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Archive for October, 2012

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Squamous cell carcinoma. What is it?

Saturday, October 13th, 2012

My beautiful girl

A lot of patients ask me what is squamous cell carcinoma (and how do you spell it)? SCC is the second most common type of skin cancer. Basal cell cancer is first. SCC is potentially more problematic because a small percentage of them metastasize (can travel to other parts of the body) and cause serious problems or death. SCC’s can spread, break apart and travel more easily. I wrote a review paper on metastatic SCC in Dermatologic Surgery, our main journal, and the cases I’ve seen can be absolutely devastating. Luckily with proper treatment and an eagle eye, many lives can be saved. We think SCC’s come from cumulative sun damage, while BCC’s may be due to long intense exposures, but it is not clear. It has been proven that sunscreen use prevents SCC’s and their precursors, actinic keratoses, better known as “precancers.”

Luckily, most SCC’s are caught early enough to not be a long term problem. SCC in-situ (those on the surface of the skin which have not invaded the middle layers microscopically) have an excellent long-term prognosis, provided they are properly treated. If on the head, neck, genitals (men and women get them usually from a past history of genital warts) or other critical places, Mohs surgery is the best choice. Let’s just hope the Affordable Care Act lets us continue with this option. Otherwise, most cases are treated with burning and scraping (electrodessication and curettage) or “ED&C” or an excision. Other non-FDA approved options include imiquimod cream and photodynamic therapy. Cryotherapy in my opinion, is not reliable.

For invasive SCC’s, if the lesion is very small (less than 5 mm) then ED&C or excision may be acceptable if the lesion is off the head and neck. I personally believe that no matter the size of the lesion, if the SCC is on the head and neck regardless if in-situ or invasive, or if the lesion is recurrent, Mohs surgery is the superior choice. Recurrent SCC’s can spell trouble, and I strongly recommend Mohs surgery in those cases.

To read more about the differences between Mohs surgery and excision with frozen sections (“fake Mohs”) please refer to this section on my website skin-salon.com

On a lighter note, loved taking my girls to the pumpkin patch last week.

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Shim family name

Friday, October 5th, 2012

I have always been curious about the origins of my last name. My uncle who researched the subject gave me a lot more information. Sometimes people ask me if I know ______Shim and I say “I hear we are all related.”

Well, it is sort of true. There are 6 (possibly 16) Shim clans in South Korea, the main one being the Cheongsong clan which comprises 80% of all Shim’s in South Korea. That is the one we are from. Shim is a rare Korean name, comprising less than 1% of the population. Cheongsong means “green pine” and there is a family emblem with pines, rivers and mountains. This may explain why I inherently love this type of landscape (like Seattle) despite growing up in the flatlands and now living close to the ocean (which really does nothing for me!)

Though I’d like to say I was a direct descendant of some important person, there is no evidence for that, though our Shim clan had a disproportionate contribution of Prime Ministers and Queens over the years. A patient had told me that a Shim contributed to the printing press in Korea, and another contributed to the Korean alphabet. Have no idea why my dad’s family ended up in North Korea either. I thought Shim was strictly Korean, but I have had a Chinese American from Hawaii call me out of the blue asking if I was a distant relative. Given the mixed heritage of so many Hawaiians perhaps she was confused?

Hope that helps someone out there!

OK, addendum. One of the clans came from China, and I am descended from someone special, my dad! He was the first native born Korean, and second Korean American, to be admitted to the bar in the US. I doubt anyone else has been an author in a NY Times Op Ed either! My late brother also helped pioneer hepatic artery cardiac catherization in children. Me? Not even Queen of the Castle, but doing my part not to let the family name down.

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