatologist may glance at areas of exposed skin but the patient should not feel that a full screening skin exam is being routinely performed. The patient I described at the top of this blog had magical thinking – somehow reasoning that she’d received skin cancer screening just because she’d seen a dermatologist, even though she hadn’t taken her clothes off! Trust me: no doctor is good enough to detect skin cancer without examining the skin.
When the CBS Doc Dot Com team was brainstorming for segment ideas recently, producer Jessica Goldman came up with the idea of following her through a complete evaluation with a dermatologist. That brings us to today’s episode with New York City dermatologist Dr. Francesca Fusco, who covers a wide range of skin issues, from cancer prevention to cosmetic dermatology.
True story: As a fourth-year medical student I spent a summer working with a dermatologist in Los Angeles. In addition to all the skin cancer removal, sun damage, and Mohs surgery patients, my preceptor had a thriving laser tattoo removal business.
One day a rock band electric guitarist came into the office requesting help for an incident he’d had the night before. Apparently he’d gotten terribly drunk (+/- stoned) and made an impulsive tattoo decision that he regretted deeply in the light of morning.
The gaunt, long-haired gentleman entered the dermatology suite with his head hung low. He sat down in the exam chair and explained that he was there for a tattoo removal consultation. “Man, I can’t believe I did this to myself,” he muttered as he unbuttoned his shirt.
I wondered what on earth could be so terrible…
And then I saw it.
It was an 8 inch by 4 inch, bright yellow and black tattoo…
While I was “homeless” my blogging friends kindly invited me to guest post at their websites. Ramona Bates at Suture For A Living posted this for me:
I have a great plastic surgeon friend who offered to fill a facial scar for me. I was bitten in the face by a dog when I was very young, and the small (1/2 inch) divot of flesh from my cheek still bothers me slightly. I’ve generally ignored it but thought it might be fun to see if it could be corrected in any way – so I happily agreed to try a Restylane (hyaluronic acid) injection.
My surgeon and I decided not to use any numbing medication because it distorts the contours of the face, making correction more challenging. So I tried my best not to squirm as he inserted a fairly long needle parallel to my nose…
While I was “homeless” my blogging friends kindly invited me to guest post at their websites. Allen Roberts (aka GruntDoc) posted this for me:
As many of my close followers know, I’m “in between blogs” at the moment. My new website has not launched yet, so I’ve asked a few close friends if I could guest-blog at their sites until further notice. Dear Grunt Doc actually offered me a password and authority to post directly to his blog. Now that’s trusting! I mean, I could fill up his site with LOLcats posts if I wanted.
A few blog-hijacking fantasies later, I decided to ask myself – “What sort of content would be appropriate to contribute to an Emergency Medicine blog?” The answer, of course, is “real photos of anything gross.”
And as luck would have it, I do have a nice photo of something gross (albeit mildly so). Even better, it’s my own grossness so there’s no HIPAA violation looming. What is it? Well, it’s the sadistic work of a dermatologist. (By the way, dermatologists have the best photo galleries of really gory conditions).
Methacillin resistant staphlococcus aureus (MRSA) is a deadly bacterium that is becoming more and more common inside and outside the hospital setting. No one is immune, not even babies like this one who died from an unknown exposure. Seven-time NBA All-Star Grant Hill has also experienced the ravages of MRSA. I interviewed him about his near-death experience.
Dr. Val: Tell me about your recent experience with a severe staph infection.
Grant: I got my MRSA infection in 2003, afterI had a surgery on my ankle in the hospital. I had never heard of MRSA before and it was a very scary ordeal(at certain points, I didn’t think I was going to make it)and it took me a long time to recover. Dealing with my own infection made me realize just how severe MRSA could be. I want to make sure others do not have to go through what I went through. I got lucky with my infection because the doctors recognized it and we were able to treat it. I will always have scars on my ankle from the infection, so I never really forget what I went through and how lucky I was to survive.
Dr. Val: How common are staph infections among basketball players?
Grant: I don’t know exact statistics regarding basketball players, but the scary thing is, now it’s not just in hospitals. Now you’re finding MRSA infections in community settings like gyms, schools, homes and locker rooms. So there is definitely a need for conversation about this, and also about ways to prevent it.
Dr. Val: As an insider, what kind of behaviors have you observed that might put players at higher risk for contracting MRSA?
Grant: One thing I have learned through all of my injuries is that tomorrow is never really promised. As athletes there are so many ways that we can get injured, we can’t underestimate something like MRSA, especially because there are easy ways to prevent it. It’s important for players to know that MRSA can be spread by sharing athletic equipment, towels and razors. To help stop the spread of MRSA in locker rooms and on sports teams, players need to wash their hands frequently and stick to using their own personal items. They also need to know that when working out, they should keep a towel down between them and shared equipment. When it comes to locker room surfaces, those should be disinfected with a bleach solution. I am very conscious of all these prevention methods in my life, because I realize how important the prevention side of it is.
Dr. Val: Now that you’ve had a staph infection, what precautions do you take to prevent re-infection?
Grant: All those little things my mom used to tell me to do still ring true. I make sure to wash my hands frequently and cover any of my cuts -I keep a whole stash of bandages in my locker. I also keep my towels to myself and disinfect with a bleach solution, that’s really easy to make. It only takes a few minutes out of my day to take these steps, but I know first-hand that it can make a world of difference. You know, I often find myself telling my daughters the same things because as a father, it is important that I keep my family safe and healthy.
Dr. Val: What should athletes know about MRSA and what advice do you have for them?
Grant: Athletes of all ages should be encouraged to hit the court or the field and have a good time while remembering the easy prevention steps. Because I have spent so much time not playing, due to injury, I am having so much fun just playing. Everyone should remember that theycan help prevent the spread of MRSA easily, so no one has to waste time on the sidelines.
Dr. Val: What’s the most important thing that you’d like to tell Americans about MRSA?
Grant: Wow, how much time do you have? I really want people to realize that MRSA is a serious infection. As I’ve mentioned, before I got it and I hadn’t even hear about it. My ordeal really opened my eyes to this and that it can affect anyone! The scary truth is that more deaths each year are caused by MRSA than AIDS. But, there are easy things people can do to help reduce the spread of MRSA. This includes: washing your hands frequently, not sharing your personal items like towels and disinfecting with a bleach solution. There is more information and tips about how to prevent getting MRSA, including a playbook of prevention, at stopmrsanow.org.
*This post was originally published at my other blog site – URL pending*
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