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Posts Tagged ‘Skin Cancer’

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Skin Cancer Awareness month

Tuesday, May 29th, 2018



Skin Cancer Awareness month is coming to an end and another Don’t Fry Day has passed. Shielding your skin from the sun, however, is a year-round project here in LA. I cannot emphasize to you enough how important it is to wear a hat, sunscreen and get regular exams. Even though younger people may not notice any problems before their 50’s, these problems do accelerate as we get older especially in those with any Celtic heritage. That being said my patients are of all ethnicities and skin types. Many people who think their “Mediterranean” skin will protect them seem to forget that their heritage may have other skin types that make them more susceptible to skin cancer. Even people with Asian and African-American backgrounds can get skin cancer. It is very common in those with HIspanic backgrounds as well. In ethnic skin types, I see these cancers being missed until they’ve gotten to a substantial size. I’ve caught quite a few melanomas on routine exam even though these patients had no prior history, no other skin cancers and normal exams in the past.

I have not been as active on this blog for many months but hope to get back into it. I’ve been more active on my Twitter account @drshim_derm which I never thought would be enjoyable but I’ve found some great people to follow. I only started that to follow my kid’s classroom not realizing it would be my practice’s main source of social media. I hope you can follow me there as well! I plan to post at least once to twice a month here as well though! I’ll have to find weird moments to do it, like at 4 in in the morning. This I think, is becoming my new normal. I’m only awake now because I’ve been worried sick that my cat got eaten by a coyote while we were out of town. We looked everywhere for her this afternoon, but alas, she came out of nowhere at 3 in the morning to welcome us back and now cannot stop talking to me!

We paid a visit to San Francisco where I lived way back when. My kids really did not want to go, but I was touched that one of my girls edited my photo. I guess she had a good time! I highly recommend a trek out to the Sutro baths where there is a new parking lot and visitor’s center, have this incredibly awesome Little Gem salad at Sutro’s in the lower level of the Cliff House. Make a trek for ice cream at Swenson’s and if you have energy, take a walk at Tennessee Valley trail in Marin, a flat, but 1 hour long walk each way. The hike is too long for most elementary school kids (I think I’ve turned my kids off from hiking, even longer than Runyon) but I did see quite a few people out with their kids. The path is mainly, but not entirely paved, and not too far from the Buckeye Roadhouse in Mill Valley where I recommend you sit in a booth in the bar area.

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Beware of the BBQ

Friday, July 14th, 2017

Did you know that aerosol sunscreens are flammable? It’s tempting to use them in the hot summer but they can lead to serious burns. If you do use one realize that they are also harmful to inhale. Always check for water resistance also, since it gets hot in the summer, some sunscreens do not have the ability to protect well after sweating or swimming. As you already know, I have a bias towards zinc oxide suncreens, such as the one from my company Verdure. In any case, sprays can be useful for hairy areas and for quick protection. Realize though that your skin is absorbing all of those chemicals through the skin, both the sunscreen ingredients as well as the inactive ingredients.

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So the compliments keep coming…

Thursday, March 23rd, 2017

I keep getting told that “you look good ” “you changed your hair”. No, but thank you! My brows are lifted! I must’ve really needed that laser eye lift!

It was a pleasant surprise to get an update on my review paper of metastatic squamous cell carcinoma which was published 7 years ago. It has been cited by 135 other articles! Ask me how we can prevent this situation. It is not common but unfortunately, there are at least a few people with it every year. It’s very rare that women get them, but last year I did see the second woman of my career that had a SCC spread to her lymph nodes. The first patient I had met was mismanaged by a medical group in town and had her tumor treated numerous times without cure. She couldn’t talk or swallow by the time she met me. It was too late. The second lady had let the tumor grow too long and just had some bad luck.

Typically, the average SCC that spreads to the lymph nodes in my practice is an older white male who has had previous treatment of the lesion with radiation or liquid nitrogen. Size of the tumor, aggressive pathology, a delay of treatment and location on the upper half of the head or back of the hand are higher risk factors in my experience, and is backed up by research.

There are ways of avoiding this situation! Mainly, wear a hat and a zinc oxide-based sunblock such as Verdure. Get frequent exams and examine your own skin by looking and feeling. Talk to me about options for treating precancers that we can’t even see or may be too numerous to treat. And most of all, don’t delay seeking help.

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Breakthrough in precancer treatment

Friday, January 13th, 2017

There’s been a new breakthrough in how to treat precancers. It involves existing medications. I’m really excited to have read up on this. It looks very promising and safe! Feel free to come in and talk to me about this. I apologize for any wait times you may encounter. Please note that most months, with the exception of this month and September, I may be out for at least a week between family time and a few meetings I am attending. However, I do not like to schedule patients more than 6 weeks ahead since so much can change between your schedule and mine. Happy New Year!

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Spring, glorious Spring

Saturday, April 30th, 2016

I loved talking to my kids’ kindergarten classes about skin and the sun. They were so curious and had tons of questions. I taught them about the structure and function of the skin, sun safety and Vitamin D. I didn’t tell them that sun is all bad, but that because of where we live, we need to protect ourselves.

I could’ve talked to them all day, but alas, I only had a half-hour. I tried to avoid talking about skin cancer, but they kept being drawn to “What is that black thing?” (illustration of melanoma).

I’ve been looking like a hot mess lately and haven’t been getting great sleep, still avoiding much makeup. But I still get compliments on my skin at least!

Happy Springj!

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Efudex and pets

Saturday, February 7th, 2015

For patients with extensive precancers (actinic keratoses) we often prescribe a topical chemotherapy cream called Efudex (5-Flourouracil). It is little known, even amongst dermatologists, that this medicine is fatal to pets. It has been around for ages, though many dermatologists do not know about this. I learned this from attending a grand rounds lecture. Spread the word!

On a more pleasant note, looking forward to Valentine’s Day!

Lovely and Amazing!

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The amazing human spirit

Friday, April 4th, 2014

One day on Facebook, I caught wind of a page for a high school classmate of mine called “Cure Eric.” He was in all my classes. I remember a quiet, but always smiling guy who didn’t have a mean bone in his body. I learned he had become a recording engineer, had metastatic colon cancer, and had been suffering for 2 years. Watching his posts was just awe inspiring. While other people are posting pictures about food and their kids, Eric is posting about how he just found out he had new lung or brain mets, and was going to go to the doctor. He never felt sorry for himself, he just talked about how he was looking forward to learning more about what the doctors would do for him. He never failed to keep up his spirits in these posts, and thanked his doctors constantly. Every time we heard about another bout of lung mets, or brain surgery, my medical mind would say, “that was it” but Eric’s courage and positive spirit were truly amazing. He survived through some bouts of illness that defy logic, and I am convinced his fighting, upbeat attitude, even towards the end helped him survive longer and better. Sadly, he was hospitalized for pneumonia recently and passed.

I also recently made a home visit to my patient who was diagnosed with ALS a couple years ago. The last time I saw her she was lying down in a gurney in my office and she was having problems getting nutrition. She hugged me and I thought she was saying goodbye to me. That must have been nearly 8 months ago. The next thing you know, she is sitting up comfortably at home and has a sophisticated computer device set up to converse with me. She is still doing well, although she cannot walk or talk anymore. Life is mysterious and beautiful!

Speaking of mysterious, I had a weird run of 3 melanoma diagnoses in one week. Even the pathologist was surprised. Then there were 2 incidental basal cell carcinomas this week, I just happened to find them even though the patients came in for other reasons. Please don’t hesitate to get yourself checked out!

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Hello from Colorado!

Saturday, March 22nd, 2014

Thank you for letting me go on vacation! I have my happy place and it is called skiing. My family enjoyed a great trip to Beaver Creek in Colorado. My first day started off with some altitude sickness. I threw up 4 times, then I felt great! I had a similar experience in Macchu Picchu. I’ve been to this area many years ago but I stayed at a lower elevation. All I can say is thankfully all I had was water that morning.

I had conversations with a lot of interesting people here from all over the world on the chairlifts: a bunch of lawyers (including a medical malpractice lawyer-defense side), Midwesterners like me, including an African American ski group, Texans, locals, and I heard accents and languages from all over. I equate skiing with what Burning Man is like, or so I hear. People are happy, civilized, generous and caring. We all can get along, can’t we?

Luckily, I came back in one piece, despite the fact that I challenged myself on a couple black diamonds. I’ve only tried one extremely short one before at Northstar. I think I can say “been there, done that.” It’s like running a marathon (which I’ve never done). It’s nice to say that you’ve done it, but it wasn’t fun and a couple is enough! Sweaty palms and the fight or flight mode are not exactly worth it for me. The lawyer was talking about how it would be a bad idea to go down a black diamond alone. That was after I had already done it, and I did it again. One of them asked, “Do you do surgeries?”

My blog has been a popular resource for intermediate skiers for Deer Valley, so here are my recommendations for Beaver Creek. Supposedly, the runs in Bachelor Gulch are simpler, but have more crowded lift lines. None of the blues on the main mountain are easy blues in my opinion. The greens up high are better to warm up on than the bunny hill, which was quite icy. Blues that are high intermediate include Latigo, Gold Dust and Larkspur Bowl. They are quite steep in places and not all that relaxing, but they are all great in parts. The easy black diamonds (easy because I survived) were Helmut’s and Centennial. The blues beneath the Centennial chair which include Centennial and 1876, are also quite steep, as is Redtail. You can only get to Larkspur Bowl via Redtail, so you kind of have to get up the courage to get down there to the lift. The nice thing is that this resort is so groomed, that it makes it more manageable. I would get acquainted with how to ski in powder, because that came up in Larkspur Bowl and Paintbrush. I quickly You Tubed a one minute tip from a Steamboat instructor which reminded to make big C’s rather than S’s and weight your feet equally. That definitely helped. I have a video below which you can click on of what I think is a tamer part of the Centennial run. So beautiful. The trails are so wide you have lots of room for yourself which is not common at so many resorts.

Vail Resorts has an interesting app to keep track of your entire families accomplishments. It is pretty cute. I apparently skied the equivalent of Mt Everest. I actually covered much more elevation than that because they only scanned my badge at certain lifts. It also keeps all the pics that they took of your family with the opportunity to download them for a small fee.

Another nice thing about this resort is it is geared for families and kids. They give out really good chocolate chip cookies to everyone, including adults, at 3 PM, free hot cocoa in the morning, free postcards to send anywhere in the world, not bad! Of course, you pay for this in the end. it is probably one of the most expensive resorts in North America ($136 a lift ticket), but for an extra $30 a day, I will take it! if you buy the lift tix ahead you can get a much better deal. People aren’t showy and flashy here, which I love. My kids built their first snowman (which was about 12 inches tall because the snow was not good for packing) and saw their first creek. Dinner reservations or going early is a must. There are few restaurants here in proportion to how many people ski here.

I used one our last Verdure sunscreens on my family, and we didn’t get burned although we only applied once. A lot of you have asked when it will be available again. We are hoping for late summer. Thanks for your patience!

Also, don’t forget to protect those lips! One of my chairlift riders had already burned hers the day before! BTW, Dr. B has a Bowen’s Disease (Squamous cell carcinoma in-situ) on his temple. We are not immune! He is the worst patient. Listening to us during the biopsy last week was like a Marx brothers episode. He also ran into a colleague of ours in the hallway of our hotel! Small world!

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Fractionated laser resurfacing; skin cancer and risk of other cancers

Tuesday, March 11th, 2014

Fractionated carbon dioxide laser resurfacing remains the gold standard for non-surgical facial rejuvenation. I’ve given the Ultherapy the 3 month wait. In conclusion, I think I look worse on the side that was treated and so do my friends (who thought I looked younger on the un-treated side). I gave a lecture to the entire Los Angeles Metropolitan Dermatological Society last month on fractionated carbon dioxide laser resurfacing. It gave me a chance to show all of the photos I’ve collected and to show how versatile the fractionated carbon dioxide laser is. I’ve used it on surgical scars, acne scars, benign lesions, brown spots, aside from just wrinkles. The talk was well received and it gave me a chance to thank those doctors that inspired me during my residency. I can’t believe how fast time flies (I mean, that was 15 years ago now!)

Also, there is new evidence that patients with a history of non-melanoma skin cancers are at higher risk for other cancers. Sometimes these studies are hard to believe, but what I can tell you is that consistently, lymphoma and other blood cancers do come up over and over. In my practice though, I can reassure you that these cancers are still rare. The vast majority of cancers patients have are the common ones, such as prostate, breast and colon cancers. I wouldn’t lose sleep over these issues. I am more alarmed at the high incidence of thyroid disease in Los Angeles. I myself have a mild case of hypothyroidism. It seems like at least 10% of my patients are on Synthroid. Jet fuel? Smog? Don’t know!

On a lighter note, enjoy my girls singing “Let It Go” from Frozen. We are in love with the songs and music, and we all belt out the songs in the car. I really think it is the greatest thing since Sound of Music. Not quite as romantic or deep, but those songs are mighty catchy!
CLICK HERE: Watch out, Mariah!

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Three Neat Guys!

Wednesday, May 9th, 2012

I just returned from Chicago after attending the Annual American College of Mohs Surgery meeting. I always learn a lot from this meeting and have a lot of fun hanging out with old friends. Nothing like three women complaining about their significant others after a few drinks and “The Wedding Planner” playing in the background! But don’t worry, I also learned the latest melanoma guidelines! The intelligence and innovation of my Mohs College colleagues never ceases to amaze me. They are a funny and down to earth bunch as well!

Other highlights included three good men. First, my dad. After one of the worst experiences of our lives, to see my 81 year old dad walking and talking like he is one year after his car accident is so amazing! As my dad said, his hard North Korean head came in handy. My mom saw the car and couldn’t believe he survived. All I can say is it was an Easter miracle. He is still practicing law.

Next, I had the pleasure of staring down Gary Sinise. The poor guy probably just wanted to be incognito, and here I was talking to my mom on my cell at the front of the hotel and I see a black town car with the “The United States of America” on it. Wondering if I’d see a Secret Service agent, I instead see a man with sunglasses come out that seems to resemble him. I stare at the guy (which I hate to do to anyone let alone a celeb) and he says hello. Oops! I just wanted to tell him what a wonderful thing he’s doing for our disabled vets and what am I supposed to do, hang up on my own mother?! I buy the guy a bag of cashews, write a card and a check to his foundation, and the concierge won’t deliver it and pretends he isn’t staying there! Sheesh! Good security on the hotel’s part! After all, my cashews could be tainted and I could be like the crazy woman who stalked David Letterman! PS-I’ll just send the check in the mail. My friend Dr Kelly had a fun time witnessing these shenanigans. If you haven’t heard about the amazing things he’s doing, look it up!

Next, comes Dr. Bennett. I am so proud of him receiving the Frederick Mohs Award (i.e. lifetime achievement award). I only wished I had videotaped it for our kids. It was beautifully presented by his former fellow, Dr. Manish Gharia. Here is the transcript:

“Good Afternoon. My name is Manish Gharia. I was fortunate enough to have been Dr. Richard Bennett’s fellow from 2001-2002. During that year and over the last ten years I have learned of Dr. Bennett’s many accomplishments and service that make him worthy of the Frederick Mohs Award and I wanted to take a few minutes to share them with you.

Dr. Bennett’s dermatology career began in 1971 at the Univ. of Penn. From there he went to NYU to train in Mohs Surgery with Dr. Perry Robins. His career took a slight detour for 2 years as he served as an officer in the US Navy where he took full advantage of the Navy’s liberal grooming policies for enlisted officers (chuckles, pic of a scrawny Doc B with full facial hair). Once out of the Navy, minus that beard, and sporting a completely new look (more chuckles, photo with long hippie hair and beads) a young energetic Dr. Bennett set out to find a career in academic medicine. Dr. Bennett’s first faculty position came at Emory University where he started the Mohs unit and a fellowship. His extensive clinical experience of having treated well over 25,000 Mohs patients and counting in his 35 plus year career is matched only by his prowess as an educator and lecturer. Dr. Bennett has been an invited lecturer at over 250 meetings in 17 countries on 4 continents. The lectures and publications, including 2 books, 12 book chapters and over 70 unique articles have also introduced many of his innovative surgical procedures. In 1984, Dr. Bennett left Atlanta and was recruited to start the Mohs program at UCLA. During that period he began work on his textbook, The Fundamentals of Cutaneous Surgery. Although the book has been out of print since being released in 1988, it is still highly sought after. At last check you can still get a copy for about $450 on Amazon. Dr. bennett will have taken on his 30th fellow this summer. The fellows have gone on to take faculty positions at 8 different academic programs and practiced Mohs in 5 countries on 3 continents. In keeping with Fred Mohs’ traditions, countless other fellows have passed through his offices as he interviews any resident and opens his office doors to all those who want to learn. He has served as the President of the ASDS over the past year and the Los Angeles Derm Society. At the Mohs College has has also served on the Fellowship Directors Committee and Slide Review Committee. He has been the recipient of the Golden Triangle Award for service from the AAD and the Samuel Stegman Award from the ASDS and many teaching awards from his dermatology residents.

Dr. Bennett’s Los Angeles practice has its fair share of Tinseltown’s elite, most of them which he doesn’t recognize (so true;) (poster of Muhammed Ali ‘Impossible is Nothing’) this poster hangs in the office and embodies what he feels can be done for all patients and instills in all his residents and fellows. Primarily to never give up on your patients, to see their care to the end. But for all the proverbs, quites and philosophies he has doled out over the years, it’s his actions that speak volumes. The most valuable lessons for his students come from his approach to patients. Now I know that at some point Dr. Bennett would like to sail off into the sunset to one of his favorite places in the world, Abaco Island in the Bahamas. But fortunately for all of us, I think he will have his hands full for quite some time still (picture of our family on an elephant). By my estimation, I think you and Dr. Shim have to do this for about another 30 years to have Amelie and Lydia be your final two fellows. So with that I introduce to you the recipient of the 2012 Frederick Mohs Award, my friend, mentor and teacher to all of us, Dr. Richard Gary Bennett.”

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