• Do I have skin cancer on my foot?

    by Dr. Don Pelto
    on Mar 21st, 2018

Here is an interview with Dr. Camille Roberts, a dermatologist in Worcester, Massachusetts where we talk about common skin conditions including cancer of the of the foot.  

(Transcript Below)

Hi and welcome to healthy living
I'm Dr. Donald Pelto and I'm here with
Dr. Camille Roberts she is a
dermatologist in the area of Worcester
and we're here to talk about her
practice and some of her areas of
interest Camille thank you for joining
us here today thank you for having me
here so today we're going to talk
a little bit about kind of dermatology
and how you kind of got interested in
the profession of dermatology and what
is some of the training like and things
like that so tell me how did you get
interested in dermatology to start with
yeah you know I have to say initially
entering medical school I always knew I
wanted to be a physician but I loved
dermatology probably starting my second
year of medical school when I had a
lecture given by one of the professors
and I sat there and it just spoke to me
I love the visual aspect of it
I like the procedures that they do and
so it was something that I thought hey
this might be worth investigating
so I started by hanging out with the
residents which the hospital was right
near nearby and that developed my
interest I did a couple of rotations
towards the third and fourth year of my
medical school training I applied for
the residency and luckily got in I was
gonna say because they say dermatology
is one of the more challenging areas to
get into is that that's what it is now
is it yeah I guess that's what they say
but you know in life if there's
something you want you have to go after
it and that's how I felt
despite all the odds probably being
stacked against me I thought you know
what this is what I wanted I went after
it and it worked out for me so you know
encourage anyone if you know it's just a
life lesson if you're interested
something just go after it right and did
you have to do an intern year of
internal medicine yes good one year I
did one year of general medicine at
Washington Hospital Center okay
prior to my three years of Durham
training and Howard University Hospital
great and then during that time what
area did you have to kind of get an area
that you in you're interested in in or
do you focus on everything so we
basically focused on everything
primarily Medical dermatology so dealing
with things like skin cancer eczema
psoriasis acne but also we had exposure
to the surgical aspects of dermatology
removing skin cancers in moles and what
have you and then also the cosmetic side
of dermatology which was really just
starting back in the early you know the
graduated residency in 2003 so lasers
were just becoming very very popular so
you know we got the taste of pretty much
everything in what your current practice
like today so my current practice is
primarily medical dermatology we also do
a little cosmetic cosmetic procedures we
do Botox and some fillers but primarily
medical dirham like acne eczema
psoriasis a lot of skin cancer and so
it's varied and I see from babies all
the way to people in their 80s and 90s
and in between we do several neat
procedures so you know a typical day in
my office is not predictable and that's
the way I like it different every little
bit different every day yeah and who
typically how do you get your patients
do they are they referred from doctors
from referrals what's a how the audio
patients show up do they give a referral
that's always a question they give me so
yes usually most of our patients come
from other physicians primary care
doctors internist or family medicine
Doc's a lot of them also come from word
of mouth whether family through family
members that have seen me or friends I
get a you know right now I have a few
families that I see my families you know
people coming in saying hey you see my
entire family not to Robert so I like
that you know I have had patients see me
for the last 13 years since I've been in
the Worcester area yes most people do
need a referral although it depends on
the type of insurance that you have so
we encourage you to check with your
insurance carrier yeah that's um we
always say yes so are a lot of the
conditions that you see if they're if
their parents have it - the children
have the same condition or the different
conditions you know it varies it varies
I mean they're few you know fairly
genetic things they're few
genetic things in dermatology and a few
contagious things in dermatology but I
see you know when I see for example
husbands and wives they come in for skin
checks some parent can come in for
eczema and bring their child in for acne
so again it just speaks to the
unpredictability of dermatology we treat
it as we see it and you know it's it's
it can be it can vary so we really have
a good time in a lot of I remember when
we were in school we talked about
dermatological things can be a
masquerader
it may look like one thing in in if for
example if I'm seeing something I'll
think it's an eczema dermatitis and it
may be something totally different like
a fungus or something else like that and
they always kind of there are few things
that have similarities like eczema
psoriasis you mentioned or sometimes
ringworm which is actually tanea which
is a fungal infection can look like
eczema but you know they're clues and
the history in the treatment options
that patients have tried that tease it
out and also sometimes we can do
biopsies to confirm certain diagnosis so
that's always helpful yeah I'm finding
more and more patients these days
they're looking on the internet before
they come and see us sure and they look
in dr. Google and they look okay here's
what I have let's see if I can find
similar pictures and they may try some
treatments sure but in the end a lot of
times they don't get better maybe they
don't have a strong enough steroid that
they need or they don't have the proper
dosage of the medication I think they
tend to get on the right track sometimes
but sometimes they don't I want to talk
about we're gonna kind of focus now on a
special aspect that's really pertinent
to those that are listening here it's
gonna be about melanomas and different
types of skin cancers basal cell cancer
and that's what I like to focus on
because you mentioned to me that's one
of your areas of interest and kind of
passion that you have right how did you
get passionate about that why have you
had some experience with certain
patients any stories you have sure well
it's probably the most common thing we
see patients for the most common thing
coming in a lesion that has changed or
maybe is newer that their concern may be
skin cancer and I think it's good that
the awareness is out because as you know
most of skin cancer is related to sun
exposure okay so it's good to know that
you know people are wearing more
sunscreen and are more aware in general
their skin and their changing moles and
are coming in for that but we just feel
a ton of it on a daily basis and
probably on an average day in my office
I see at least five really yes yes okay
so let's kind of keep it simple for
those that are watching sure we're going
to first show a picture here of some
skin cancer sure what are people gonna
look for when they look at their skin
how do they know they need to see you
what are they looking for what is this
position so the first slide here shows a
basal cell skin cancer the three main
types but the basal cell skin cancer is
actually the most common type of skin
cancer there is there is a statistic
that maybe one in five Americans in
their lifetime will develop skin cancer
despite all the awareness and the
protection that we're using and this is
the most unrelated type of skin cancer
there is having said that while cancer
can be a scary word the basal type is
very slowly growing okay people can pick
up on us this you know skin cancer this
particular type by that the Perlina
Sauvage if you see here in this picture
it kind of has a pearly Sheen to it it's
more of a bump on the skin sometimes in
later stages it can crust over it may
come and go it's newer but because it
grows slowly it can kind of come and go
over several years before patients come
in
is it a uniform color or does it have
different kind of shades so usually a
pearly translucent type color to it in
the initial stages and as it progresses
down into the skin it can become eroded
so it can look like an open sore or a
pimple so anything that is not healing
or is newer or is coming and going um
can be a sign of basal cell skin cancer
where would you find this is it normally
on the face on Sun exposed areas mostly
good question and so we mentioned that
it's Sun it's unrelated so you expect to
see it on Sun exposed areas I find most
of my basal cell skin cancers actually
on the face probably secondarily second
would be on the arms extremities and
the chest their back okay here is that
maybe you go to the beach and you're not
wearing a shirt as we know you know you
should really wear sunscreen all day
long and even in the winter when you're
outside a lot of it is from incidental
sun exposure so people are for example
driving in the car after automotive have
their arm out the window not realized
that you know UV light that can lead to
sunscreen is coming in so basal cell
again while very common is easily cured
but it's locally destructive so you know
the per leanness the the white hue to it
a bump that's kind of coming and going
something that you think may be an acne
lesion okay but it's not going away any
of those things you need to come in for
so let's talk about let's say someone
does come in for something that you
think it might be this type of a cancer
what's the first step you would you look
at it and say okay we can remove that or
do you say what's biopsy at first you do
a shave or a punch or what type of
biopsy do you do on that yeah sure
usually for basal cells we can
clinically diagnosed most of these we do
like to confirm though with a shave
biopsy which we simply take a small
shave scraping of the lesion in the
office and send it to the lab for
confirmation not taking the whole thing
out just a little bit just a little
sample of it so biopsy and I usually
will tell patients prior to taking that
sample that you know my thought is that
it could be a basal cell skin cancer so
that they're prepared you know when I do
call within a week with the results and
we sometimes talk about the steps that
are necessary for treating that basal
cell and we can talk a little bit about
treatment so what's that let's say it
comes back they get the biopsy report
and you prepared them okay it's one of
the better types of cancer I guess you
could say to have how what's the next
step
so usually basal saw the treatment will
depend on location so if it's on the
face usually we refer to a plastic
surgeon or a Mohs surgeon so the plastic
surgeon will then go ahead and remove
the skin cancer it may take some normal
skin surrounding it to make sure that
everything is gone both on the wide
margin and also on the deeper margin
okay lesion and they do a very good job
with closure also it's
when people come in sooner than later
because and that will determine the size
of the scar okay so the smaller the
basal cell the smaller the faster for
more extensive basal cell skin cancers
or those like located on for example on
the nose an area where there's not a
whole lot of skin to move we do refer to
a Mohs surgeon and a mole surgeon or the
most procedure basically involves going
into someone who has been undergoing
undergone additional training okay a
dermatologist has undergone additional
training and they remove the skin cancer
in layers and then while you're waiting
they will look under the microscope to
see if all the margins are chlorophyll
the skin cancer is gone before they
close off yeah and we are sure people
that are listening they've they've heard
of they've had this type of a procedure
it's a very effective procedures yeah
pretty much the standard of care for
these types of areas absolutely know
with confidence say you have a larger
basal cell on the nose you know that hey
it's it's pretty much gone by the time
they close up as opposed to thinking
it's gone and unfortunately then the
pathology comes back that maybe there is
still some there then you have to go
back for additional treatment so that's
what I was gonna ask how often is it to
have basal cell in two different areas
or to have basal cell come back so if
you have mo surgery the risk of
recurrence in that you know same area is
very very very low most of the surgeons
if not all who remove skin cancer will
send it to the lab so the likelihood of
recurrence in that particular area is
low okay sometimes with very superficial
basal cell skin cancers because they're
more surface on higher on the skin we
may also prescribe a topical cream you
know to treat that area in that
circumstance sometimes the risk of
recurrence may be slightly higher okay
I'm been in surgical procedures it's one
of those creams that kind of exfoliates
the top layers of the skin you know
because the the skin cancer so so you
know early and just so superficial on
the skin a cream is all that you need
another procedure for superficial
Basil's Author Dr. Don Pelto

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