Dr Whitney - Skin Cancer

This is a podcast episode in which the host, Mike Roth, talks to Dr. Zach Whitney, a dermatologist in the Villages, Florida. Dr. Whitney discusses his background in dermatology and his experience treating skin cancer in the older population. He emphasizes the importance of sun protection and recommends wearing mineral-based sunscreen with SPF 30 or higher. He suggests that individuals over 50 should have an annual skin check to detect any early signs of skin cancer. Dr. Whitney also explains the ABCDEs of melanoma and what to look for when examining moles. A full body skin exam with a dermatologist typically takes 5 to 15 minutes and may involve freezing pre-cancers or performing biopsies. Welcome to the open forum in the Villages Florida podcast. In this show we talk to leaders in the community, leaders of clubs and interesting folks who live here in the villages to get perspectives of what is happening here in the Villages Florida. How can you support our podcast? This is Mike Roth and listeners I'm thrilled to share with you this podcast which is my passion project for you. This podcast brings me joy, brings you knowledge, inspiration and a lot of things that people need to know about the villages and the people that are living here and what's actually going on. Creating this podcast is a labor of love even though it demands more time than I can easily spare but hey time isn't something we can buy back right? Now here's where you come in, the unsung heroes and heroines. You can help us keep the podcast alive and thriving. How? By becoming a supporter. There are two simple ways that you can support us. The first is a small monthly donation. Visit our podcast website openforuminthevillagesflorida.com and click on the black supporter box. Even a small three to ten dollar a month donation makes a difference and guess what you can cancel any time no strings attached. 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They have a training program credentialed residency dermatology program in the Orlando area. Great program, received great training. They host about nine residents, good medical dermatology, surgical training, a little bit of everything. I had good laser training. So I was down there for three years and my wife and I decided to stick around. We were enjoying central Florida. We stuck around and I'm loving the Villages so far. I've been in the Villages for almost a year now and having a good time. Patient population is amazing up here so it's been a great opportunity for me. There's a lot of older folks who've been exposed. Just going through residency and my training, I always enjoyed being around the more mature populations. I like treating and diagnosing skin cancer. That's my preference, my specialty per se. So a lot of skin cancer up here, do a lot of procedures and that's exactly what I wanted. So it's been a good time. Good. You mentioned something in your training that I thought might be interesting. You said laser. Do you use lasers against skin cancer? Currently, we have a laser guy. Probably we'll start treating more patients with laser here in the near future. But you can't technically treat skin cancer, certain superficial skin cancers with a CO2 laser. Not something that's currently recommended by the National Cancer Society or the American Academy of Dermatology. But hopefully in the near future actually, there will be some unique treatments for skin cancer as far as laser resurfacing and things like that. But mainly cosmetic and cosmetic resurfacing and that's typical of lasers for. I got it. Dr. Whitney, why don't you explain to our audience what the best ways are to prevent skin cancer and maybe take a perspective from people who are 55 plus who live here in the villages who are exposed to a lot of some like whether they're playing pickle or riding a horse. Yeah, aside from building a time machine and being able to travel back in time and protect yourself from the sun when we were all young and dumb teenagers and then early 20s laying out on the beach with baby oil and iodine. Right now, obviously still important but unfortunately, a lot of the damage is done. Just like smoking, it takes a solid 30, 40, 50 years of kind of that slow accumulation of radiation to finally start manifesting a skin cancer. And right now, it's still important to protect yourself from the sun. I think I'm a little bit more conservative as far as most dermatologists go. I'm definitely not anti-sun. The sun is good for us obviously. It makes us happy and I get it. The sun feels good when it hits your skin. But if you're going to be outside most of the day or longer than 15-20 minutes, it's worth trying to protect yourself. And sunscreen obviously, hats, long sleeves, sunglasses, those are all really good things and you could go on and on about different sun protection. But typically, just yeah, wearing a good mineral-based sunscreen and trying to protect yourself with wide-brim hats, those are some of the main things you can do. So what SPF would you recommend? So we typically say 30 and higher. There's a lot of good sunscreens out there nowadays and that is a good question and a common question I get in clinic a lot is what type of sunscreen I should be using. So typically, I recommend any mineral-based sunscreen. So there's a couple different kinds of sunscreens out there. There's chemical-based and there's mineral-based. And so if you can get a mineral-based sunscreen, usually that's titanium dioxide, iron oxide, zinc. Those are going to be more broad-spectrum, block out more radiation and you're not absorbing anything. So that's typically what we recommend. Okay. How often should a see their dermatologist? That's a great question because there's actually no guidelines out there as far as like annual full-body skin exams, as far as some of these cancer societies. But I think that the general consensus in the dermatology world is just going once a year. When you get into your early 50s, that's when a lot of this pre-cancer stuff starts showing up. These dry scaly things on top of the ears, dry skin that never goes away that's on your forehead or nose. And so that's when a lot of this stuff starts showing up. So I typically recommend a yearly annual skin check. Late 40s, early 50s. But again, totally depends on your genetics. Darker skin tones are naturally protected a little bit more. If you have red hair, blonde hair, light brown hair, family history of melanoma and skin cancer, things like that. It's definitely worth starting to go have a board-certified dermatologist look at your skin at least once a year. And what are the early signs of skin cancer that our listeners should be aware of and looking for? One thing I tell my patients is if you have a bug bite that is lingering for more than three or four weeks, not quite going away, or some type of what you think is a pimple, a scab that keeps bleeding and it's been there longer than three or four weeks, that's a good early indication or sign that it may be a very early skin cancer. Sometimes these pre-cancers can be tender or look like scabs. So that's a good sign. You just have a healing scab or bug bite, like I said, that is not quite going away and it's on a sun-exposed area like your arm or face or leg. I know the public, when the public, we always talk about the ABCDEs of melanoma and I'm sure you or some of the listeners have heard that before. But that's a good guideline for things to watch out for as far as moles and so if you have a mole that breaks one of these rules, and I'll go over them right now, it's A for asymmetry. If you have a mole that's very asymmetric, it should be fairly well-defined, nice and circular. B for border, very irregular border, that's a good reason to get a mole checked. C, color, a mole that's different colors or one that looks really dark and black or even changing color, that's a good reason to get that mole checked. D for diameter, typically say if you have a mole that's larger than like a pencil eraser, another good reason to get that mole checked or if it's growing rapidly, obviously that's another appropriate reason to see the dermatologist. And then E for evolution and we touched on that, but just a mole that's changing. You notice maybe over the two or three months time span, you have a mole that just doesn't look right or used to be the same for 20 years and now all of a sudden it's changing, that's another good reason to get a mole checked. When you say changing, do you mean getting smaller and or larger? Typically just larger, yeah typically larger. Nothing I think any villager should really have to worry about. Usually new moles show up when we're young and winter your 20s, you're allowed to still make new moles. But after 30, 40, you really shouldn't be making new moles. And so like a new dark spot that's never been there before, another very good reason to go see the dermatologist. And as a dermatologist, when you're doing a skin check, what should our listeners expect? Very good question. Typically, we'll get you in, we put you in a gown. You don't have to wear the gown, but it's a full body skin exam. We're essentially looking at every inch of your body, head to toe. If you have something in the groin area or the buttock area you want us to examine, we'll go ahead and examine that as well. A few times a year, we'll find a skin cancer in the groin area. It's a not terribly uncommon area to grow a melanoma. But even on the bottom of the feet, in between the toes, we check your body all over. And typically, a full body skin exam, anywhere from 5 to 15 minutes. You can be extra thorough and we'll take pictures. And typically, it consists of maybe freezing a few pre-cancers or potentially doing a biopsy for any suspicious spots. But fairly straightforward. It's one of the easiest cancer screenings I think you'll ever have. For the most part, at any dermatology office, you're in and out fairly quick. It's not a mammogram, it's not a colonoscopy, which I'm not quite to that age yet where I've had to undergo those experiences. Fortunately, I know it's people don't like colonoscopies and the prep work it takes to undergo that cancer screening. So it's an easy cancer screening and that's the nice part. Our skin is the window and to our body and should be easy to check. Do you use any special instruments for the skin screening? Yes. Most dermatologists nowadays use what's called a dermatoscope. When the dermatoscope was invented, the specificity and sensitivity of skin cancer diagnosis improved pretty drastically. So it's a definitely useful tool that we use and helps us look at even these very early melanomas and be able to get those out of there. If there's a biopsy done, advanced dermatology, you do those biopsies, the pathology of those biopsies locally or do you send those out? We send those out to essentially a local dermatopathology lab. So we have one, we have several around town, Orlando. I think one goes at Jacksonville, potentially Tampa. And typically, it takes about a week and a half to get the results back. So it's fairly straightforward, fairly fast I guess you could say compared to other biopsy techniques and medicine. So it comes back as a cancerous or pre-cancerous lesion that needs to be removed. How long does it take to get an appointment to go in and how important is it to be rapidly removed? It definitely depends on the type of skin cancer but usually, it's a pretty straightforward, fast process. We do the biopsy which the biopsy itself maybe takes a minute to do, little drop of numbing medicine and you shave it off, send it into the lab, takes about a week and a half to get those results back. And usually, depending again, like I said, depending on what it is, we can get you in within the next week or so to remove that lesion. And melanomas definitely take precedence and so if it's an invasive melanoma or something that needs to be dealt with in a more timely fashion, we get you in pretty fast and it's a relatively smooth process. At Advanced Dermatology, how many days a week do you guys operate? We're five days a week for the most part. We have a few providers as well that even work some Saturdays. In fact, I worked this last Saturday down in the Brownwood Clinic. I know it's helpful for a lot of people who are busy during the week and so we have a lot of available openings and it's fairly easy or easier to get into the dermatologist here in Florida and especially in the villages compared to a lot of these northeastern states. Patients tell me that all the time. They go back up to New York or Pennsylvania and like man, it takes me four months to get in to go see my dermatologist and if I call you guys and I'm in in two or three days, we do always keep openings available too for patients. It may have some dermatologic emergency or want to be seen a little bit quicker so there's always those faster openings available as well. Special cases. Yeah. Right. Let's take a quick break here and listen to a message from Dr. Craig Curtis on Alzheimer's. Dr. Curtis, what can someone do if they know that they have Alzheimer's that runs in their family? There's a lot that they can do. Published actually in the Journal of the American Medical Association in February of 2024, so this month, this was a study done primarily at Rush University in Chicago looking at those with brain amyloid. So those people that already have amyloid, can a healthy lifestyle protect them from developing dementia? And the answer was yes by following these five healthy habits that were tracked and those where they did not smoke, they did moderate exercise for at least 150 minutes a week, they kept their alcohol consumption to a minimum, approximately one to two drinks a day and they regularly stimulated their brain by reading, going to museums, etc. And the final category was how well they followed the MIND diet or a Mediterranean type diet and they used autopsies. They actually used approximately 530 autopsies to prove that those that followed those healthy lifestyle habits or had those healthy lifestyle habits actually had less amyloid. It correlated those had less amyloid in their brain. With over 20 years of experience studying brain health, Dr. Curtis's goal is to educate the villages community on how to live a longer healthier life. To learn more, visit his website CraigCurtisMD.com or call 352-500-5252 to attend a free seminar. Thank you, Dr. Curtis. Okay, let me ask you another question. Sometimes older adults like myself sometimes get purple blue bruises or purple bruises on their arms. What does that mean from a skin cancer perspective? This is one of the most common questions I get in clinic and it's a good question because it's concerning and for a lot of patients, it just starts happening seemingly like out of the blue and we used to call this the senile purpura which just sounds terrible, right? No one likes the word senile. So recently, we actually changed the name from senile to actinic purpura. Purpura meaning bruise and actinic meaning sun-induced and technically speaking, yeah, it's from the sun. Long-term sun exposure decreases the collagen in your skin and the skin on the arms is already pretty thin and it's very vascular and so just after 40-50 years of sun exposure, that skin really starts to thin out and any little nick or bump barely brush up against the doorway or your puppy maybe brushes up against you a little too hard can really cause a bruise and of course, it's worse than if you're taking blood thinners, aspirin, things like that. Even certain vitamins, vitamin E, fish oil can cause some thinning of the blood. So yeah, very common. In fact, it's probably more common to have those than not have those. So typically, I tell patients, welcome to the party. Okay, so here in Florida, we're exposed to the sun regularly when we get into our cars and drive. Do you have any recommendations there? Should we be using sunscreen inside of our cars? We do know that window glass, so automotive glass typically blocks UVB which in a simple sense, that's the bad wavelength of UV light from the sun. Those are more cancer-inducing. UVA does contribute a little bit to that process but UVA typically causes what we refer to as like the aging, that's the aging wavelength of light and you know that the sun causes wrinkles, it causes loss of elasticity and loss of collagen and so sunscreen, even when you're driving, can be very helpful. And even on cloudy days, up to 80% of the sun's rays still penetrate through those clouds and reach the earth's surface and even if it's a cloudy day at the beach or whatever, it's still pretty important to either wear long sleeves or put on sunscreen to protect yourself from both skin cancer and aging if you care about that. Okay, so these people who are playing water volleyball, they should be wearing protective? Yeah, water is tough especially if you're actively playing a sport where you're in the water maybe for an hour, two hours. You can put on as much water-resistant sunscreen as you want but I think it's still going to be pretty tough. So usually, the best way to protect yourself when you're out in the water actively for an hour, two hours is just wearing those long sleeves and they're pretty, they got some stylish shirts out there nowadays. They're in style. I don't think no one's going to be making fun of you for wearing those long sun protective shirts and that's what we typically recommend and that's what I'll throw on my kids. Do you recommend wearing gloves? Gloves are tough. I think sunscreen on the hands is usually probably okay. If you want to wear gloves, that's fine but again, everything in moderation, I think. Right, so how long will the sunscreen that you put on stay on if you're in the water? I think a lot of these bigger sunscreen companies, they do all these big randomized trials and that's a tough question because it's a hard trial to perform. Like I said, I don't think it's an easy task measuring the amount of sunscreen that comes off when you're in the water. Just in general, we advise patients to apply sunscreen every two to three hours while they're out in the sun and if you're out there swimming for solid 30 minutes, then it's probably a good idea to either reapply or to make it easy on yourself, just wear some sun protective clothing. So if a patient has a diagnosis from a biopsy of a cancerous lesion on their skin, what are the recommendations after the first treat? Yeah, that's an excellent question. So we typically recommend or at least the standard of care is to see your dermatologist every four to six months after that initial skin cancer diagnosis. We say that because after a basal cell carcinoma, which is the most common type of skin cancer, you actually have a 40% risk of growing a new one within the following two to three years. And so usually, we'll see those patients every four to six months for a few visits a couple years and if no more skin cancer, those patients can graduate back to just coming once a year. Melanoma is a little bit differently, especially those invasive melanomas. If you have a melanoma diagnosis, then typically we like to see every four months for quite some time and usually just every six months afterwards for life. But again, depending on how much skin cancer you've grown in the past, but we do know it comes in waves which makes sense because if you had a bad burn as a kid and that was it that kind of stimulated those cancers 40, 50 years later, that's why they sometimes seem to show up all at once. So it's important to have more closer follow-up with your dermatologist after an initial diagnosis or after your first skin cancer. Do you guys use radiation to treat skin cancer? We don't in our practice but we have very close relationships with great oncologists in the area who do that radiation therapy. I think more studies need to be done but I think it's a great option depending on your age. Obviously, if you're young and fairly healthy, that's probably not the best option because there is some surrounding skin damage that takes place about 10 years later. So you really want to be selective about who you offer that treatment option to but it's a great option that works really well for these superficial skin cancers and we have a close relationship with some great oncologists and radiation oncologists who perform that. So that sounds like that would be a secondary recommendation as opposed to a primary? Yes, just because I think surgery, again it's still surgery, you're cutting the skin, it's fairly straightforward. You can cut out a skin cancer and suture it back up in about 20-25 minutes and usually it leaves a far superior cosmetic outcome. You get a nice linear scar and even on the face, it heals remarkably well. The cure rate is higher, you know it's gone. You have the pathologist telling you that it's gone at least under the microscope and so yeah, higher cure rate, I think better cosmetic outcome in most cases. So I think surgery still is, it still will be considered the standard of care I think for a long time but there's a lot of other good options to treat skin cancer and radiation certainly is one of those. If for select population. What are the other option? What are the other options beyond skin surgery? So you can use certain topical therapeutic creams to treat more superficial skin cancers. You can use cryo-liquid nitrogen which works fairly well for more superficial skin cancers but some of these skin cancers that start growing a little bit deeper have roots. Those can be difficult to treat but again depending on the study, you read anywhere from a 40 to 70-80% cure rates. I've done properly and a little bit of risk with insufficient treatment and recurrence but for superficial skin cancers, when you catch these things early and they're small, it's a very good option. Dr. Whitney, is there anything else that you'd like to tell our listeners about your practice at Advanced Dermatology? Yes, so we have four locations in the villages. I'm currently at the Brownwood location in Lake Sumter Landing and it's a great practice. There's a lot of good practices in the villages, a lot of great dermatologists. We always try to do the right thing and treat patients as if they were our own family members and I take that similar approach but it's a great practice. We have a lot of resources and we get a lot of referrals from other community doctors and the villages health care system and it's been a fun time practicing with Advanced Dermatology so it's a great practice. Okay. Dr. Whitney, how does someone contact your practice to set up an appointment? We can make online appointments which I think is almost the preferable method nowadays, fairly easy and straightforward to do is going online and AdvancedDermatology.com. Okay, and if we have some people here who aren't comfortable with doing a computerized appointment and they want to do it over the phone, what number do they call? Yes, so by phone, we have both corporate numbers and every office has a local number but our phone number is 866-400-3376. You can book an appointment or online through AdvancedDerm.com but very easy and straightforward and like I said before, it's typically, you can usually get in, if not that same week, the next one's pretty straightforward. Great. Thanks for joining us today on Open Forum and the Villages, Dr. Zachary. I'm sure you'll be hearing from some of our people. Thanks for having me. You've been great, Mike, and like I said, I love the people in the villages. They're great people. Remember, our next episode will be released next Friday at 9 a.m. Should you want to become a major supporter of the show or have questions, please contact us at Mike at Rothvoice.com. This is a shout out for supporters Tweek Coleman, Ed Williams, and major supporter Dr. Craig Curtis at K2 in the Villages. We will be hearing more from Dr. Curtis with short Alzheimer's tips each week. If you know someone who should be on the show, contact us at Mike at Rothvoice.com. We thank everyone for listening to the show. The content of the show is copyrighted by Rothvoice 2024, all rights reserved.