Melanie Cole, MS (Host): Welcome to LifeCast, the podcast from the specialists at Infirmary Health. I'm Melanie Cole. And today, we're highlighting melanoma and skin cancer surgery with my guest, Dr. Colin Buckley. He's a general surgeon with Infirmary Health. Dr. Buckley, thank you so much for joining us today. I'd like to start by just asking you about the prevalence, about skin cancer and how common this is. Are we seeing a lot of it today? Are we seeing less of it than we used to?

Dr. Colin Buckley: Yeah, Melanie. We are definitely seeing more skin cancer. Part of that is because we know how to surveil for it and monitor it. But skin cancer's on the rise. A lot of sun exposure in the youth. So, the current generation, the older generation, is seeing more of those changes from the damages they may have had in their youth. Also, tanning beds became pretty prevalent, which can give you a very large dose of UV radiation and are actually classified as a carcinogen by several worldwide health organizations.

Melanie Cole, MS: Wow. Times certainly have changed. We know so much more from the times when I was a kid, you know, and it was baby oil. We know so much more now. And one of the scariest forms of skin cancer is melanoma. Tell us a little bit about that, what is it, and who is at risk for this.

Dr. Colin Buckley: So, melanoma is fortunately not the most common skin cancer compared to the more garden variety cancers like squamous cell and basal cell carcinoma of the skin. What makes melanoma, as you say, scary is it tends to be more aggressive because it has the ability to travel to lymph nodes and distant organs.

So, anyone can get melanoma, but we do know there are several risk factors. Frequent sun exposures, specifically multiple histories of sunburns. Patients that are more fair-skinned, light blue eyes, people that have a large number of moles. And then, as I said before, tanning bed exposure is known to increase your risk for melanoma as well.

Melanie Cole, MS: Well, thank you for that. So, signs and symptoms, Dr. Buckley, what are we looking for as we check ourselves? And I know we're supposed to be checking and looking around or having someone do that. Can you tell us what are we looking for for melanoma? Is there a specific look to whatever we're looking for?

Dr. Colin Buckley: Well, yeah, so just as you said, checking yourself, that's a great easy first start. Just having a good skin survey and a good idea of what your moles look like and where you have moles. One of the classic things that we teach people is the ugly duckling sign. You have one mole that just doesn't look like the rest. That's a good sign that maybe you should have that lesion or that change in your skin taken a look at.

Another easy thing to remember is the ABCDE rule. This is an acronym that stands for some certain features or changes of a skin lesion or mole that you might want to pay attention to. The A stands for asymmetry. So, think of one side of the lesion doesn't look like the other side. B stands for borders, so irregular or jagged edges of the mole. C stands for color or color variation. So, a mole that has multiple colors, blue, purple, black. D stands for diameter. So, anything greater than the size of about a pencil eraser or something increasing in size. And then, E stands for evolution. So, a mole that's changing in size, shape, or behavior. It's becoming itchy. It's becoming bleeding. All these things would be alarm signs that would want to prompt someone to see a dermatologist or a surgeon or their primary care doctor to get it taken a look at.

Melanie Cole, MS: Well then, tell us if someone comes to see you, what do you do for them? Tell us about the melanoma surgeries that you provide your patients and kind of walk us through the steps.

Dr. Colin Buckley: So, the first thing that usually happens before a patient sees me is the skin mole or lesion is biopsied. I do biopsies as well. This is often done in the primary physician's office or the dermatologist's office. But the first thing we have to do is we have to biopsy it to establish what it is, is it a melanoma, and look for some certain features which truly guide the management and what type of surgical options are available.

A biopsy is usually performed as a punch biopsy. It's a very small, quick procedure. Things that we're looking for are primarily how deep that melanoma has invaded through that layer of skin. The good news is melanomas that are caught early. Again, why we're talking about what to look for and how to protect ourselves, melanomas that are caught early are usually curable with just surgery alone. So, those melanomas that aren't very deep and don't have any other suspicious or concerning findings on their biopsy, those usually just need a simple skin surgery where we remove that mole and a healthy border of the surrounding skin to make sure that we get all of it. Often, that is curative for these early stage melanomas, and that's all they need. After surgery, they see their dermatologist for a few months at a time for the first few years and then yearly thereafter, because we know that they're at increased risk.

Sometimes the melanoma, if it has not been caught early or it's deeper, what we will add to that surgery is at the time of removing the skin cancer, we will also take a look at the lymph nodes that are closest to that skin cancer. Those are often in the armpit or the groin, and we will inject some dye and a radio tracer in there, and we will take out one or two of those lymph nodes to look to see if there's cancer inside it. And that is to help us determine, has the cancer already started to spread? And if it has, then we have fortunately some new options.

In the last decade, the treatment for more advanced melanoma has really blossomed, and we have a lot better treatment options, things like immunotherapy, that we can give patients to help attack any remaining skin cancer cells that have traveled elsewhere in the body and prevent it from coming back.

Melanie Cole, MS: Well, there's certainly more tools in your armamentarium these days, Dr. Buckley. Now, tell us a little bit about that melanoma surgery you mentioned, because, I mean, vanity is certainly something that people are concerned about, the way that they look. And tell us if there's a scar when you do this, or how do the edges look when you're done with surgery?

Dr. Colin Buckley: So, of course, the cosmetic concern is always something we're worried about with surgery. There's no way to do surgery without a scar. Unfortunately, melanoma doesn't care about your scars or where it's going to pop up. So cosmetically, if it's, commonly seen on the arm or the back or the chest sun-exposed areas, that's going to be a visible scar just as long as it has to be to make sure that we get the whole cancer out. The important thing is we get all the cancer so it doesn't travel to organs. Once melanoma travels past the skin to the lymph nodes and the organs, your risk of dying from this disease goes up. So, that's why we cure it.

There is a trade-off cosmetically. When we're operating in more sensitive areas like the face, for example, or the scalp often there's some reconstructive techniques that need to be done. I'll often perform skin grafts in areas that are tighter skin that are difficult to close, like on the scalp, and that does help with some of the cosmetic appearance. And then, for face lesions, on the nose, on the cheek, that's when we involve our plastic surgeons that are experienced in doing some rotational flaps and can do tremendous work to really give you a normal contour and minimal scarring.

Melanie Cole, MS: Well, thank you so much for sharing that. And Dr. Buckley, what other surgeries do you provide?

Dr. Colin Buckley: So, I'm a general surgeon here in Fairhope, Alabama at Thomas Hospital. And I perform a pretty broad scope of surgery. I do a lot of robotic surgery, a lot of abdominal surgery. Think of abdominal organs, the gallbladder, the appendix, the colon, the small bowel. I also have a passion for operating the neck and endocrine surgery. So, I like to do procedures for thyroids and parathyroids and adrenal glands.

Melanie Cole, MS: Well, that's so comprehensive, Dr. Buckley. And how does someone make an appointment with you? What's involved in that?

Dr. Colin Buckley: Well, it's actually quite easy. We have a clinic over here. Our number is 251-990-9191. If you think you have a surgical problem or certainly a skin cancer, I encourage you to reach out to your primary care physician get a referral to us or a dermatologist to see your skin. But we accept walk-ins. We, depending on your insurance, often will require a referral. So again, if you think you have a surgical problem, just talk with your primary care physician.

Melanie Cole, MS: Wow, you've given us so much great advice and really informative information that we can look at these moles and determine whether we need to come see you. Thank you so much. Now, I'd love some final thoughts, your best advice for prevention so that maybe we don't have to worry about melanoma.

Dr. Colin Buckley: So for prevention, again, getting a good baseline inspection of your skin, knowing what your skin looks like, what your moles look like, especially if you have a lot of moles. Looking out for that ugly duckling sign that we talked about earlier. And then, wearing skin protective clothing. Protect your skin from the sun when you're going to be out in the sun for a long period of time. Good quality sunscreen with reapplications, especially if you're getting in the water. And I would recommend avoiding tanning beds altogether.

Melanie Cole, MS: Well, that is certainly great advice. Thank you so much, Dr. Buckley, for joining us today and really sharing your incredible expertise for listeners. Thank you again. And for more information, you can go to infirmaryhealth.org. If you enjoyed this podcast, please share on your social media and subscribe, rate, and review on your favorite podcast apps. I'm Melanie Cole. And you've been listening to LifeCast, the podcast from the specialists at Infirmary Health. Thank you so much for joining us today.