It’s that part of the job that I’ve never gotten used to. I hope I never do.
I saw a man recently with an unexpected finding on his exam – a “lesion” that should not have been there. I was seeing him for his diabetes and blood pressure, and was doing my “ritual” physical exam, when the “lesion” blared into my vision.
I say “ritual” exam because the exam itself had little to do with his medical problems. It is just my practice to do a cursory exam of the head, neck, chest, and lungs of most everyone who comes to the office. I guess it’s the “laying on of hands” part of the practice of medicine that makes me do this; there is something about the human touch that makes a doctor’s visit different from a visit to the accountant. Read more »
After surgery I am often asked, “When can I get back in the tanning bed?” I say something like, “I would rather you not use a tanning bed. You need to protect you new scar from the sun, that includes tanning beds, for at least 6 months.”
“But, if I cover up the scar, when can I get back in the tanning bed?” is the usual response.
I then counter with, “IF you feel you must, then yes cover the scars. Please, limit or reduce the time you spend in the tanning bed. I would rather you not use a tanning bed.”
Most see “no harm” in using a tanning bed. After all, it’s not like laying out in the sun for hours. Too many see tanning beds as a “safe” way to get a tan. It isn’t.
These same experts have moved tanning beds and ultraviolet radiation into the top cancer risk category, deeming both to be as deadly as arsenic and mustard gas. The new classification also puts them in the list of definite causes of cancer, alongside tobacco, the hepatitis B virus and chimney sweeping, among others.
I would not mind tanning bed extinction. Regular use increased the risk of melanoma. It is much better to have a “peaches and cream” complexion or to use self-tanning creams. Skin cancer is no fun.
Heading out for a family walk over the weekend, we barely got beyond the end of the driveway before we quickly turned back…sunblock. We forgot to goop! A quick retreat back to the garage, we all lathered up and were on our way.
Over kill for such a mild sun day? Not in our experience. We’ve not only been caught off guard before and had “low intensity” sun days create rather intense burns behind necks, knees and arms, but have a family history of melanoma that haunts us ever time we step outside. My husband’s dad lost his life to melanoma. He was in the Navy and sunblock wasn’t what it is today, nor was the treatment for melanoma. He didn’t have the control we do today and would be really upset with us for tossing caution to the wind with our skin and our kids.
As reported by ABC news, there are 1 million cases of skin cancer a year and counting, melanoma, a year with 90% of those related to sun-exposure. We are truly playing with fire every time we step outside without sunblock on.
There’s nothing wrong with getting a tan if you some common sense and use sunblock – SPF 15 or higher with UVA and UVB protection. The key is to avoid becoming a french fry and to remember to reapply the sunblock liberally and often (each hour is the expert recommendation). As Dr. Doris Day, a NYC dermatologist interviewed by ABC noted: “You need to go through sunscreen…One bottle should not last a summer.”
Kids, too, need sun protection and it’s a myth that babies can not have sunblock applied to their skin. Infants older than 6 months of age can have the sunscreen applied to the entire skin and infants under 6 months of age can have sunscreen applied to very exposed area such as the hands and face in just the amount needed to cover those areas.
By the way, sun protection isn’t just for our weekend warrior moments. Think of it as part of your every day skin care. If your kids walk to and from school, they need sun protection. If you walk outside during your work day, you need sun protection. Many daily moisturizers now include SPF 15 and are great for that daily purpose where you need a bit of protection but not the intense protection as you do on weekends when outdoors more.
So, go ahead and get outside and get some sun…just do it safely and take the few extra minutes to apply sun protection. It’s fine to get a tan but no tan is worth dying for and that’s the point we all have to remember.
For more tips on sun safety for infants and kids, click here and here.
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.
It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…
I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…
I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…
When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…
I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…
