A Dermatologist's Perspective

As promised, I have been interviewing professionals and asking the questions that I think others want to know the answers to. I have had the opportunity to speak with Dr. Holly Sanders (my sister!) who is a dermatologist, or specialist in skin, hair, and nail disorders. I hope you find the questions compelling and the answers I found interesting and helpful. Here's to a healthier YOU!!



Me: How often should I visit my dermatologist?

Dr. Sanders: If you have a 1^st degree relative with melanoma (your sister, mother, father, brother) and/or have many moles ( more than 50) and/or atypical moles (more than 5 mm in size with some color variation), a baseline examination would be warranted. If you have a personal history of skin cancer, then in most cases you should see your dermatologist at least annually. Otherwise, you should seek the help of a dermatologist with any lesion concerning for skin cancer or for help with disorders affecting the skin, hair, or nails.

Me: What is the normal life cycle of a mole?

Dr. Sanders: In general, people develop new moles (nevi) into their early to mid 30’s. Moles can be flat, dome shaped, or a combination. Most people make a “signature nevus”, meaning that the moles on their skin tend to resemble one another. Sometimes moles that begin as flat and brown earlier in life will gradually become dome shaped and lose their color. Once a mole appears, it should be mostly stable with the exception that a gradual symmetric change over years is probably ok, especially if it is proportional to a change in body size. Any rapid and/or asymmetric change in a mole should prompt you to seek immediate attention.

Me: What are skin cancer warning signs?

Dr. Sanders: Most skin cancers arise on sun exposed skin. Any new lesion that is growing and develops symptoms such as persistent itching or easy bleeding should be evaluated as these are signs/symptoms of skin cancer. The “ABCDEs” are the warning signs of melanoma. Asymmetry (most normal moles are symmetric), Border irregularity (normal moles generally have well defined, smooth borders), Color variegation (melanomas may display multiple colors including brown, black, red, white, and blue), Diameter larger than 6 mm, and Evolution (possibly the most important sign is change over time).

Me: What qualifications should I search for in a dermatologist?

Dr. Sanders: For any physician, it is wise to make sure that they are board certified to practice their specialty. A dermatologist is a physician that has completed at least 3 years of residency in dermatology (the study of diseases affecting the skin, hair and nails) and then ideally is accredited by the American Board of Dermatology. Professional and personal referrals can be helpful when looking for a physician.

Me: What is the best sunscreen available and what SPF should I wear?

Dr. Sanders: You should use a broad spectrum sunscreen that blocks UVA and UVB. Sunscreens in the past primarily worked by blocking UVB and “SPF” refers to the UVB blocking ability of a sunscreen. Many newer products are 'broad spectrum'. Ingredients to look for to ensure that your sunscreen blocks UVA are avobenzone (parsol 1789) and/or titanium dioxide and zinc oxide. For most people that are capable of getting sunburned, I recommend at least an SPF of 30. It is best to apply 20-30 minutes before going out and then reapply often. It is also important to apply liberally- most people underdose their sunscreen. The recommended amount for an average adult is 1 ounce (30 mL or 1 shot glass).

Me: I have moderate adult acne. Are over the counter and mail order products okay? Which are the best?

Dr. Sanders: Over-the-counter products are often adequate for mild forms of acne. The mail order products available without a prescription are composed of widely available over-the-counter ingredients (i.e. benzoyl peroxide, salicylic acid) and tend to be expensive. Again, they are helpful for mild acne. Acne that is moderate to severe, especially if causing scarring, likely requires prescription treatment.

Me: I have heard of Mohs surgery. What is it and when should I request a dermatologist who is also a Mohs surgeon?

Dr. Sanders: Mohs surgery is a specialized type of skin cancer surgery named for its developer, Dr. Fred Mohs. Usually, a Mohs surgeon has completed an additional year of training. Mohs surgery is unique in that the physician is both the surgeon and the pathologist- they remove the skin cancer, process the specimen while you wait, and examine 100% of the margins. They can then precisely map any remaining cancer. In this way, they are able to provide the highest cure rate while sparing the most normal skin. This surgery has many indications, including large skin cancers located in functionally and/or aesthetically sensitive areas (i.e. the nose, the fingertip), and more aggressive subtypes of skin cancers. In general, your dermatologist will refer you to a Mohs surgeon when appropriate.

**I want to thank Holly for taking the time to answer all of these questions and hope that you have learned something today!!