Season 2 Ep. 22 - See Something, Say Something featuring Kristen Hebert

As providers, what is our responsibility when we see something suspicious? Do we say something? Is it even our responsibility? If it is, what are we looking for? How do we have conversation? 

All of these questions and more are answered in this episode. Dermatology PA, Kristen Hebert shares her knowledge of suspicious skin moles. Kristen brings insight to a sensitive topic of skin cancer. 

Tune in to continue the conversation!

Transcript

SPEAKER_00 0:07

Hello, welcome to this introvert. I'm your host, Sam Bazil. So today's topic is going to be a little sensitive. It's going to talk about skin cancer. And I have to thank an aesthetician for this topic. Uh I had someone reach out to me on social media and she asked if I could cover a topic around skin cancer. As an aesthetician, we learn certain things in school about how to identify things, but we're not allowed to diagnose. She was asking if if I could talk about how to feel comfortable to say something, say something, and what should be referred out, what shouldn't be referred out, and really dig into the nitty-gritty of that topic. So thank you for recommending that topic. I thought long and hard about who I should bring on. And I'm telling you, there is no one else I would rather share with you than Kristen. Kristen is a Durham PA that has taken care of my family personally. She is incredibly talented at what she does. She is also beautiful and so smart. And she brings a lot to the table. I wanted you guys to hear directly from her how to handle this topic and when you should see something, say something. So welcome, Kristen. Um, fun fact Kristen has been taking care of me and my family for a long time. I would not have wanted to trust this conversation with anyone else. So super excited to have you and tell everybody a little bit about you.

SPEAKER_01 1:26

Yeah, so um I'm a dermatology PA and injector out of Baton Rouge, Louisiana. I've been in practice for approximately 10 years now. I just made 10 years on June 2nd. So um, and then really initially in my career tapped into medical derm mostly. About six years into my career, started doing the aesthetic side. So like Botox and fillers, and and now I do it all. So I'll do, you know, your general dermatology, which includes acne, skin check, psoriasis. I do uh mild um dermatologic surgery, and then I also do uh aesthetic injections. Woo! You do it all. Yes, I wanted to do it all. This career's fun.

SPEAKER_00 2:04

Okay, well, I want to talk about something before we get into the real topic, because this is something you and I brought up. So there's for whatever reason on social media, it's kind of like there's a line drawn between the DERM community, the aesthetics community, and what how does that affect you specifically? Do people not know that you like do certain things?

SPEAKER_01 2:24

Yeah, actually, yeah. So I think, you know, for the longest time, I think everyone agreed, like, knew it was kind of Derm brought this like aesthetics thing to market, and then aesthetics took a very wide range of who you can see for as your provider. Um, and what that's not a problem at all. But I think in in that type of movement, we've kind of maybe forgotten that dermatology also can do aesthetics. Not every dermatology provider chooses or opts to do the aesthetics portion. Um, but a majority of the time, the person that you're sitting in front of dermatologically can address a lot of aesthetics conditions and can do procedures like Botox, fillers, et cetera.

SPEAKER_00 3:01

Well, thank you for clearing that up because that's definitely something that even I see when I go from you know clinic to clinic to clinic, people are, oh, I didn't know that she did that, or this one did that. So yeah, no, I'm glad we brought that up. That's definitely something that needs to be addressed and kind of weird that we've gotten so far into aesthetics that we wouldn't think a physician or a deram practitioner would handle facial aesthetics. So bizarre. Right.

SPEAKER_01 3:28

And then I've had the opposite too, where um just by assumptions, patients have assumed I only do cosmetics, that I don't do skincare anymore. And it's like, no, it can all be done. You can do it all. You don't like, you know, it's like riding a bike, you don't lose your tricks.

SPEAKER_00 3:42

Well, I hate to like give in to that whole like stigma with you, but just to share something, when I went to set up an appointment for my son with you to get one of his little suspicious moles, you know, taken care of. He was like, Mom, come on. And I'm like, what? He's like, she's so pretty. And I'm like, Well, what did you expect? Like, did she have to be this like mean ogre, like to take care of you? Like he was so taken aback by like your beauty that he couldn't believe that you were gonna have to like look at his mole. So yeah, you know, funny story, but okay, so that kind of segues into where we are today. Let's talk about these like suspicious moles and things like that. So I, when I was in practice and I was still seeing patients as an aesthetician, obviously I was taught at school what we should look for, what is kind of suspicious. We were told very specifically we cannot diagnose, there's a lot of things we can and can't do, but it is critical if you see something, say something. And I've realized just being in this industry, that maybe it's not not necessarily they don't know, but maybe they're unsure of when to see something, say something, when to refer something out, or is this treatable in my office? Like I actually saw someone say, Oh, I'm just gonna laser that. And I was like, Well, we probably shouldn't. We probably should just refer out for that. So I think maybe with this communication today, with this topic today, you could clear up some things. So I have some like QA's that we can go over just to kind of help the community that is not necessarily maybe they know, but they're not comfortable that they don't know. So, first, why do you think it's important that aesthetics providers should care about skin cancer detection?

SPEAKER_01 5:29

Well, it's not their responsibility. The question asks, why should they care? And I think ultimately all aestheticians and aesthetic providers in general genuinely care about skin health. And so when we're discussing skin health, we're worried about stuff like that, right? So it's not just aging or, you know, photoprotection. We are looking into finding things that can potentially harm this patient. Um, so they're at the front line of seeing that. They are likely seeing the patient more frequent than we are, to be honest with you. Um and so they're likely to be the first person to catch something, especially because a lot of patients don't even routinely see a dermatologist until later in life when they have a suspicious lesion. So I would say they should care because they are the front line, they are in the skin business and they genuinely care about health for the patient.

SPEAKER_00 6:17

Okay, so tell me this. What is the potential impact that a patient might have catching something early versus waiting? And maybe that can encourage people to see something, say something. For sure.

SPEAKER_01 6:29

So the earlier detection is key. So prevention, if if we can catch it early, we can likely bypass deeper cutting, potential metastasis, which is really unfortunate. Um, and so whenever we're doing, you know, whenever we're seeing something that's suspicious and we're doing biopsies, we're grading how you know how aggressive that tumor is. When we see things sooner, it's likely that we don't progress in the aggressive nature of certain skin lesions that can be harmful, like cancers.

SPEAKER_00 6:56

Okay. That's enough of a reason, I would say.

SPEAKER_01 7:00

Yeah, like it's a big one. Yeah, it's pretty, pretty simple, but it's pretty big.

SPEAKER_00 7:04

Cancer's scary, and I think sometimes people don't give melanoma the respect that it deserves. They think of it as just something like, eh, but that's you can just cut that out.

SPEAKER_01 7:13

And you can sometimes.

SPEAKER_00 7:15

Sometimes not. So, with that said, have you ever diagnosed skin cancer because of another aesthetics provider encouraging a patient to come see you or get it checked out? I have.

SPEAKER_01 7:26

And even, yes, the answer is yes. Even if it's not cancer, some moles are not truly melanoma. But some moles sit in this little gray area called an atypical mole. We we refer to them as dysplastic moles, and those are risks to become melanoma. So there are instances, very commonly actually, that patients are referred to me, that it is atypical. It may not be a full-blown cancer, but it is an atypical mole that needed surveillance and requires the patient coming back for routine skin exams. It ignites a fire in them to kind of come back and keep doing their routine maintenance. But yes, I also have had patients that have been referred, mostly men, uh, by aesthetic providers that had maybe skin cancer on their arm like carcinomas.

SPEAKER_00 8:04

Ooh, that's scary. Or back.

SPEAKER_01 8:06

Yeah.

SPEAKER_00 8:07

So we hear a lot of different uh terminologies when it comes to skin cancer. So things like basal cell carcinoma, squamous cell carcinoma, and melanoma. I know it's kind of hard not being able to show us anything, but are there um little significant things that we should look for to maybe just be able to see the difference between those?

SPEAKER_01 8:25

For sure. So melanoma and the carcinomas are kind of, I would say, categorized into two separate type tumors. Um, the squamous and the basal cell carcinomas are what we call non-melanoma skin cancers. Those tend to be less aggressive than a melanoma overall. Of all the skin cancers, the basal cell carcinoma is the one that can be the most easily confused. A lot of patients say these look like pimples. Oh, that was just a pimple that was there forever. Um, but it is an actual cancer, and they can be very tiny or large. Squamous cell carcinoma tends to look more like a wart, um and it usually has a lot of pain about it. So that's a differentiating feature from a true wart, which is typically asymptomatic. But these like warty type growths tend to be sensitive. They have a little red hue to their base, they can feel like they have a nodularity in the skin, like a deep kind of um bead-like structure in the skin, and they can bleed. And then melanoma, this is kind of an overall basis, but it usually is a darker pigmented lesion. Now they do have amelanotic, which we will get into. But it's usually a mole. This is a true mole that has developed a cancerous predisposition. So that typically tends to run darker. So, like your really dark browns, your blacks can have multiple different hues of browns or blacks, and those tend to be asymptomatic, which is what is so scary about those. You don't actually know you have one, you don't feel it like you do the carcinomas. Yeah, feel as in like symptoms, pain, itchy, tenderness, bleeding. Usually melanomas are kind of silent.

SPEAKER_00 9:56

Which is even more scary.

SPEAKER_01 9:57

It's scary, yeah. It can be scary.

SPEAKER_00 9:59

Out of the ones we talked about, what are gonna be the most common and which ones are the most dangerous, do you think?

SPEAKER_01 10:05

Of those, the basal cell carcinoma is the most common. As a matter of fact, of all the cancers in the world, not just the skin world, basal cell carcinoma is the most common cancer. Uh, the most uncommon is gonna be melanoma. Um, and it, you know, it just depends because melanoma has different staging, uh, but melanoma is the most rare of those three.

SPEAKER_00 10:26

Okay. What do you think are the most the most common misconceptions that patients have about skin cancer?

SPEAKER_01 10:34

That it has to be brown. So just mentioning the amelanotic melanoma. Um, not all tumors look exactly like the books, right? Like in school, you learn one way. When when patients are gonna Google, they're gonna learn one way, but that one way is not all the ways. As a matter of fact, there's different subtypes of these tumors. Basal cell has several subtypes, squamous cell has several subtypes, melanoma has several subtypes, and all those subtypes have different appearances and different risk profile. But the most misunderstood thing is that melanoma has to be brown, which to make everyone even more scared, it could be flesh-toned, like your own color. It can look like a little scar. It could be red, it could be pink, it could be kind of like, I don't know, almost like a like a cleary type color, like obviously skin color, but maybe like a little translucent. It has a very vast appearance. So, of course, we teach this one thing because that's the most common appearance of melanoma, but they do have these subtypes that are very concerning to our trained eye.

SPEAKER_00 11:33

That makes me like, I feel like I need to make another appointment to come check.

SPEAKER_01 11:36

I feel like I'm fear-mongering. I'm sorry.

SPEAKER_00 11:38

But I don't think that it's I think there needs to be a healthy respect for it. Maybe not a fear. You don't need to be constantly checking your body all day, every day, but you need to be conscious of it and have a healthy respect for it because you and I, we're here in Louisiana, so we live in a climate where we are exposed in our lifestyles a lot. So it I see, I think it's definitely something we need to be conscious of. Now, what about providers? So, specific aesthetic providers. What should they be paying attention to in treatments? And what do you think they should look for that should be considered suspicious?

SPEAKER_01 12:17

So, you know, I I I think about each different tumor type. Um, I kind of have a different answer for each tumor type. But overall, something that hurts the patient's always a huge, a huge trigger. Like if it's more sensitive, if it stands out, if it spontaneously bleeds. Granted, there's other lesions that do that that are completely harmless. But pain, bleeding of some kind, and a persistence, like it's been there a while, it's been read a while, it's had this symptom off and on for a while, those are things that I think we should be asking the patient to gain clarity to whether we should be concerned or not. And when in doubt, refer it out. I would always say, like if you don't know and you have a little inkling of suspicion, follow your intuition. I think that we're trained to do that. Um, but I would say some things aesthetic providers can look for are a little more sensitivity in one little area, bleeding, and then kind of a history greater than a month, I would say.

SPEAKER_00 13:13

Okay. All right, easy enough. Now, this is something that I think is good, obviously, for providers to know, but patients really, if you're a patient and you're tuning into this, you definitely need to know the A, B, C, D, E rule for melanoma. So would you walk us through that A, B, C, D, E rule?

SPEAKER_01 13:31

Absolutely. So A stands for asymmetry, meaning that if we took this mole and we folded it down, you know, divided it down the middle, folded it in half, its left shot side should match its right side, its upper layer should match its lower layer, it should overall have a symmetry to it. B stands for border, that is the very edge of that mole. That mole should have a clear border, which this one's a little bit difficult to describe. But the way I can best describe it is color should start and stop very white and black. You know, dark pigment stops. Um, pigment that kind of fades in, kind of fades out. That's a little suspicious. And that would be one of the one of the things that we look at in a melanoma protocol. C is color. The darker it is, the more we get concerned. Scratch what I just said about a melanotic. C in this particular stance is darker, or a change in color, like it went from black to white. It went from a brown mole to a black mole. And so obviously, black is kind of a concern. D is diameter, anything greater than six millimeters, which for reference is about the size of a pencil eraser, those tend to have a higher risk of melanoma. And then E is evolution, and evolution can be something the patient is responsible for. It's also something that we as dermatology providers are responsible for once we do a skin exam. But evolution is the change of a mole. Any change of the aforementioned characteristics, any change in pain, any change in size, any change in color would be a reason to be suspicious of a melanoma. Okay. I also want to mention that most melanomas are actually what we call de novo. So that means they're new developing moles. They are not developing in an old mole that's been there six since six years old. Melanomas are most commonly, not always, but most commonly a brand new developing mole.

SPEAKER_00 15:16

Okay. Now we you did mention this a little bit, but I want to make sure we do bring this up aside from moles, because this ABCDE rule is like usually we're looking at moles. Um, but are there certain warning signs other than just there being a mole that should raise concerns?

SPEAKER_01 15:36

Yes. Um, some other warning signs, and this is not necessarily true of only just melanomas, but um, you can have an amelanotic melanoma that looks kind of like, like I said, a scar a second ago. And if that was not there before and you can't isolate an injury as to why you might have like what looks like a little white patch or a little scarred patch, that would be a reason to be suspicious as well. And then again, I I know most melanomas are asymptomatic, but like pain, random ulceration, which ulceration kind of looks like scabbing. That would be strange. Again, this is without history of injury.

SPEAKER_00 16:12

Okay. So obviously, when a patient is visiting an aesthetics provider, usually the aesthetics provider is looking at the face, maybe the neck, the declete, things like that. But there are other areas of the body where skin cancer presents, and maybe your provider might not see it. But as a patient, you may want to look. So, what are some body areas that are most commonly overlooked by patients that get skin cancer?

SPEAKER_01 16:40

The most common one's gonna be the arms and hands. Hands are huge, especially the backs of here from driving up here on a steering wheel. Um, the back is also very common in men. I think men go shirtless a lot, not as common in women, but um, the shoulders, the back, the forearms, the hands, and in women, the calves and the lower legs, because we wear skirts and we wear shorts, so we expose our legs a little bit more.

SPEAKER_00 17:04

Okay. And why do you think the scalp is I missed that one? That was a good one. That's a good one. Well, and look, I'm only saying that because I dealt with it myself. So why do you think people miss that so much? Why are they not focused on that? We just don't really apply sunscreens there, right?

SPEAKER_01 17:21

Like, I don't think people think that's a thing that they can do, and you absolutely can and should. I also don't think there's a lot of vehicles that are very scalp friendly. I mean, no one wants grease, super greasy hair, you know. I mean, I know that most times we're outdoors, we're still sweating, so we're gonna wash it anyway. But um, the idea that putting like a lotion or a cream in the scalp would be a thing is just like not thought of, although it's extremely possible. And of course, the hair part is the most common area to develop of a sun-type lesion, so carcinoma melanoma. But I see it all the time in patients that, you know, our hair is porous, sun will get through it, even when you're wearing like a cap that's netted or a hat that's netted, kind of like a wicker hat. There are some little pores where the sun can come through. And so I always tell patients, especially as they get older and they have issues with their scalp, to wear um UPF clothing, UPF hats, cloth hats that are that don't really have, you know, that porous nature. Um, something is better than nothing. So if you're gonna do something, I'd rather you wear a hat than not wear a hat. Um, but yeah, the scalp is often missed. And I should have mentioned that. That is a common area for cancers.

SPEAKER_00 18:28

Well, and I think too, you know, anybody that's listening to this that has children, don't forget that with the babies. Like you're putting sunscreen all over everything else, but you're forgetting the scalp, the top tears. Yeah. And they're they're going through it. So yeah, I'm glad we brought that up.

SPEAKER_01 18:42

Yeah, I did. I do see, I more commonly see those cloth hats on babies than I do adults, obviously. It's not like the most fashion forward look. Um, but they do make some UPF hats like Academy that aren't bad. I got my husband one and he rocks it. I'm like, this is great. And maybe I think it's awesome because he's my husband, but I'm like, this doesn't look terrible. It's not, it's not a terrible look.

SPEAKER_00 19:02

I know, right? Well, you know, when it comes to cancer fashion is secondary, but okay. So we've talked a lot about identifying the issue, but I've talked to some providers that don't necessarily feel comfortable having the conversation. It's like they don't know what to say or how to say it. So how do you or how would you guide a provider if they see something? How should they approach the conversation? And maybe what wording do you recommend?

SPEAKER_01 19:30

And this is to the patient, correct?

SPEAKER_00 19:32

Correct.

SPEAKER_01 19:33

Yeah, I can understand how that's difficult. Because like, what if you're wrong and you waste the patient's time? But I'd rather you waste the patient's time and be safe. Um, the way that the aesthetics provider can approach that would be hey, there's, you know, there's a little spot on your face. How long has that been there? Get a history, ask the questions. And some of the most common questions we ask are like, you know, duration, how long has it been there? Is it bothering you? Does it ever randomly spontaneously bleed? Have you tried picking at it to make it go away? Or are you picking at it to keep it there? You know, trauma history. And then if all of those signs point to it has been there a good bit, it is maybe causing the patient some issues, I would say, okay, well, look, listen, not to scare you, because again, I don't want to fear monger patients, but it would be in your best interest to just make an appointment with a dermatologist and get that checked out because I can't diagnose here. But that, you know, we have these specific tools called dermatoscopes. We can look at it with our trained eye and a dermatoscope if we need another layer, um, just to give us a better confirmation of diagnosis. And then we know and we can say, yes, it is nothing, you know, it's nothing. You're you're good, like you can go on, or we can biopsy it in that visit.

SPEAKER_00 20:37

Well, I think you hit the nail on the head. I think just making them not panicking, but making them comfortable to know that it's their decision to take it further. That way, I think as a provider, you know you've done what you needed to do, you've said something.

SPEAKER_01 20:54

Exactly. The due diligence.

SPEAKER_00 20:56

I don't know if I'm sure you have this because you do work alongside of aestheticians, but I think if you are an aesthetician, um, a nurse practi, a PA that is in an aesthetics environment and you are not derm certified or you're not with a dermatologist, I think it's super important that you find a dermatologist that you can work with, that you can refer out to, because that way you know you have a direct relationship with them and it's comfortable. Because I think, like, for example, if you were my person that I was referring to, I think it would be helpful for me to share some information with you, maybe to kind of prep you for the patient. So if they are to, you know, join forces or really just have someone that they can refer out to, what information would be helpful for you to know to help these specific patients and make this transition work well?

SPEAKER_01 21:51

And Sam, on that topic, I do have aestheticians that are even outside of my office and other injectors, you know, that don't practice dermatology, just do cosmetic injections. That text me pictures. Hey, should she be worried? Should we be worried? And while I'm not always like camped by my phone in the middle of a workday, I do get back. So, and you can always call the patient later. If you send the patient and say, I'll talk to her, I'll get back to you and tell you if this is something you should be worried about. Notably, a picture isn't a diagnosis either, but it's something to say, yes, come in or absolutely not, don't worry. Um, but what I'm looking for whenever a patient's being referred to me, I think insurance is a huge thing. Um, you don't have to have insurance to see it, so you can self-pay if you don't have insurance. But a lot of the times insurance dictates who you see. So, like making sure that the provider this person is sending to is within network. How do they know that? They do not. But they could send over like a referral, which would be just, you know, the patient's demographic information, so name, address, et cetera. And then we can call the patient and inquire about their insurance. Um, other things we would need is like their um history, like just like a basic history that you got from them. That way we kind of have an inkling of what we're walking into and of course the location of the specific lesions that are of concern. Most cases I'm doing a full body scan exam anyway. I'm gonna convince you to do it. I'm not gonna make you, I'm just gonna convince you. And so I'm looking everywhere anyway, but kind of being in the know of what the concerning lesion was. And then I can report back to that aesthetics provider, like, hey, thank you for the referral. This is what it was, if the patient wants me to.

SPEAKER_00 23:17

I love that. Okay. All right. So I know you've seen lots of different cases, cases that were just mild, no need for concern. It was totally fine, up to the absolute worst of the worst. Can you share maybe a story or a time without giving any personal information, but just an example of something where a referral truly changed or saved a patient's life? Yes.

SPEAKER_01 23:43

Um, and not specifically from an aesthetics provider, but from a family member. The patient noticed it, the patient said something, uh, the family member noticed it, the family member said something. It was indeed a melanoma, and it was an aggressive melanoma. And we ended up getting her an excellent care. Obviously, I had to use multiple providers to get that done. But um, I and she ended up sending me a year later this monster floral bouquet. So I'll never forget her. It was like she was the most appreciative because we saved her life and because someone said something. Um, and then I also had another patient, um, an elderly female that was referred by an aesthetics provider, and it was a carcinoma, and that carcinoma was able to be removed on the spot that day. So, yes, see something, say something.

SPEAKER_00 24:24

That's why this is important. Save lives out here. It's not just about saving lives. It's gonna look pretty and I want them to be healthy and happy and alive. Yes, for sure.

SPEAKER_01 24:33

And like most of these are very treatable, very treatable. I think a lot of patients stall on getting in because they're like, I just don't want bad news. Like, as if the bad news would be a life-ending piece of news. Um, but cancer in our setting can be very curable. We actually cure cancer all the time. So it's not something that's a death sentence. This is it could be if not if neglected, but if treated, we often get, you know, really great clearance.

SPEAKER_00 24:59

Well, I want to ask you this question because maybe other people might have this question as well, because I did deal with um melanoma with my husband. And what was so, so small and so so tiny, they literally took a football-sized chunk out of his leg. What is the reason for that? And why do they have to go so big for something just so small?

SPEAKER_01 25:24

Great question. I get this a lot, and the size chunk that's being taken is directly proportionate to the size or the um grade of that lesion. Do you recall what grade his melanoma was? I don't. I don't um, nevertheless, most of the time, whenever we're doing a melanoma, melanoma is a little more risky. What we're seeing with our clinical eye isn't the whole picture. There's often these little like auras around that mole that can contain melanoma tumor. There's also depth to that melanoma tumor. It can kind of be star like underneath the skin. They can kind of, they don't have always a well-formed, perfect nature to them. And so within knowing that, there's been protocols set forth by the American Academy of Dermatology to have different margin protocols. And what that means is we will take more healthy skin, healthy appearing tissue around. This starts for a melanoma at five millimeters. So a melanoma in site two, which is a stage zero, we start at five millimeters. And as the staging increases, the margin increases. It can get as large as two or three centimeters, which is a very huge gap. So this would explain why your husband ended up getting a very large cut. Now, in addition to that mole being, you know, this big when it's removed, if it is, you can't close a circle like that and it'd be pretty. So oftentimes we're taking these extra pieces of tissue in like a football shape pattern, like you know, like that. Um, that way that closure for that surgery has a pretty line instead of some puckering on the ends. So then we're taking more additional tissue that are not included in the margin.

SPEAKER_00 26:59

So is cutting it out the only option, or are there other things that a patient that has melanoma can do?

SPEAKER_01 27:08

Cutting it out is always the option. And then there's additional things we can do. So there's radiation. Um, I often refer to oncology when there are deeper stages because they do figure out if there's going to be chemotherapy, radiation, what type of surgery are we going to test lymph nodes? Which lymph nodes should we be testing? That's very advanced for us. We do the diagnosis, we may treat an Insight 2 or a smaller tumor, but more advanced tumors end up in the hands of an oncologist or an on surgeon.

SPEAKER_00 27:36

Okay. All right. Okay, so I have some little rapid-fire myth busting questions for you. So is this myth or fact? Only fair-skinned people get skin cancer.

SPEAKER_01 27:50

Myth, myth, myth.

SPEAKER_00 27:52

Okay. So even if you're dark, you have skin too, and it can develop cancer. Didn't Bob Watson die from melanoma? He did on the bottom of his foot.

unknown 28:01

Okay.

SPEAKER_00 28:01

Like where the sun don't shine. There you go. And he's definitely not a white man. No.

SPEAKER_01 28:06

No, and carcinomas are also um possible. You know, all tumor types are possible through all skin types. Um, I have seen a squamous cell carcinoma from chafing, like a patient that just chronically chafed over and over and over where the skin would always stay mad and inflamed, a squamous developed there, which can happen. Um, so yes, they are not exempt from skin cancer, even if it's not directly mediated by sun exposures.

SPEAKER_00 28:29

Okay, this is just me like geeking out over this. But do you is it so like if it it came in the place where the skin was constantly chafing, is that maybe because of injury and inflammation constantly being there that cancer just developed in that area?

SPEAKER_01 28:44

That is correct. That is the theory. Um, because it was in the inguinal, like the inner thigh. Uh, and I'm not saying that the thigh has not seen the sun. I am certain it has. But this was a gentleman who likely wore trunks when he was at the beach or or outdoors. So it was likely mostly covered. And this is a patient who did not do a tanning bed, you know. Um, so yes, I think it's this particular case was almost exclusively due to chronic friction and inflammation that would never let the skin fully heal healthily. And then a tumor developed subsequently to that. Wild.

SPEAKER_00 29:14

Okay. Young people can't get skin cancer.

SPEAKER_01 29:19

Uh my youngest melanoma was a 21-year-old. Yeah.

SPEAKER_00 29:24

Um, the Academ, is it the Academy of Skin Cancer? American Academy of Dermat. Yes. They posted um something on Instagram uh the other day. I actually reposted it. Um, it was a bunch of dermatologists that were sharing their youngest, the youngest patient that they ever diagnosed with skin cancer. And this one uh male dermatologist said it was a 10-year-old. And I could not believe that it was heartbreaking. So that is heartbreaking. We got to keep an eye on our babies too. They're not immune from it, unfortunately.

SPEAKER_01 29:53

They are not, and they're not too young for a skin exam either. So I've had like a two-month get a skin exam because the mom wanted it done, and I'm happy to do it. Never too young.

SPEAKER_00 30:02

I think Leighton was 16 when I brought him to you because it was weird, it was atypical, it wouldn't, it didn't have a good shape, it was dark, and I'm not playing around my babies.

SPEAKER_01 30:12

Well, and his family history, right? Like that's another thing, too, that really plays into this. So good. You're at higher risk if a first degree relative has had a skin cancer.

SPEAKER_00 30:21

Yep. Okay, so we did talk about this, but obviously it's gonna be a myth. Skin cancer only happens in sun exposed areas.

SPEAKER_01 30:31

Yep, myth. Myth, myth, myth. It can happen anywhere. Anywhere skin is bottom of feet, uh, vulvar skin. I've seen a melanoma on the vulva, uh, which is uh yeah, it's like the the lips uh to the you know female genitalia. Um penile lesions are possible. Um, so yeah, it can happen anywhere there is skin.

SPEAKER_00 30:52

That's insane to me. But although I kind of feel like I'm a sitting duck anyway, because I was uh baking in tanning beds, you know, when I was younger. So kind of like waiting, you know, just in fun fact.

SPEAKER_01 31:04

Uh my mom owned a tanning salon my whole youth. Like I was in the fifth grade when she opened the salon, and I think I tanned every other day for years. Um, and then when I went to college, because I'd been tanning, you know, my whole high school, uh, my apartment just had a tanning bed there too, that I could just go. And so then when I got into this career, I'm like dying. Like, no, no, no, no. Like, how do I undo this? And I'm still undoing the damage, and I'm very scared that I will develop something because of all those years.

SPEAKER_00 31:33

Well, okay, here's the same fun fact. My first job ever, I managed a planet beach, and um, I was 16 managing a tanning, so I don't know what I was thinking. Managing loss. They were desperate, apparently when I was younger.

SPEAKER_01 31:48

I mean, isn't there like a loss against that? I'm not sure.

SPEAKER_00 31:50

Probably. But also, my mother had a tanning bed in our home. So how often were you in that bad boy? It was bad. I would tan, this is how bad it was. I would tan in the morning before I would jump in the shower, and then I would usually tan at work at some time during the day, some point during the day. So a lot of days it was twice a day, which is and and then I was putting on, I don't know if you remember, those lotions that would make your whole body tingle and burn. Yes, girl.

SPEAKER_01 32:16

Yeah, because that's like the accelerators, the little stickers, the little like bunny ear stickers. Oh my gosh. And tanning beds still exist, by the way. Like those are still out there.

SPEAKER_00 32:27

Just like how are people doing this?

SPEAKER_01 32:29

Knowing I don't know. I I I guess because like it's there is no mandate against them. The AAD has been working heavily against this for a long time to like ban them or have some type of regulatory control over it. Uh, and I think they've made headway, like you can't attend a so like a you can't do twice a day. Uh, I think you can only do like three or four times a week. There, there are some mandates that have been in place, but like they still very much exist and they're successful. Like spray tan, fake bake, correct.

SPEAKER_00 32:59

I feel like that works better anyway.

SPEAKER_01 33:02

I agree.

SPEAKER_00 33:03

You don't have that weird, you know, it's immediate, but you get that butt line from tanning. You don't have that with a spray tan.

SPEAKER_01 33:09

You get all the areas, you get all the areas, and it stays for like and it's immediate, and it stays for like a whole week. You don't have to keep working it up and working it up to get your color. You're you're there, you're there. Yes. Oh my gosh, pro fake bake.

SPEAKER_00 33:23

I look, I love me a good fake tan, man. I have some of my favorites for what I like to do on myself at home, but when I do get over my modesty kicks and I can really get in there and have somebody spray me down, there's nothing, nothing better than that. Nothing better than that.

SPEAKER_01 33:38

I know, brand new.

SPEAKER_00 33:40

Well, I am very grateful that I was able to have you on today. I think a lot of this information is going to be so helpful to aesthetics providers. And I would say I would like you to obviously share one big takeaway from this. I'm gonna share my biggest takeaway from this, only because I was an aesthetician. If you are an aesthetician watching this and you practice independently, you're not in a clinic with other medical providers, please find a dermatologist that you can partner with. So that way when you do see something, you can say something and you have a good relationship like Kristen does with her aesthetician and aesthetics injectors, where they can, you know, text her because you could be what saves a person's life.

SPEAKER_01 34:20

100%. And to add to that, not necessarily on the aesthetic or you know, the provider front, but patient comfortability. I think patients also just don't want to come to us. It's uncomfortable. You just mentioned it about the spray tan. Um, but big takeaway here is don't feel embarrassed for a measly little thing. There's nothing too small for a visit. Um, and if you don't want to do a full body or you're just like really anxious about doing something like that, you do not have to. Of course, we prefer it. But I want patients to feel comfortable in knowing that they can advocate for themselves. If you just want one spot checked, we can do that. You can kind of slow step your way into the Durham world, or we can do full body skin exams in your visit. So just be comfortable. Know that we're not gonna make you feel uncomfortable or be judgmental of your tiny little complaint or your body or your body hair. Come on down. It's a judgment-free zone. We're just trying to save your life.

SPEAKER_00 35:08

I'm gonna tell you guys what I told um a patient when I was lasering her her butt. She was like, I'm so embarrassed. I don't want to do this. I said, Girl, look, there's not a butthole that is gonna make me shake or or or cringe. I've seen all the buttholes. Let's hurry up and get this.

SPEAKER_01 35:25

Like and literally, it's just a butthole.

SPEAKER_00 35:28

Your dermatologist has seen it all. There's nothing special about your butthole. So go get your butthole checked too, because you can get skin can. Oh gosh. All right. Thank you so much, Kristen. Thank you so much, Sam. And look, before we say goodbye, if anybody wants to come see you in practice or if they want to give you a follow, what is your information and where can they find you?

SPEAKER_01 35:50

So you can follow me on social media at In the Skin with Kristen with an E N. And then I practice dermatology at Louisiana Dermatology Associates. It is in Baton Rouge, Louisiana, off of Jefferson Highway. Our website is LouisianaHyphen Dermatology.com. We do online scheduling. We do phone call scheduling. If you have questions, call on in. I'm happy to help. Love that.

SPEAKER_00 36:13

All right. Thanks so much, Kristen, and thank you all for tuning in. Till next time. Bye, guys. Bye, guys. Think of this introvert as your aesthetics roundtable, not a training manual. This podcast is for professional education and discussion. It's not medical advice. Your scope of practice matters, regulations vary, and your license always works for us. To continue the conversation or follow this introvert on Apple, Spotify, or Army platform or five.