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Scott Webb (Host): Whether we're concerned about skin cancer, clinical conditions like dermatitis, or we want to explore the benefits of cosmetic treatments, dermatologists can help. And I'm joined today by Dr. May Chow. She's a Dermatologist with decades of experience and she's affiliated with Franciscan Health This is the Franciscan Health Doc Pod. I'm Scott Webb. So, Doctor it's so great to have you on. We're going to talk about a few things today, but mainly we want to talk about when is it time to see a Dermatologist and specifically upfront here, I wanted to talk about skin cancer and you know, what are the signs we should be on the lookout for? And then what should maybe prompt us to see someone like yourself?

May Chow, MD (Guest): Number one, it depends on your skin situation. Have you ever had many sunburns, have you had a family history of skin cancer and have a lot of moles, lumps or bumps on your body that you're concerned with. Let's start with family history of skin cancer, your father, your mother, your siblings, or relatives who had melanoma that you need a yearly check.

Even starteing at a very young age. I am talking about as young as puberty. Okay. And especially second thing is you have sunburn, have not used sunscreen in the past and have many bout on repeated sunburn. That you need to see a dermatologist. Say how frequent I see that dermatologist? If you had a history or family history of melanoma, you need to see a dermatologist at least once a year. What is the best time to say dermatologist? Nobody ever remember this, they say one year ago? Two years ago?

Host: Yeah.

Dr. Chow: The best time is your birthday. Okay. Let's say your birthday is in March, March 1st. March 1st, I will need to see a Dermatologist to check my birthday suit.

Host: Yes. I love that.

Dr. Chow: Okay. That's a good way to remember is every year around your birthday to check your birthday suit. Okay. Second thing is, is how do I know whether I really have skin cancer? If you develop any moles, any lumps and bumps. A B, C, D E, there are five things to know. A is asymmetry. B, irregular border. The border, you know looks like devil grabbing you. Okay. Not regular, not smooth. C, color. Very, very dark blue, black, brown, all different shades of color in one mole. D, the size diameter. Usually if it's bigger than the size of the pencil eraser and changing fast. E is evolving, changing. If it's changing, evolving quick, then you're really concerned. Rule of seven and anything over seven months, you really must see a dermatologist. Okay. Seven days it goes away, probably is an acne.

Acne bump that comes and goes. Okay. If it is seven months, is still persistent and getting bigger. You must take care of it. Seven years or longer. Probably it's a lipoma and some fatty tumor that probably is harmless. It doesn't change or it just stays there. Okay. So that's rule of seven.

Now, what are the most common skin cancers we know of? Number one is basal cell carcinoma. Very, very, very common and almost everybody who has sunburned will experience basal cell carcinoma. How does it look like it? It looks like a little pink bump. Sometimes it bleeds a little bit on the center. Okay. That's one of the most common kinds of skin cancer. The next one is squamous cell carcinoma. Squamous cell itself is mostly located on the head and neck, sun exposed area. And they are not as smooth, like basal cell. Okay. We just remember name. Okay. So, squamous cell is a little more invasive than basal cell. Okay. It's not life-threatening. However, it can be very aggressive. If untreated, the squamous cell carcinoma can grow very fast and very large and can get into the blood vessel cause bleeding. May have some serious complications from spreading.

The most dangerous one is melanoma. Melanoma can be deadly even with the advance of medicine now. We do have treatments for melanoma. But I do believe prevention is much, much better than treatment. Prevention means you know, using sunscreen, using sun protective clothing, and check with a dermatologist frequently. Does that make sense?

Host: It does. Yeah. And a lot to unpack here. I'm just making sure I'm trying to lock these things in the, the rule of seven, A through E. Really great advice. When to see a dermatologist. And also, as you say, like to have your birthday suit checked out. So just rather than trying to remember, cause none of us can, just do it on or about your birthday every year.

So a really great, advice. Very helpful. Also want to talk about some of the clinical reasons why folks may come to see a dermatologist be that dermatitis, dry skin, whatever it might be. Maybe you can go through those as well.

Dr. Chow: Okay. It's also age dependent. All right. When you are very, very young, usually as eczema, little baby, little children, they have dry skin, eczematous skin, the eczema. Then once you get to puberty, then it becomes acne. Okay. Very, very common. Now a teenager always come in. That's the second most frequent visit is at acne for teenager. Acne is not just a disease or condition of teenager. Acne can be from cradle to grave.

Host: Yeah, it really can.

Dr. Chow: Just changing. Yup. Yup. Yup. You see that people, maybe you're too young to remember this comedian called WC Fields.

Host: I am just a bit, yeah, a little bit too young. Yes.

Dr. Chow: Okay. So anyway, you see some of the older men with big giant nose with a lot pimples on the nose. Okay. Even Bill Clinton had rosacea. That means it's a form acne, but later on acne rosacea changing into Acne like breakout on the face. Okay. So acne and rosacea is one category that I see on all ages. Now, psoriasis is another big, big, big, big topic. We call that inflammatory diseases of the skin, like psoriasis, eczema, and all kinds of different conditions that cause inflammation of the skin. Okay. That is a big, big topic all by itself. Now, as we get older, over 30, over 40, we start to see some wrinkles. We start to see uneven pigmentation, some brown spots, some age spots on our face.

Then patient come into see me for cosmetic reasons. Okay. And a lot of them, professional, they want to look younger. They want to feel better about themselves. Okay. They want to have a better skin. Then they come to see me for cosmetic reasons. And cosmetic is another big, big topic that we can discuss.

Host: It is a, yeah, it's a massive topic. And I'm just, just thinking about what you're saying here is, is I'm 53. And so I look in the mirror and I see some broken blood vessels, you know, around my nose and some brown spots and things like that. And I look at it and I say, there's no reason for concern here, like medical concern, but maybe it would help my self-confidence. Maybe it would make me look a little bit younger.

Dr. Chow: Yes, let's talk about that. Okay. That is the majority of my 40, 50 years old patients. Not only women, men. I have a lot of executives. Okay. They just want to feel better about themselves. They come in, they say Dr. Chow can you fix my broken blood vessel on the nose and I say, I'm more than happy to.

I'm going to explain to them. Number one, the broken blood vessel, sometime it caused by the sun sometime is hormonal. Sometime is the inflammation of the skin that caused all this problem. We do have a combination of treatments using laser. The laser can shrink down the blood vessel and also topical medication, which involve topical antioxidants and, and also topical retinoid to help to decrease a blood vessel or eliminate a blood vessel.

Brown spot is another thing we can also use laser to treat brown spot. We can use chemical peeling, a peeling agent to get rid of the brown spot and we can also use topical medication. So there's a combination treatments to make the skin better.

Host: The buzz word for me is always anytime we can use lasers or robots, you know, that's definitely going to interest me even more. I want to have you talk about neuromodulators.

Dr. Chow: Now Botox.

Host: Yeah. So that's something that's probably very popular, right?

Dr. Chow: Actually, this is nothing really new. I start using Botox neuromodulator 30 some years ago. Okay. It started actually in the last millennium, 1980s when we discovered that this is actually a muscle relaxant. We used that first in patients who had strabismus, the people who have squinty eye and also in patient who has cerebral palsy.

Just think the neuromodulator basically as a muscle relaxant. So when your muscle relax on the forehand, you don't wrinkle. When you put the muscle relaxant in between the eyebrow, you don't have the number 11 line. Okay. You put the muscle relaxant around the eye, then you don't have crow's feet. So it's a very, very common practice for dermatologists. And we do that. We are actually the first one who started it 30, some years ago. And after many, many studies, they finally approved it about 20 years ago. Now as we have more baby boomers, okay, baby boomer is defined as anybody who is in their late 50 or mid 50 all the way until the seventies, eighties. Yeah. So, you can use Botox. There are three kinds of neuromodulator now available on the market, but the trade name is Botox, Dysport and Juvederm. Okay. I just use the generic name called botulinum toxin. I just use a generic.

So, botulinum toxin is very useful in terms of treatment for many, many skin and also medical conditions, not just to treat wrinkles. In a good hand, if you use it right, it should really relax the muscle, make you feel better. If you do it right and don't over do it. You put too much, you have frozen the face, that doesn't look right. If you just the appropriate amount, everything has to be appropriate. Don't over shoot it, that you will get tremendous benefits from that.

Host: And I think that that's one of the things, you know, when we see stars, movie stars, TV stars, we often notice where it feels like they've just gone too far with these things, with the cosmetic part of it, you know? Whether it's actual plastic surgery or Botox, whatever it might be. And I think that's such an important point that you're making.

Dr. Chow: It's something we call body dysmorphic syndrome. Okay. I've believe they truly depend on their looks to, to sell. I mean, to be in the business to the point that, they become very insecure, then they constantly go to the plastic surgeon. Some of the plastic surgeons, every time you do a procedure, they charge you. They will never refuse. Okay. That's

Host: No, they won't, right?

Dr. Chow: That's the unfortunate thing. No,

Host: Yeah.

Dr. Chow: Now, for me, I do what is right for the patient. Do the right thing. I actually tell the patient that I think you had done enough. You will look strange. You won't look like yourself. I want you to look natural. Be honest with the patient and just tell them you know, what is appropriate? What's best for them.

Host: I love that. So great talking to you, you know, do the right thing, encourage patients to do what's appropriate. And it's so great to speak with you because we've talked about, you know, for medical like cancer and the rule of seven and those types of things to clinical and cosmetic. I mean, you're just a endless source of information. This is wonderful. We do have to wrap up though, and as we do, what takeaways do you have for listeners? When is the right time to come and see Dr. Chow?

Dr. Chow: When you are concerned about a condition. Okay. If it bothers you, if you say I got to do it, then that's the time you must pick up the phone and call and make the appointment. Okay. I know there truly is a shortage of dermatologists and no question about that. You may have to wait some time, but now we do the best we could to accommodate the patient. And it all depends on what's the urgency. I always will stay late, whatever it takes to see patient who have cancer. That's a given. Okay. And then you say, you know, for cosmetic reasons, for whatever reason, I will try also to accommodate, but you know, everything will take time to do. I mean, any procedure I will take time. So you can only see so many patients a day. I do believe one other problem is access. A-C-C-E-S-S, access to a doctor, not only dermatologists, I believe it's all doctors.

We truly do have shortage. There is no question about that. Now there are two official websites. One is ASDS American Society of Derm Surgery. Okay. That is most on the cosmetic and surgical side and aad.org is all medical clinical diseases site. Okay. The public is encouraged to look at the aad.org and to check who is the Board Certified Dermatologist in your area. Okay. Because the best thing is to look at the official organization. They will direct you to Board Certified dermatologists.

Host: Yeah. And I did not know that of all the things I've learned today from you. I did not know that there was a shortage of dermatologists. It is such a fascinating field, the range of things that you do, what your expertise covers is really amazing. I've really appreciated this conversation. Thanks so much.

Dr. Chow: Oh, you're so welcome. You're so welcome. Thank you.

Host: For more information, visit Franciscanhealth.org and search dermatology. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan health doc pod. I'm Scott Webb stay well, and we'll talk again next time.