March 26, 2024 • 32 mins
One out of every five Americans will develop skin cancer in their lifetime.
Scary indeed, but the good news is that most cases are curable if they are diagnosed and treated early enough.
Joined by the esteemed Dr. Ariel Ostad, a Triple Board-Certified expert in Facial Cosmetic Surgery, Mohs Micrographic Skin Cancer Reconstructive Surgery, and Cosmetic Dermatology, we’ll explore the alarming facts surrounding skin cancer, the realities of MOHS surgery, and essential prevention tips to safeguard your skin health.
It's a conversation that's vital for everyone, regardless of age or skin type.
- Skin Cancer Facts:
- In the U.S., more than 9,500 people are diagnosed with skin cancer every day. More than two people die of the disease every hour.
- Early detection is crucial for successful treatment.
- Complete removal of cancerous cells is essential to prevent spread.
- Sun Safety Tips:
- Importance of practicing "safe sun" behaviors.
- Recommendations for effective sunscreen usage.
- Detection Tips:
- Annual skin checks by a dermatologist are vital.
- Dr. Ostad provides guidance on what to look for at home.
- MOHS Surgery:
- Dr. Ostad explains the procedure and its significance in skin cancer treatment.
- Insights into the recovery process post-surgery.
- Cosmetic Implications:
- Discussion on reconstructive options for facial skin cancer.
- Balancing medical necessity with cosmetic outcomes.
Understanding skin cancer risks, the role of MOHS surgery, and adopting preventative measures are crucial steps towards maintaining healthy skin.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
This is the Art Beauty podcast where weare always reaching for truth in beauty.
Remember, the people and the brands inthe show are not paying to be here.
So we get to ask them the tough questions
that we know you want answeredbecause you deserve to be informed
so you can make the best choicesfor yourself.
With that said, I'm Amber Milt and todaymy fabulous co-host is Dr.
(00:22):
Ariel Ostad He is a triple board certified
dermatologist who specializes in MOHS,
which is skin cancerremoval, surgery and cosmetic dermatology.
Welcome to the show.
Thank you so much for being here,Dr. Ostad.
Thank you so much, Amber for having me.
It's a pleasure to be here. I'm excited.
So, you know, spring is upon us.
(00:46):
And I feel like for peoplewho've been listening,
I've been doing this podcastnow almost five years.
Everybody has heard mealways say, wear your SPF,
wear your SPF,wear your SPF every day, even indoors.
I'm wearing it right now.
But I think that sometimes
realityand the truth can be the best teacher.
(01:07):
And I wanted to bring you on todayto kind of walk us through, you know,
some of the realities of what skin cancerremoval surgery.
Most surgery is like,you know, not necessarily to scare people
into wearing that SPF, but just to kind ofgive them insight into maybe,
you know, the realities of skin cancerand what that's like.
(01:29):
So before we even get into that, doyou have any statistics on how many people
deal with skin
cancer every year or diagnosed with that?
Absolutely.
So let's get started with statistics.
You know, generally it's it'svery well documented that one out of
every five Americans will developskin cancer in their lifetime.
(01:51):
And currently there is approximately 1.5million cases
of what we call non-melanoma skin cancerdiagnosed annually.
So that comprises basal cell carcinoma,squamous cell carcinoma, melanoma,
which is unfortunately the most dangerous,
the deadliest form of skin cancer, happensmuch less frequently.
(02:13):
But ironically, in young womenin their twenties and thirties,
it is the second most commoncause of cancer after breast cancer.
So it is something where unfortunatelyhas reached epidemic proportions,
partially from the factthat we are spending more time outdoors.
The sun is strongerdue to the depletion of the ozone layer.
(02:36):
So it's so important to wear
that sunscreen to really helpminimize your risk of skin cancer.
Now, and I don't meanto put you on the spot and it's
okay if you don't know this,but but how much of this,
you know, is is predetermined by genetics
that were pre destined to get skin cancerand how much of
it is really by by wearing the SPF
(02:58):
and behavioral minimizing sun exposureand that type of thing?
That's a great question.
So I would say to you, easily over80% of skin cancer is lifestyle related.
It's environmental, it's
our behavior, It'show we choose to take care of ourselves.
I would say to you less than 20%
is sort of predetermined by our genes.
(03:21):
Certainly people who are fairskinned, blond haired, blue eyes,
those are the individualsthat get a lot of skin cancer.
But I've seen skin cancer in darkskin, people in Mediterranean,
Latinos, African-Americans.
So the more
time we spend in the sun is unfortunatelygoing to lead to skin cancer.
Later, studies show that the majorityof skin cancers that happen in our forties
(03:44):
and beyond are due to sun exposure reallyin our childhood before the age of 18.
So our our lifestylechoices are so critical.
I mean, you know, and thinking back this,you know, to me to now in my mid-forties,
I, you know, I don't think people were as
(04:04):
as diligent about SPF back then,although I have to give my mother credit
because, you know,
we spent a lot of time outdoors and,you know, she would bring us in, you know,
at the hottest points of the day
and definitely made surethat we did wear sunscreen.
But I think now it's really moresomething that people incorporate
into their everyday routines.
(04:26):
You know,
that, if you don't mind,is that unfortunately,
you know, truly 20 years ago,there were not great sunscreens around.
And certainly,
if anything, our culturewas about really putting like suntan oil.
It was about really tryingto get that perfect tan.
I remember like, you know, growingup, people
would be sitting with their reflectorsand and
(04:47):
and basically suntan oiland trying to get that.
So a lot of it is like, you know,just I'm glad there's a cultural shift.
There's more awareness, lessabout the importance of sun avoidance.
If anything.
Back then we used to thinksun is so good for you.
Go into the sun and sun is an essential
aspect of vitamin D production,
(05:08):
so it is important to get some sun,but we tend to unfortunately overdo it.
So it's importantto wear your sunscreen again.
I mean, before we get into,you know, moles and what that entails
for those of us, Allison,
I like to go on vacation a couple timesa year, and I have to admit it.
(05:28):
I like to sit outside in the sun, however,
General, do it under an umbrellawith my wife, at least everywhere.
But like, is how does one balance that?
You know, like, I mean, I know some a girllike I can't give up the sun.
So is there kind of like a
I don't know, coming from an expertlike yourself,
is there any sort of like,good guidelines that we can follow?
(05:51):
Yeah. Yeah. Great, Great question.
Definitely.
I think it's important to validatethat Sun makes us feel better, right?
It is not only essential for vitaminD production, but psychologically
getting sun through our retina,through our eyes just allows us to,
you know, have good,
good feel of hormones, whether it'sserotonin, whether it's dopamine.
(06:13):
So I think it is.
We can't deny that.
And so but at the same time, what we cando is to sort of create some boundaries
about what sun safety is,is to try to really avoid midday sun,
really avoid the sun, let's say
from the hours of 12to 5, try to enjoy the sun before 12,
before the sun reaches its maximumheight in the in the atmosphere.
(06:35):
So go out into the beach, walk around.
I think it's important.
Still wear your sunscreen.
Get a sort of wide brimmed hat
and then try
to not be in the sunwhen the sun is at its strongest.
So avoid that midday and then you canresume back after, let's say, 5:00.
A lot of times we do a lot of water sportsand that's kind of a double hit
(06:56):
because not onlyare you getting the direct sun,
but you're also getting the sunthat reflects off the water.
So, so important to wear that sunshirt as well and reapply sunscreen.
Use the right sunscreen.
It doesn't mean thatyou have to be a hermit and hide inside.
You can go enjoy yourself, but try to situnder an umbrella and avoid that midday.
Yeah, I mean, everybody,you know, all summer
(07:17):
I will go to the beach, but my husbandand I both, like I said, I put
on that sunscreen and you have to do itif you're using a chemical sunscreen.
Friendly reminder here a half hourbefore you go out.
I still fight with my husbandbecause he'll be like,
I'll just put it onwhen I get to the beach.
And I'm like, no, wait.
And it's not working.
Unless you've got a good mineral onethat will work pretty much immediately.
(07:38):
The chemical onesdo take a little bit longer,
you know, and
you can you can agree or disagree with me,but for me,
the sunscreen,any sunscreen you will wear, is it
And we're say any sunscreenis a good thing, but whether it's chemical
or if you will wear the sunscreen,in my opinion, that's a good sunscreen.
Yeah, totally true to my patients.
(08:00):
The best sunscreenis the one that you like that you'll use
if you good for you and you like it.
So you'll use it.
If it's going to feel good on your skin,you're not going to use it. So.
So any sunscreen is better.
Ideally, as you said,
mineral based sunscreensare better than chemical based sunscreens.
They just filter out the sunbetter than the chemical sunscreens.
(08:22):
And then ideally, you want to use likesomething that has an SPF 30 and above.
Yeah.
So, you know what?
Again, we're going to get into sort of,
I think, something that's gonna be likea little bit more tough to handle.
Before we get there, though,do you have some sunscreens
as a professionalthat you absolutely love?
I like all sunscreensthat are mineral based.
(08:45):
Mineral based zinc and titanium.
I have some favorite ones like Eltamd.
These are really good one.
So I love that product.
So true.
The mineral based sunscreens are better.
There's some controversyabout chemical based sunscreens.
Not only you can develop allergy to them,
they're not as good filters of the sun.
(09:07):
And there are some studies in animalsthat show that
chemical sunscreenscan potentially be carcinogenic.
So I usually try to sway my patientsto stay away from chemical sunscreens.
Great, great advice.
Yeah, we've had Tyson here before,which I've talked about.
I love their products.
They've got a really great line,mineral line, very wearable products.
(09:28):
Great. That's a great brand. So,
okay, now
we have to get into the tough stuffbecause
I wonder if people don't quite understand.
Let's talk about, you know, skin cancer.
Most surgery.
How do people even determineif if they have
(09:48):
something that needs to be removed?
Great question.
I think
if someone's fair skinned,
blond, blue eyed, fairskin has a history of sunburns,
I think it's really prudentto get an annual skin exam,
allow the dermatologist to be
the one to check youand know what to look for.
(10:10):
I certainly my intention is neverto make my patients anxious.
But some commonalities amongstwhat skin cancer looks like
is anything that may look like a pimplethat bleeds,
that's been around,let's say, for 2 to 3 months.
It doesn't go away. It's scabs.
So anything that's kind of bleeding,
anything that may be like appearslike a pimple, it's isolated.
(10:32):
It's a single lesion. It it itches.
Or it's maybe a little tender or anythingthat's scaly and rough.
And then certainly any moldthat's changing in terms of its color,
it has different color
variations of brown, black,anything that has irregular borders.
Those are some
common general descriptionsof what skin cancer looks like.
(10:56):
But what I would say is if anything looksawkward and it's been persistent,
it's so important to go to a dermatologistbecause early
detection is really leads to a cure,especially with melanoma,
because when you catch these things early,they're easily treatable.
It's when someone assumesjust because there's a bump there
(11:16):
and they assume maybe it'sjust like a mole and it's getting bigger,
they ignore it.
And then that could be,unfortunately, a huge tragedy
where things that could have been treatedearly is sometimes maybe too late.
So I would say it's importantin your twenties
to start seeing a dermatologistjust for an annual exam.
Yes, I got some great advice once,which was
(11:39):
be in your birthday suitaround your birthday.
Right. So a great way to remember.
shoot, Dad, I do my annual examthis year is around your birthday.
Get into your birthday suit. Right.
Because you go in therepretty naked and get that full exam.
But it's something that stuck with meand I've never forgotten.
I'm go make sure to do that every yearright around my birthday time.
So. So let's
(12:00):
can you tell us a little bit about nowlet's were there we find something wrong?
What are some of the different phasesand stages and treatments
that are available?
Sure.
So the different treatment optionsis really
based on the type of skin cancersomeone has
(12:21):
many timespatients present with pre cancers
and that's I need to catch somethingbefore it becomes a skin cancer.
Pre-cancer is generally eithershow up as scaly rough spots or a mole.
That's changing the treatment for that.
If it's a pre-cancer
that's scaly and rough, we eitherkind of freeze it and burn it off
(12:43):
for older patients who have many of them,hundreds of them on their face.
There are certain topical chemotherapycreams that work very effectively.
There are
lasers or there is what we call special
energy based devices that work quitewell for that
for a pre-cancer up to a melanoma,
you ultimately have to just remove itconservatively stitches.
(13:06):
Once you have a skin cancer, it's
important to determinewhat type of skin cancer you have.
80 to 85% of skin cancers are what we callbasal cell carcinoma,
and those appear as little tiny pimples
that look like a little tiny bumpthat just doesn't go away.
It starts bleeding about 10 to 15%or what we call
(13:28):
squamous cell carcinoma,which are these worthy appearing lesions.
And then less than 2 to 3% are melanomas,which are these dark,
irregularly shaped moles.
The treatment options variesbased on the type of skin cancer.
So basal cell carcinoma eyesthat are on the body sometimes can be just
treated with burning and scraping down.
(13:50):
Sometimes you can justconservatively remove them.
Sometimes you can just put a cream on itand make it go away,
although that's the least common wayof treating it
with a squamous cell carcinoma,because it has the potential
to metastasize,it has the potential to travel.
You certainly want to be morea little bit more aggressive.
So you want to get what we callmargin controlled, meaning that
(14:12):
you tend to remove it and examineit under the microscope
to evaluate the edges, The bottom,that's what we call the margins
to make sure that the canceris completely removed
so we don't have to worry about itcoming back.
And certainly with melanoma,the treatment for
the treatment is based on how deep it is.
(14:32):
If you catch melanoma early, you can justexcise it with adequate healthy tissue.
If a melanoma is more advancedand unfortunately either
treatmentbecomes much more complicated with
not only surgery but having lymph nodesremoved and things like that.
So it's really the the important thingbecomes to catch these things early
because then the treatment becomesjust conservative removal.
(14:55):
And that's where most surgery comes in,because it's the most
ideal, most cancer of any wayof treating these skin cancers.
Now, I do want to give a little PSA here.
When I started getting I've been goingregularly to a dermatologist,
but I think it was in my mid-twentieswhen I started going
and at the timeI had to have a number of biopsies.
(15:18):
Funny enough, all down my back.
And one of the thingsthat I was talking about,
my dermatologist, he was like,Let's see, when you try to put on your own
suntan lotion, like, what's the one areain the middle of your back?
You can't reach?
You're having some issues here.
But one of them was,I remember, pretty deep.
Luckily, nothing was positive.
But I do have now like a scarbecause they did have to take out like a
(15:41):
a good, decent chunk.
You know, for those of uswho are listening, who are still like
I had two friendswho had to have them removed on the face.
And that can be problematic, right?
I mean, just from a cosmetic perspective.
Absolutely.
So, unfortunately, the majority of basalcell carcinoma happen on the face.
(16:05):
That's an area that's constantlyexposed to the sun.
So you get that chronic sun exposure.
And when it comesto skin cancers on the face,
you want to make sure that that canceris completely removed.
So it doesn't come back.
There are a lot of vital structureson the face,
whether it be nerves,muscle, arteries, veins,
and you don't want to poorlytreat that skin cancer.
(16:29):
So the goal becomes, number one,get the cancer out completely.
Number two, cosmetically restrict
that area, reconstruct that areaso that there's minimal scarring.
And the ideal treatment optionfor skin cancers
on the face is most micro graphic surgery.
Okay.
So what is that?
Can you can you tell us a little bitabout that? Sure.
(16:51):
So most micrographic surgery is a treatment
that was developed back in the sixtiesby Doctor Frederick Moss out in Wisconsin.
So it's named after hisit really revolutionized the treatment
of skin cancer because prior to the adventof most surgery,
majority of cancers were patientswould be admitted into the hospital
under anesthesia.
(17:11):
A big chunk of skin was removed,
which would ultimately leave peoplewith a lot of deformity.
He came up with the ideaof basically ultimately
under local anesthesia,conservatively removing that cancer.
The technique has been modifiedsince he basically developed it.
But what happens now is in the office,we numb the area locally.
(17:32):
The patient's fully awake.
We remove that skin cancer withconservative remove healthy looking skin.
The goal is to preserve as much normal
skin as possible while the patient
is relaxed and sitting in the exam roomwith a bandage over that area.
The skin is basically evaluatedunder the microscope
(17:53):
to check the margins,check the edges, check the bottom.
And in the eventthat the cancer is not removed,
we can pinpoint exactly wherein which portion
of that skin that was removedstill has the cancer in it,
whether it's at the base,whether it's at one corner.
If you imagine a clock with the topbeing 12, the bottom being six,
(18:16):
we can map the tumor to
the perimeterof where it's still remaining.
And if it's still positive, we go back.
The patient is nonwe remove a little bit more
and we repeat thatuntil the cancer is removed.
So it's a staged stepwise fashionof removing the cancer.
It allows us to be so preciseto curators, 99% So we get the cancer out
(18:39):
and then at that point in this,we have a wound
we call a defect, the woundthat is as narrow as small as it can be.
So it therefore leads to much bettercosmetic outcome.
And then, you know, I'mjust imagining, for example, let's say
like I had a girlfriendwho had one on her cheek,
there is a little bitmore fat there to pull together.
(18:59):
What about on the tip of the noseor maybe in the forehead?
What do we do for those areas?
Cosmetically?
Yeah, there are, you know, knock on wood,
and more importantly,the cancer has been removed.
Sure.
So once the cancer is removed,the next step
is this cosmetic reconstructionto put the skin back together,
(19:22):
whether it's the nose, the
as you said, the eyebrow, the forehead,the cheek to certain areas like the cheek
where there's laxity, you can just pullthe skin together and create a fine line.
There are certain areaswhere it becomes challenging
due to the lack of loose skin,whether it's the note led to the forehead.
In those situations,we rely on more advanced
(19:42):
reconstructive techniques,whether what we call flaps or grafts.
Yeah,
generally we want to utilize what we call
a flap is where we take advantageof the loose skin
adjacent to that woundand free up the skin
by making that same incisionfrom the wound away from that area
(20:06):
into an areathat's loose skin and freeing up the skin
so we can mobilize itbetter and bring it together.
So flaps are like a workhorsein my practice
because majority of skin cancersthat get referred to me are on the nose.
And so it is so important to be ableto have an understanding
of the anatomyand knowing what type of flap to use
(20:30):
in the last resort
when a wound is so bigthat you just cannot do a flap,
then you do what's called the skin graft,and that's taking skin from another
part of the body, whether it be behindthe ear, along the collarbone, collarbone
or in the thigh area, and transferand get into that area.
And that happens, unfortunately, when whenthe skin cancer is so large and so wide.
(20:56):
Another reasonto try to catch these things super early
to, you know, just cosmetically,it leads to such better outcomes.
Absolutely.
You know, as I'm
sort of thinking this throughand I hope everybody listening at home,
you know,that's why I wanted to do this podcast
today, not to necessarily scare people,but but to just remind you
that by getting these checkupsby by practicing some sun
(21:18):
safety e
by catching these thingsearly, like you said,
there are better outcomes out there.
You know, are there
is there any other advice that you havefor people?
You know, I don't want to I don't wantthis to be sort of like a warning,
but but really more focusedon the realities of things
(21:41):
we can be doing, thingsthat we should be doing.
I mean, I guess we mentioned sun safety,getting checkups.
If we think there's
something wrong,should we just immediately call a doctor?
I certainly
don't want to encourage peopleto live in anxiety.
That's not a good link.
So I don't advise that at all.
(22:02):
But what I would sayis just have mindful illness to be mindful
that if a particular growth on your skin
is just getting biggerand it's been there for 2 to 3 months
and it doesn't look quite like a pimple,and maybe
it's beginning to bleed or scabor it's changing color
(22:22):
and a couple of months has goneby, go see your doctor.
So and no reason to get overly anxious.
Just be prudentand just go get it checked.
So I think just making a good decision,
I and I don't want
our listeners, viewers to thinkthat there's this just a small window
(22:42):
of opportunity beyond which,God forbid, people are going to die.
That's not the case at all.
We run into these horrific,horrible stories of our patients die
of skin cancer because it was not treatedfor, let's say, a year or two.
So it's it's not likethere's just a small window.
That's not the case at all.
But that'swhy ideally get a skin exam once a year.
(23:04):
If you see something after 2 to 3 months,just go see your doctor.
And think who you are.
You actually answered the question
I was going to ask next, which is like,how long is that window generally?
Right?I mean, is it something that's fast?
But I gotcha.
You know, so certainly
I sure for every person and everybody,it's going to be a little bit different.
But it's not like
if you don't do this today, tomorrow,
(23:27):
it could be deadly, butyou certainly don't want to wait too long.
You know, in talkinggoing back to these modes
and with some of these things,whether it is a little bit
more conservative or somethingthat requires a skin graft,
what does that recovery really look like
when you see that in patients?
The recovery is is
(23:48):
you know, it varies based on one'sperception, to be honest with you.
Some people
may see it as
significant, but it really dependsultimately on the size of the skin cancer.
But for a majority of people,the recovery is not terrible.
There's generally some bruising,so there's generally some swelling.
(24:09):
If we do, let's say, surgery on the nose,generally people
tend to get a little swellingon their eyelids in their upper cheeks,
but there is generally some swelling,
there is some tenderness,but it's minimal.
We always
go through the preoperativepre-operative plan with our patients
to minimize bruising and swellingso we make them aware ahead of time.
(24:32):
We make sure they stay away from bloodthinners that can contribute to bruising.
We talk about using Arnica.
We talk about using the appropriatehomeopathic stuff to give them
sort of the least amount of recovery.
But it's not terrible. It'snot excruciating pain.
But a lot of patients truly dogo back to work after a couple of days.
(24:54):
Again, it reallydepends on the size of the skin cancer.
But for the most part, there's anticipatesome swelling, some bruising.
If it's, for example, under lip,
their lip is going to get swollenif it's, you know, near their eyelid
that their eye may somewhatnarrow and close, shut a bit.
But usually that goes away in like 2 to 3days.
Bruising takes about a week.
(25:15):
Swelling can take about a weekor two certain times.
We do flaps where it's muchmore complicated for it to look its best.
It is going to take about 3 to 6 months.
So I always tell my patients, no mattertruly what, where we're doing the surgery
and what kind of whether it'ssmall or not, your ultimate results
(25:35):
take really about six months, even longer,because it takes that long for your body
to go through a healing periodand for the inflammation to go away for
for the stitchesbelow the skin to dissolve.
So it's about really just being patient.
You know,
if anybody has come to this podcastby way of like Googling
or maybe they found outthat they had something
(25:57):
in a tricky area, like the nose,like the cheek, like the lip.
And I do know
so much of surgery is dependenton the surgeons.
I'm not asking you to make a buy.
I'm asking youto make a blanket statement.
But if somebody has had
that in their freaking out,wow, we're going to have this giant scar.
Is it possible to have, you know,
(26:20):
sort of skin cancer removed?
And is the technology good enoughif you're with a good enough surgeon
like yourself for it to be somethingthat is going to be unnoticeable?
Yeah, without a doubt.
I think if you really like you said, it'sso important that it's so important
to have a surgeon who has experience,understands the anatomy,
(26:40):
is quite patient in their
meticulousnessand is not rushing and has enough empathy
to understand this is someone's faceand we want to really do what we can.
So it takes all those things.
But ultimately, without a doubt, I'mso glad you brought it up.
The message that I think it's importantto pass on is that most surgery or skin
cancer surgery is not going to leave youwith a deformity,
(27:03):
that the scarring is minimal,that ultimately
there are so many people who have had skincancer surgery and they look great.
You can't tell their where the scar is.
They almost have to the patientalmost has to point it out to you.
So what the patient has control overis trying to see a dermatologist
(27:24):
as soon as you know, with an annual exam
to minimize the size and then ultimatelychoosing the right surgeon
who really understands the artistry
and the and the proper way of stitching.
And it's remarkablehow we do these surgeries.
And patients are always so gratefulthat six months later they're like, Doc,
I was so worried,but I can't see anything.
(27:45):
I'm so happy.
You're always if you look closely,you'll see something.
But for the person standing,a sort of average
distance of 2 to 3 feet, you almost haveto point it out to someone.
Thank you.
I'm sure there's a lot of people who aregoing to take a lot of solace in that.
You know,when you when you hear something,
I'm sure as scary as cancer,there's so many emotions that go
(28:07):
along with that actually, on that note,do you have any advice for anybody
who who has been diagnosedwith some varying form of of skin cancer.
Advicein terms of how to manage emotions or.
Yeah. Yeah.
So I think it is so important that
(28:29):
I try to put them at ease to knowthat they're not alone,
number one, that it happensunfortunately, to so many people
and everybody makes it throughand that they're going to make it through,
that they're not going to have deformity,
that everything is going to turnout fine just to be patient
and trust their intuition.
And in terms of their interaction
(28:51):
with their surgeon, with their doctor,so that they feel that connection,
because I think that connectionis really important for the outcome.
Ultimately. And just to know that
with proper patients
and just listening to the doctor,
things will turn out fine
and that all that uncertaintyand negativity
(29:14):
and fear will eventually subside.
You know, I know that you are
based here in New York City,as am I for people.
We've got listeners around the world.
If if they are looking for a specialist
in Mo's, where are thereany places that we can go for information?
Is it just sort of seeking outindividual doctors?
(29:37):
Is there any advice for somebodywho might not be lucky enough
to be here in New York Cityand get to come see you?
That's great.
Absolutely.
I would say the sort of premier resource
for most surgery is what we callthe American College of Most surgery,
AC, EMS, the American College of
most surgeryhas so much information, videos
(30:00):
about what skin cancer is,how most surgery is performed,
who are themost surgeons across the United States,
within each state,within each district of each state.
So there's
just so much information therewhere you can find the most surgeon.
The other thing that I would sayis it's important that also
(30:22):
your most surgeonis going to do a great job
of removing the cancerand not every most surgeon
is a reconstructive surgeryin terms of stitching.
So at that point,you want to have an open conversation
with your most surgeon about who'sgoing to be doing the stitches.
So most surgeons will refer you out,and some most surgeons will actually,
(30:43):
with experience, will immediatelydo the stitching right there,
which is certainly much more practicalfor the patient.
Well, great advice.
I mean, I want to thank you so much, Dr.
Ostad You've given us so much information.
And of course, if people want to find you,if they're here in New York City,
what's the best way to find you?
Thank you so much.
(31:04):
So I practice on the Upper East Side.
I am on Lexington Avenue and 67th Street.
I've been in practice for 27 years. I
teach at NYU Langone Health.
I teach this surgeryto two young doctors in training.
But I'm here in the Upper East Side,and I'm just so grateful
(31:25):
for this opportunityto to talk to you about this.
I'm so grateful to, you know, I
one of the reasons that I startedthis podcast was to provide information.
And again, for everybody listening,this isn't to scare you.
I don't want to give you anxiety,but you've heard it from doctors,
from experts.
Skin cancer can be one of the most deadly,if not caught.
But it's also one of the most preventableand if caught early, Treatable.
(31:48):
Yeah. Is that correct?
So make sure you're going out there.
Make sure you're wearing your sunscreen,avoiding the sun from 12 to 5,
and then, of course,getting those annual checkups.
And if you think something's wrong,I would say
you got to be your best medical advocate.
Make sure to get it checked.
Thank you so much for being on with ustoday, Dr.
Ostad A really appreciateall the information that you've given us.
(32:11):
Thank you so much, Amber.Thank you for having me.
I think you're wonderful resource and Ithink you're doing incredible things. And
thank you.
Well, if you are
listening at home or have any questionsyou want me to pass on to Dr.
Ostad or his team,I'm always happy to do that.
You can email me at Hello at artbeauty podcast dot com.
You can find us on Facebook, Instagramand YouTube @ArtBeautyPodcastand
(32:35):
we will make sure to put Dr.
Austin's information in the show notes.
So don't even worry about that.
And of course,we will see you next Tuesday, hopefully
being a little bit more sun safe by
(32:55):
right.
This is the Art Beauty podcast where weare always reaching for truth in beauty.
Remember, the people and the brands inthe show are not paying to be here.
So we get to ask them the tough questions
that we know you want answeredbecause you deserve to be informed
so you can make the best choicesfor yourself.
With that said, I'm Amber Milt and todaymy fabulous co-host is Dr.
(00:22):
Ariel Ostad He is a triple board certified
dermatologist who specializes in MOHS,
which is skin cancerremoval, surgery and cosmetic dermatology.
Welcome to the show.
Thank you so much for being here,Dr. Ostad.
Thank you so much, Amber for having me.
It's a pleasure to be here. I'm excited.
So, you know, spring is upon us.
(00:46):
And I feel like for peoplewho've been listening,
I've been doing this podcastnow almost five years.
Everybody has heard mealways say, wear your SPF,
wear your SPF,wear your SPF every day, even indoors.
I'm wearing it right now.
But I think that sometimes
realityand the truth can be the best teacher.
(01:07):
And I wanted to bring you on todayto kind of walk us through, you know,
some of the realities of what skin cancerremoval surgery.
Most surgery is like,you know, not necessarily to scare people
into wearing that SPF, but just to kind ofgive them insight into maybe,
you know, the realities of skin cancerand what that's like.
(01:29):
So before we even get into that, doyou have any statistics on how many people
deal with skin
cancer every year or diagnosed with that?
Absolutely.
So let's get started with statistics.
You know, generally it's it'svery well documented that one out of
every five Americans will developskin cancer in their lifetime.
(01:51):
And currently there is approximately 1.5million cases
of what we call non-melanoma skin cancerdiagnosed annually.
So that comprises basal cell carcinoma,squamous cell carcinoma, melanoma,
which is unfortunately the most dangerous,
the deadliest form of skin cancer, happensmuch less frequently.
(02:13):
But ironically, in young womenin their twenties and thirties,
it is the second most commoncause of cancer after breast cancer.
So it is something where unfortunatelyhas reached epidemic proportions,
partially from the factthat we are spending more time outdoors.
The sun is strongerdue to the depletion of the ozone layer.
(02:36):
So it's so important to wear
that sunscreen to really helpminimize your risk of skin cancer.
Now, and I don't meanto put you on the spot and it's
okay if you don't know this,but but how much of this,
you know, is is predetermined by genetics
that were pre destined to get skin cancerand how much of
it is really by by wearing the SPF
(02:58):
and behavioral minimizing sun exposureand that type of thing?
That's a great question.
So I would say to you, easily over80% of skin cancer is lifestyle related.
It's environmental, it's
our behavior, It'show we choose to take care of ourselves.
I would say to you less than 20%
is sort of predetermined by our genes.
(03:21):
Certainly people who are fairskinned, blond haired, blue eyes,
those are the individualsthat get a lot of skin cancer.
But I've seen skin cancer in darkskin, people in Mediterranean,
Latinos, African-Americans.
So the more
time we spend in the sun is unfortunatelygoing to lead to skin cancer.
Later, studies show that the majorityof skin cancers that happen in our forties
(03:44):
and beyond are due to sun exposure reallyin our childhood before the age of 18.
So our our lifestylechoices are so critical.
I mean, you know, and thinking back this,you know, to me to now in my mid-forties,
I, you know, I don't think people were as
(04:04):
as diligent about SPF back then,although I have to give my mother credit
because, you know,
we spent a lot of time outdoors and,you know, she would bring us in, you know,
at the hottest points of the day
and definitely made surethat we did wear sunscreen.
But I think now it's really moresomething that people incorporate
into their everyday routines.
(04:26):
You know,
that, if you don't mind,is that unfortunately,
you know, truly 20 years ago,there were not great sunscreens around.
And certainly,
if anything, our culturewas about really putting like suntan oil.
It was about really tryingto get that perfect tan.
I remember like, you know, growingup, people
would be sitting with their reflectorsand and
(04:47):
and basically suntan oiland trying to get that.
So a lot of it is like, you know,just I'm glad there's a cultural shift.
There's more awareness, lessabout the importance of sun avoidance.
If anything.
Back then we used to thinksun is so good for you.
Go into the sun and sun is an essential
aspect of vitamin D production,
(05:08):
so it is important to get some sun,but we tend to unfortunately overdo it.
So it's importantto wear your sunscreen again.
I mean, before we get into,you know, moles and what that entails
for those of us, Allison,
I like to go on vacation a couple timesa year, and I have to admit it.
(05:28):
I like to sit outside in the sun, however,
General, do it under an umbrellawith my wife, at least everywhere.
But like, is how does one balance that?
You know, like, I mean, I know some a girllike I can't give up the sun.
So is there kind of like a
I don't know, coming from an expertlike yourself,
is there any sort of like,good guidelines that we can follow?
(05:51):
Yeah. Yeah. Great, Great question.
Definitely.
I think it's important to validatethat Sun makes us feel better, right?
It is not only essential for vitaminD production, but psychologically
getting sun through our retina,through our eyes just allows us to,
you know, have good,
good feel of hormones, whether it'sserotonin, whether it's dopamine.
(06:13):
So I think it is.
We can't deny that.
And so but at the same time, what we cando is to sort of create some boundaries
about what sun safety is,is to try to really avoid midday sun,
really avoid the sun, let's say
from the hours of 12to 5, try to enjoy the sun before 12,
before the sun reaches its maximumheight in the in the atmosphere.
(06:35):
So go out into the beach, walk around.
I think it's important.
Still wear your sunscreen.
Get a sort of wide brimmed hat
and then try
to not be in the sunwhen the sun is at its strongest.
So avoid that midday and then you canresume back after, let's say, 5:00.
A lot of times we do a lot of water sportsand that's kind of a double hit
(06:56):
because not onlyare you getting the direct sun,
but you're also getting the sunthat reflects off the water.
So, so important to wear that sunshirt as well and reapply sunscreen.
Use the right sunscreen.
It doesn't mean thatyou have to be a hermit and hide inside.
You can go enjoy yourself, but try to situnder an umbrella and avoid that midday.
Yeah, I mean, everybody,you know, all summer
(07:17):
I will go to the beach, but my husbandand I both, like I said, I put
on that sunscreen and you have to do itif you're using a chemical sunscreen.
Friendly reminder here a half hourbefore you go out.
I still fight with my husbandbecause he'll be like,
I'll just put it onwhen I get to the beach.
And I'm like, no, wait.
And it's not working.
Unless you've got a good mineral onethat will work pretty much immediately.
(07:38):
The chemical onesdo take a little bit longer,
you know, and
you can you can agree or disagree with me,but for me,
the sunscreen,any sunscreen you will wear, is it
And we're say any sunscreenis a good thing, but whether it's chemical
or if you will wear the sunscreen,in my opinion, that's a good sunscreen.
Yeah, totally true to my patients.
(08:00):
The best sunscreenis the one that you like that you'll use
if you good for you and you like it.
So you'll use it.
If it's going to feel good on your skin,you're not going to use it. So.
So any sunscreen is better.
Ideally, as you said,
mineral based sunscreensare better than chemical based sunscreens.
They just filter out the sunbetter than the chemical sunscreens.
(08:22):
And then ideally, you want to use likesomething that has an SPF 30 and above.
Yeah.
So, you know what?
Again, we're going to get into sort of,
I think, something that's gonna be likea little bit more tough to handle.
Before we get there, though,do you have some sunscreens
as a professionalthat you absolutely love?
I like all sunscreensthat are mineral based.
(08:45):
Mineral based zinc and titanium.
I have some favorite ones like Eltamd.
These are really good one.
So I love that product.
So true.
The mineral based sunscreens are better.
There's some controversyabout chemical based sunscreens.
Not only you can develop allergy to them,
they're not as good filters of the sun.
(09:07):
And there are some studies in animalsthat show that
chemical sunscreenscan potentially be carcinogenic.
So I usually try to sway my patientsto stay away from chemical sunscreens.
Great, great advice.
Yeah, we've had Tyson here before,which I've talked about.
I love their products.
They've got a really great line,mineral line, very wearable products.
(09:28):
Great. That's a great brand. So,
okay, now
we have to get into the tough stuffbecause
I wonder if people don't quite understand.
Let's talk about, you know, skin cancer.
Most surgery.
How do people even determineif if they have
(09:48):
something that needs to be removed?
Great question.
I think
if someone's fair skinned,
blond, blue eyed, fairskin has a history of sunburns,
I think it's really prudentto get an annual skin exam,
allow the dermatologist to be
the one to check youand know what to look for.
(10:10):
I certainly my intention is neverto make my patients anxious.
But some commonalities amongstwhat skin cancer looks like
is anything that may look like a pimplethat bleeds,
that's been around,let's say, for 2 to 3 months.
It doesn't go away. It's scabs.
So anything that's kind of bleeding,
anything that may be like appearslike a pimple, it's isolated.
(10:32):
It's a single lesion. It it itches.
Or it's maybe a little tender or anythingthat's scaly and rough.
And then certainly any moldthat's changing in terms of its color,
it has different color
variations of brown, black,anything that has irregular borders.
Those are some
common general descriptionsof what skin cancer looks like.
(10:56):
But what I would say is if anything looksawkward and it's been persistent,
it's so important to go to a dermatologistbecause early
detection is really leads to a cure,especially with melanoma,
because when you catch these things early,they're easily treatable.
It's when someone assumesjust because there's a bump there
(11:16):
and they assume maybe it'sjust like a mole and it's getting bigger,
they ignore it.
And then that could be,unfortunately, a huge tragedy
where things that could have been treatedearly is sometimes maybe too late.
So I would say it's importantin your twenties
to start seeing a dermatologistjust for an annual exam.
Yes, I got some great advice once,which was
(11:39):
be in your birthday suitaround your birthday.
Right. So a great way to remember.
shoot, Dad, I do my annual examthis year is around your birthday.
Get into your birthday suit. Right.
Because you go in therepretty naked and get that full exam.
But it's something that stuck with meand I've never forgotten.
I'm go make sure to do that every yearright around my birthday time.
So. So let's
(12:00):
can you tell us a little bit about nowlet's were there we find something wrong?
What are some of the different phasesand stages and treatments
that are available?
Sure.
So the different treatment optionsis really
based on the type of skin cancersomeone has
(12:21):
many timespatients present with pre cancers
and that's I need to catch somethingbefore it becomes a skin cancer.
Pre-cancer is generally eithershow up as scaly rough spots or a mole.
That's changing the treatment for that.
If it's a pre-cancer
that's scaly and rough, we eitherkind of freeze it and burn it off
(12:43):
for older patients who have many of them,hundreds of them on their face.
There are certain topical chemotherapycreams that work very effectively.
There are
lasers or there is what we call special
energy based devices that work quitewell for that
for a pre-cancer up to a melanoma,
you ultimately have to just remove itconservatively stitches.
(13:06):
Once you have a skin cancer, it's
important to determinewhat type of skin cancer you have.
80 to 85% of skin cancers are what we callbasal cell carcinoma,
and those appear as little tiny pimples
that look like a little tiny bumpthat just doesn't go away.
It starts bleeding about 10 to 15%or what we call
(13:28):
squamous cell carcinoma,which are these worthy appearing lesions.
And then less than 2 to 3% are melanomas,which are these dark,
irregularly shaped moles.
The treatment options variesbased on the type of skin cancer.
So basal cell carcinoma eyesthat are on the body sometimes can be just
treated with burning and scraping down.
(13:50):
Sometimes you can justconservatively remove them.
Sometimes you can just put a cream on itand make it go away,
although that's the least common wayof treating it
with a squamous cell carcinoma,because it has the potential
to metastasize,it has the potential to travel.
You certainly want to be morea little bit more aggressive.
So you want to get what we callmargin controlled, meaning that
(14:12):
you tend to remove it and examineit under the microscope
to evaluate the edges, The bottom,that's what we call the margins
to make sure that the canceris completely removed
so we don't have to worry about itcoming back.
And certainly with melanoma,the treatment for
the treatment is based on how deep it is.
(14:32):
If you catch melanoma early, you can justexcise it with adequate healthy tissue.
If a melanoma is more advancedand unfortunately either
treatmentbecomes much more complicated with
not only surgery but having lymph nodesremoved and things like that.
So it's really the the important thingbecomes to catch these things early
because then the treatment becomesjust conservative removal.
(14:55):
And that's where most surgery comes in,because it's the most
ideal, most cancer of any wayof treating these skin cancers.
Now, I do want to give a little PSA here.
When I started getting I've been goingregularly to a dermatologist,
but I think it was in my mid-twentieswhen I started going
and at the timeI had to have a number of biopsies.
(15:18):
Funny enough, all down my back.
And one of the thingsthat I was talking about,
my dermatologist, he was like,Let's see, when you try to put on your own
suntan lotion, like, what's the one areain the middle of your back?
You can't reach?
You're having some issues here.
But one of them was,I remember, pretty deep.
Luckily, nothing was positive.
But I do have now like a scarbecause they did have to take out like a
(15:41):
a good, decent chunk.
You know, for those of uswho are listening, who are still like
I had two friendswho had to have them removed on the face.
And that can be problematic, right?
I mean, just from a cosmetic perspective.
Absolutely.
So, unfortunately, the majority of basalcell carcinoma happen on the face.
(16:05):
That's an area that's constantlyexposed to the sun.
So you get that chronic sun exposure.
And when it comesto skin cancers on the face,
you want to make sure that that canceris completely removed.
So it doesn't come back.
There are a lot of vital structureson the face,
whether it be nerves,muscle, arteries, veins,
and you don't want to poorlytreat that skin cancer.
(16:29):
So the goal becomes, number one,get the cancer out completely.
Number two, cosmetically restrict
that area, reconstruct that areaso that there's minimal scarring.
And the ideal treatment optionfor skin cancers
on the face is most micro graphic surgery.
Okay.
So what is that?
Can you can you tell us a little bitabout that? Sure.
(16:51):
So most micrographic surgery is a treatment
that was developed back in the sixtiesby Doctor Frederick Moss out in Wisconsin.
So it's named after hisit really revolutionized the treatment
of skin cancer because prior to the adventof most surgery,
majority of cancers were patientswould be admitted into the hospital
under anesthesia.
(17:11):
A big chunk of skin was removed,
which would ultimately leave peoplewith a lot of deformity.
He came up with the ideaof basically ultimately
under local anesthesia,conservatively removing that cancer.
The technique has been modifiedsince he basically developed it.
But what happens now is in the office,we numb the area locally.
(17:32):
The patient's fully awake.
We remove that skin cancer withconservative remove healthy looking skin.
The goal is to preserve as much normal
skin as possible while the patient
is relaxed and sitting in the exam roomwith a bandage over that area.
The skin is basically evaluatedunder the microscope
(17:53):
to check the margins,check the edges, check the bottom.
And in the eventthat the cancer is not removed,
we can pinpoint exactly wherein which portion
of that skin that was removedstill has the cancer in it,
whether it's at the base,whether it's at one corner.
If you imagine a clock with the topbeing 12, the bottom being six,
(18:16):
we can map the tumor to
the perimeterof where it's still remaining.
And if it's still positive, we go back.
The patient is nonwe remove a little bit more
and we repeat thatuntil the cancer is removed.
So it's a staged stepwise fashionof removing the cancer.
It allows us to be so preciseto curators, 99% So we get the cancer out
(18:39):
and then at that point in this,we have a wound
we call a defect, the woundthat is as narrow as small as it can be.
So it therefore leads to much bettercosmetic outcome.
And then, you know, I'mjust imagining, for example, let's say
like I had a girlfriendwho had one on her cheek,
there is a little bitmore fat there to pull together.
(18:59):
What about on the tip of the noseor maybe in the forehead?
What do we do for those areas?
Cosmetically?
Yeah, there are, you know, knock on wood,
and more importantly,the cancer has been removed.
Sure.
So once the cancer is removed,the next step
is this cosmetic reconstructionto put the skin back together,
(19:22):
whether it's the nose, the
as you said, the eyebrow, the forehead,the cheek to certain areas like the cheek
where there's laxity, you can just pullthe skin together and create a fine line.
There are certain areaswhere it becomes challenging
due to the lack of loose skin,whether it's the note led to the forehead.
In those situations,we rely on more advanced
(19:42):
reconstructive techniques,whether what we call flaps or grafts.
Yeah,
generally we want to utilize what we call
a flap is where we take advantageof the loose skin
adjacent to that woundand free up the skin
by making that same incisionfrom the wound away from that area
(20:06):
into an areathat's loose skin and freeing up the skin
so we can mobilize itbetter and bring it together.
So flaps are like a workhorsein my practice
because majority of skin cancersthat get referred to me are on the nose.
And so it is so important to be ableto have an understanding
of the anatomyand knowing what type of flap to use
(20:30):
in the last resort
when a wound is so bigthat you just cannot do a flap,
then you do what's called the skin graft,and that's taking skin from another
part of the body, whether it be behindthe ear, along the collarbone, collarbone
or in the thigh area, and transferand get into that area.
And that happens, unfortunately, when whenthe skin cancer is so large and so wide.
(20:56):
Another reasonto try to catch these things super early
to, you know, just cosmetically,it leads to such better outcomes.
Absolutely.
You know, as I'm
sort of thinking this throughand I hope everybody listening at home,
you know,that's why I wanted to do this podcast
today, not to necessarily scare people,but but to just remind you
that by getting these checkupsby by practicing some sun
(21:18):
safety e
by catching these thingsearly, like you said,
there are better outcomes out there.
You know, are there
is there any other advice that you havefor people?
You know, I don't want to I don't wantthis to be sort of like a warning,
but but really more focusedon the realities of things
(21:41):
we can be doing, thingsthat we should be doing.
I mean, I guess we mentioned sun safety,getting checkups.
If we think there's
something wrong,should we just immediately call a doctor?
I certainly
don't want to encourage peopleto live in anxiety.
That's not a good link.
So I don't advise that at all.
(22:02):
But what I would sayis just have mindful illness to be mindful
that if a particular growth on your skin
is just getting biggerand it's been there for 2 to 3 months
and it doesn't look quite like a pimple,and maybe
it's beginning to bleed or scabor it's changing color
(22:22):
and a couple of months has goneby, go see your doctor.
So and no reason to get overly anxious.
Just be prudentand just go get it checked.
So I think just making a good decision,
I and I don't want
our listeners, viewers to thinkthat there's this just a small window
(22:42):
of opportunity beyond which,God forbid, people are going to die.
That's not the case at all.
We run into these horrific,horrible stories of our patients die
of skin cancer because it was not treatedfor, let's say, a year or two.
So it's it's not likethere's just a small window.
That's not the case at all.
But that'swhy ideally get a skin exam once a year.
(23:04):
If you see something after 2 to 3 months,just go see your doctor.
And think who you are.
You actually answered the question
I was going to ask next, which is like,how long is that window generally?
Right?I mean, is it something that's fast?
But I gotcha.
You know, so certainly
I sure for every person and everybody,it's going to be a little bit different.
But it's not like
if you don't do this today, tomorrow,
(23:27):
it could be deadly, butyou certainly don't want to wait too long.
You know, in talkinggoing back to these modes
and with some of these things,whether it is a little bit
more conservative or somethingthat requires a skin graft,
what does that recovery really look like
when you see that in patients?
The recovery is is
(23:48):
you know, it varies based on one'sperception, to be honest with you.
Some people
may see it as
significant, but it really dependsultimately on the size of the skin cancer.
But for a majority of people,the recovery is not terrible.
There's generally some bruising,so there's generally some swelling.
(24:09):
If we do, let's say, surgery on the nose,generally people
tend to get a little swellingon their eyelids in their upper cheeks,
but there is generally some swelling,
there is some tenderness,but it's minimal.
We always
go through the preoperativepre-operative plan with our patients
to minimize bruising and swellingso we make them aware ahead of time.
(24:32):
We make sure they stay away from bloodthinners that can contribute to bruising.
We talk about using Arnica.
We talk about using the appropriatehomeopathic stuff to give them
sort of the least amount of recovery.
But it's not terrible. It'snot excruciating pain.
But a lot of patients truly dogo back to work after a couple of days.
(24:54):
Again, it reallydepends on the size of the skin cancer.
But for the most part, there's anticipatesome swelling, some bruising.
If it's, for example, under lip,
their lip is going to get swollenif it's, you know, near their eyelid
that their eye may somewhatnarrow and close, shut a bit.
But usually that goes away in like 2 to 3days.
Bruising takes about a week.
(25:15):
Swelling can take about a weekor two certain times.
We do flaps where it's muchmore complicated for it to look its best.
It is going to take about 3 to 6 months.
So I always tell my patients, no mattertruly what, where we're doing the surgery
and what kind of whether it'ssmall or not, your ultimate results
(25:35):
take really about six months, even longer,because it takes that long for your body
to go through a healing periodand for the inflammation to go away for
for the stitchesbelow the skin to dissolve.
So it's about really just being patient.
You know,
if anybody has come to this podcastby way of like Googling
or maybe they found outthat they had something
(25:57):
in a tricky area, like the nose,like the cheek, like the lip.
And I do know
so much of surgery is dependenton the surgeons.
I'm not asking you to make a buy.
I'm asking youto make a blanket statement.
But if somebody has had
that in their freaking out,wow, we're going to have this giant scar.
Is it possible to have, you know,
(26:20):
sort of skin cancer removed?
And is the technology good enoughif you're with a good enough surgeon
like yourself for it to be somethingthat is going to be unnoticeable?
Yeah, without a doubt.
I think if you really like you said, it'sso important that it's so important
to have a surgeon who has experience,understands the anatomy,
(26:40):
is quite patient in their
meticulousnessand is not rushing and has enough empathy
to understand this is someone's faceand we want to really do what we can.
So it takes all those things.
But ultimately, without a doubt, I'mso glad you brought it up.
The message that I think it's importantto pass on is that most surgery or skin
cancer surgery is not going to leave youwith a deformity,
(27:03):
that the scarring is minimal,that ultimately
there are so many people who have had skincancer surgery and they look great.
You can't tell their where the scar is.
They almost have to the patientalmost has to point it out to you.
So what the patient has control overis trying to see a dermatologist
(27:24):
as soon as you know, with an annual exam
to minimize the size and then ultimatelychoosing the right surgeon
who really understands the artistry
and the and the proper way of stitching.
And it's remarkablehow we do these surgeries.
And patients are always so gratefulthat six months later they're like, Doc,
I was so worried,but I can't see anything.
(27:45):
I'm so happy.
You're always if you look closely,you'll see something.
But for the person standing,a sort of average
distance of 2 to 3 feet, you almost haveto point it out to someone.
Thank you.
I'm sure there's a lot of people who aregoing to take a lot of solace in that.
You know,when you when you hear something,
I'm sure as scary as cancer,there's so many emotions that go
(28:07):
along with that actually, on that note,do you have any advice for anybody
who who has been diagnosedwith some varying form of of skin cancer.
Advicein terms of how to manage emotions or.
Yeah. Yeah.
So I think it is so important that
(28:29):
I try to put them at ease to knowthat they're not alone,
number one, that it happensunfortunately, to so many people
and everybody makes it throughand that they're going to make it through,
that they're not going to have deformity,
that everything is going to turnout fine just to be patient
and trust their intuition.
And in terms of their interaction
(28:51):
with their surgeon, with their doctor,so that they feel that connection,
because I think that connectionis really important for the outcome.
Ultimately. And just to know that
with proper patients
and just listening to the doctor,
things will turn out fine
and that all that uncertaintyand negativity
(29:14):
and fear will eventually subside.
You know, I know that you are
based here in New York City,as am I for people.
We've got listeners around the world.
If if they are looking for a specialist
in Mo's, where are thereany places that we can go for information?
Is it just sort of seeking outindividual doctors?
(29:37):
Is there any advice for somebodywho might not be lucky enough
to be here in New York Cityand get to come see you?
That's great.
Absolutely.
I would say the sort of premier resource
for most surgery is what we callthe American College of Most surgery,
AC, EMS, the American College of
most surgeryhas so much information, videos
(30:00):
about what skin cancer is,how most surgery is performed,
who are themost surgeons across the United States,
within each state,within each district of each state.
So there's
just so much information therewhere you can find the most surgeon.
The other thing that I would sayis it's important that also
(30:22):
your most surgeonis going to do a great job
of removing the cancerand not every most surgeon
is a reconstructive surgeryin terms of stitching.
So at that point,you want to have an open conversation
with your most surgeon about who'sgoing to be doing the stitches.
So most surgeons will refer you out,and some most surgeons will actually,
(30:43):
with experience, will immediatelydo the stitching right there,
which is certainly much more practicalfor the patient.
Well, great advice.
I mean, I want to thank you so much, Dr.
Ostad You've given us so much information.
And of course, if people want to find you,if they're here in New York City,
what's the best way to find you?
Thank you so much.
(31:04):
So I practice on the Upper East Side.
I am on Lexington Avenue and 67th Street.
I've been in practice for 27 years. I
teach at NYU Langone Health.
I teach this surgeryto two young doctors in training.
But I'm here in the Upper East Side,and I'm just so grateful
(31:25):
for this opportunityto to talk to you about this.
I'm so grateful to, you know, I
one of the reasons that I startedthis podcast was to provide information.
And again, for everybody listening,this isn't to scare you.
I don't want to give you anxiety,but you've heard it from doctors,
from experts.
Skin cancer can be one of the most deadly,if not caught.
But it's also one of the most preventableand if caught early, Treatable.
(31:48):
Yeah. Is that correct?
So make sure you're going out there.
Make sure you're wearing your sunscreen,avoiding the sun from 12 to 5,
and then, of course,getting those annual checkups.
And if you think something's wrong,I would say
you got to be your best medical advocate.
Make sure to get it checked.
Thank you so much for being on with ustoday, Dr.
Ostad A really appreciateall the information that you've given us.
(32:11):
Thank you so much, Amber.Thank you for having me.
I think you're wonderful resource and Ithink you're doing incredible things. And
thank you.
Well, if you are
listening at home or have any questionsyou want me to pass on to Dr.
Ostad or his team,I'm always happy to do that.
You can email me at Hello at artbeauty podcast dot com.
You can find us on Facebook, Instagramand YouTube @ArtBeautyPodcastand
(32:35):
we will make sure to put Dr.
Austin's information in the show notes.
So don't even worry about that.
And of course,we will see you next Tuesday, hopefully
being a little bit more sun safe by
(32:55):
right.
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