An experienced dermatologist can often recognize a skin cancer in its earliest stages, though every dermatologist has missed something at some point in their careers. (And if they claim they have not, they are big fat liars!). Therefore, we rely on patients to do their own self exam and observe any suspicious lesions for changes in color, shape, size and border, and to come in for periodic exams. Don’t let anyone freeze any lesions more than once without discussing the possibility of a biopsy for any persistent or recurrent lesion. The person that set the record in my office for the longest time spent in Mohs surgery in one day was a celebrity in his 40’s who had had a lesion frozen twice with two different dermatologists. He pulled through wonderfully and took it very well considering, but we were both dumbfounded at the extent that this tumor had grown.

I love what I do and I get the most satisfaction from educating my patients on their skin lesions and skin cancer, but I would rather not be cutting off parts of your nose, eyelids, lips, etc for your sake. Preventative care is really important.

Warning-offensive language. Funny video for the weekend. Scary thing is, I have said, “I just saw David Spade” (he saw my daughter and said, “look at the little girl in the hot pants” a bit disturbing?!), I take care of a star on Dexter, I love In and Out Burger, hiking in Runyon Canyon (but haven’t done it in about 5 years!), Intelligentsia coffee (which is from Chicago, not LA) and kale. I wish for parking karma, have misread parking signs even though I was a star student in AP English lit, and have sworn at parking enforcement. But don’t worry, I don’t hang out with Skeet Ulrich.

Basically, if you are over 70, you will be put out to pasture like a sick cow. I am sorry to get political here, but I am not a fan of socialism or socialized medicine, and this is basically what is spelled out in the Obamacare policies. Most congressmen don’t even know the details of this plan.

We need to repeal these policies and we also need your help to preserve the current Medicare fee schedule which is set to be cut 27% by March. This will be absolutely chaotic as many seniors will be denied care. I won’t deny care, but my waiting room will be really a “waiting” room as I and other physicians will have to overbook and overschedule patients in order to make up for the problem. Please contact all of your congressmen by googling their offices and send them an email (it is really easy as they all have a direct email submission form) and tell them how you feel about this.

We have access to the most advanced, high quality medical care in the entire world and we are killing this and jobs with these new policies. We are the 1%, but we employ nearly 20 people with a living wage. The 1% pay most of the taxes in this country and small businesses and healthcare account for many, many jobs. Do you want to have “slow Mohs” like the patients in the Netherlands who have to wait 3 weeks for their pathology reports with an open wound? At that rate, a patient with 3 stages of Mohs would carry on for 3 months. Furthermore, the doctors from socialized systems like the Netherlands, England and Sweden come to UCSD every year to learn reconstruction from us and tell us how they are not allowed to perform Mohs due to bureaucracy and costs.

I believe we will have an even worse two-tiered system with those able to afford to pay outside Medicare, and those who cannot, with longer waits and worse care. Remember the quote from Animal Farm, “All animals are equal, but some are more equal than others?” Please act!

To change the subject, RIP Don Cornelius. I used to watch Soul Train religiously after American Bandstand when I was a kid. I loved his deep, smooth, calm voice, the word scramble, watching performances from artists like Michael Jackson, Donna Summer and Chaka Khan and all the cool dancers! More music news today, I have lots of funny Facebook posts about 2-1-12 today. You’d have to be a Rush fan to get it! My brother would have loved that one.

Juan Epstein RIP

So sad to hear that he died. I loved Welcome Back Kotter as a kid. This was probably one of the only shows my brother made me watch that we both actually enjoyed. It had great characters including Juan Epstein, the Puerto Rican Jew, and a great theme song. He was my favorite Sweathog on the show. I liked the twinkle in his eye. He was a sweet-talker and a bit of a smart alec. The funniest running bit about his character were the fake excuse notes for missing class signed by “Epstein’s mother.” It is pretty funny reading some people’s comments on the internet today about his passing, “Juan won’t be in class today, he is in heaven. Signed, Epstein’s mother.”

Also, I was disappointed to hear that La Cachette just closed on the Eater LA blog that I follow. We had such a good time there recently.

Not all dysplastic nevi need to be biopsied, however it is important to have an experienced dermatologist do regular total body exams and for the patient to do self exams. Often times, not all lesions need to be removed. We even do total body photography on some patients. Dysplastic nevi are now categorized as having mild, moderate or severe atypia on a biopsy report. This determines whether they need to be cut out again. Dysplastic nevi with severe atypia are what I like to call “pre-melanomas” which absolutely need to be removed.

Dysplastic nevi are not necessarily going to turn into melanoma, but are a marker for a much higher risk of melanoma in general. Therefore, anyone with these lesions should take extra precautions in the sun, as we know that sun does cause direct damage to moles as well as the skin in general. Because this also tends to be an inherited trait, it is important to have family members also screened

My experiences lately are bringing back memories from my dermatology residency in NYC. Bellevue was the mecca of STD treatment for the NYC county clinics and I treated my share of them. One of my attendings in this clinic was a complete hoot and I have a funny story to share that shall go untold here in cyberspace.

This is a good time to initiate your fractionated CO2 laser treatments, Efudex, etc. I’ve been performing a lot of laser on brown spots, wrinkles and scars with very good results. They do often take multiple treatments so this is a good time to start.

Anyone remember the Ronco Mr. Microphone commercial?