May 6, 2025 • 25 mins
Dr. Brent Moody—double board-certified dermatologist and skin cancer expert—breaks down the most common (and overlooked) cancer in humans. From why squamous cell carcinoma actually kills more people than melanoma, to how modern treatments like Mohs surgery and immunotherapy are changing the game, this episode replaces fear with facts.
His advice? No gimmicks—just wear sunscreen and a hat.
Whether you're a patient, supporter, or just skin-curious, this is a must-listen for Skin Cancer Awareness Month.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Dermot Trotter Don't Swear About Skin
Care where host Dr Shannon CTrotter, a board-certified
dermatologist, sits down withfellow dermatologists and skin
care experts to separate factfrom fiction and simplify skin
care.
Let's get started.
Speaker 2 (00:20):
Welcome to the Dermot Trotter Don't Swear About Skin
Care podcast.
I have a great guest here withus today, dr Brent Moody.
He's double board certified indermatology and dermatologic
surgery.
He's a practicing Mohs surgeonwho specializes in skin cancer.
In fact, his practice is prettymuch entirely dedicated to skin
cancer and he's here today toreally give us the skinny on
(00:44):
skin cancer and help youunderstand it a little bit
better and maybe treatment.
So when you walk out of hereyou'll have just a better grasp
on what we mean when we talkabout skin cancer the most
common cancer, just to leteveryone know and remind you out
there because it deservesattention.
So welcome to the podcast,brent.
Speaker 3 (01:00):
Thanks, shannon, I really appreciate the
opportunity.
Speaker 2 (01:04):
Well, you know, skin cancer.
I think a lot of people stop,you know, probably if you know
they're in the office talkingwith you and you've diagnosed
them.
Or maybe we're reaching out viaphone and saying, yep, you have
skin cancer, and immediatelythey stop listening because
cancer is, you know, seriousbusiness.
We know this in healthcare.
When we think about skin cancer, do you mind talking a little
bit about the more common typesof skin cancer and why do they
(01:27):
actually even form in the skin?
Speaker 3 (01:37):
Yeah, thanks for having this as a topic on your
podcast.
This is a big topic and, morelikely than not, either you or a
loved one or a friend at somepoint in their life is going to
develop skin cancer.
It is so common.
And really, when we talk aboutskin cancer, while there is a
huge, long list of types of skincancer, most people are going
to be dealing with one of thetwo most common types, that's,
(02:00):
basal cell carcinoma andsquamous cell carcinoma.
So first question well, why dopeople get skin cancer?
We know there are certain thingsthat predispose people to
developing skin cancers,although in some instances, to
be honest, it just appears badluck.
We don't know why you got askin cancer, you just got one.
(02:21):
But we do know that peoplewho've had greater sun exposure
over their lives, people whohave had tanning bed use, those
type of behaviors, canpredispose someone to a skin
cancer, and there are certainmedical conditions that can
predispose people to skin canceras well.
(02:42):
We know the immune system isreally important in keeping skin
cancers in check.
So folks who have eithermedical conditions or take
medications that alter theimmune system can lead to skin
cancer.
So those are some of the thingswe know that cause them, and so
the first thing I like to tellpeople is we do have an idea
(03:02):
what leads to this.
So let's try to modifybehaviors and avoid the sun, put
on sunscreen, wear long sleeves, wear a hat.
These are the simplest things,and as a while I do specialize
in skin cancer, people also askme just about skin in general
and they'll say what can I dofor my skin to look as good as
it can?
And so let's keep it simple.
(03:23):
I'm not going to sell you anypotions or lotions.
I want you to put on a hat andwear sunscreen.
So that's how strongly I feelabout really patients taking
control of their own skin andmitigating those risk factors.
As far as how does it developand what's the difference, I
(03:43):
would say for the vast majorityof the basal cell carcinomas and
the squamous cell carcinomas,you know, for most people
they're basically going to bethe same.
I mean it comes from the skin.
It's a slightly different cellin the skin that turned into
cancer, but for all practicalpurposes, the risk factors of
(04:04):
getting it are similar.
The treatments can be similarfor the vast majority of skin
cancers.
It's really only when we startgetting more advanced basal cell
carcinomas or advanced squamouscell carcinomas that there can
be dramatic differences in thetwo in the tube.
Speaker 2 (04:26):
I like what you comment on there too about the
prevention piece, because Ithink a lot of people think, oh
gosh, I've got a skin cancer andnow what I'm going to do?
That's very important, butcircling back to maybe
preventing them from gettinganother one, or even from the
first place, important things tohighlight.
And then also, what I loveabout what you said is you're
not telling people to live likea vampire and don't enjoy life.
You know, I think sometimes weget a bad reputation as
dermatologists that we hate thesun, and I always tell patients
(04:49):
no, we don't hate the sun, thesun's good for you know health
and mood and obviously you knowall the environmental impact.
But like anything else,moderation.
Just do it smarter when you'reout there and work on that
prevention piece.
And you mentioned basal cell andsquamous cell.
You know the two most commontypes of skin cancer we tend to
deal with and kind of how theycome from different cells in the
(05:12):
skin and behave.
You know somewhat similar untilthey kind of get advanced.
And you touched a little bit ontreatments being the same.
Do you mind kind of describinga little bit more about what are
some of the treatment options,because I think people probably
know surgery and maybe touch alittle bit on Mohs in particular
, what you specialize in,because people don't even know
what Mohs is and you know, forthose folks that maybe think,
well, surgery not for me, youknow, what are some other
(05:34):
options that I might be able todo?
Speaker 3 (05:37):
Well, the first thing I want to let people know is we
have lots of great treatmentoptions for skin cancer.
So the vast majority of peoplewho get a skin cancer granted
you don't want to have one right, you'd rather not have to deal
with it at all.
But if you are someone thatdoes have to deal with it, know
that in the vast majority ofinstances we're going to be able
to take care of that skincancer one way or the other with
(06:00):
great success.
So you're more likely than notyou're going to do just fine
with great success.
So you're more likely than notyou're going to do just fine, I
would say.
Typically, surgery is sort of amainstay.
We've done it for decades anddecades and decades.
It's very effective.
It's very cost effective.
It's generally done in theoffice setting.
We don't have to go to thehospital, you don't have to be
(06:23):
put to sleep by ananesthesiologist.
It's generally done in thedermatologist office.
So so it's a verycost-effective way to treat a
skin cancer and for many timesyou remove it, put in some
stitches and that's going to bethe end of the matter.
You specifically asked aboutMohs surgery, and Mohs surgery
is a specialized form of surgerythat makes sense for certain
(06:45):
skin cancers it's not for everyskin cancer is the cancer is
removed in a stepwise fashionand allows the Mohs surgeon to
(07:11):
prepare microscope slides andlook for the roots of the cancer
.
While we go.
I tell my patients that skincancer is sort of like a weed
there's what we see on thesurface and there's roots.
And if we just scrape the topoff of a skin cancer just like
if we just cut the top off of askin cancer, just like if we
just cut the top off of a weedbut leave the roots it'll come
back.
So it allows us to find thoseroots and it's very effective.
(07:32):
It's been around for manydecades and there are many
really great Mohs surgeons allover the country, so I think
Present company included Brent.
Speaker 2 (07:40):
Present company included so.
Speaker 3 (07:42):
I think if you need Mohs surgery you should be able
to find someone pretty close toyou who offers this service.
Now, that's not for every skincancer.
Many skin cancers can be justremoved surgically without that
instant microscope examination.
That's very effective.
So if your doctor recommendsjust a regular surgical
(08:03):
procedure and not necessarilyMohs surgery, it's probably fine
.
So don't feel like, oh, Ialways have to have this Mohs
surgery.
But, as you said, surgery somepeople don't want surgery.
Many skin cancers can be treatedwithout a surgical procedure
and so surgery works for many ofthem.
And we have really goodnon-surgical options at the two
(08:27):
extremes.
We have great non-surgicaloptions for really early skin
cancers and we have some reallygreat non-surgical options for
more advanced skin cancers.
Now, advanced ones in the pastwould have been treated with a
really involved, large surgicalprocedure.
We'll talk about those in aminute.
(08:48):
But many early skin cancers,ones that are very small, very
superficial, can be treated withtopical medications.
There are several creams thathave been around for a long time
that can be really effectivefor these early skin cancers.
So your doctor may suggest youtry one of these creams, and I
use those routinely in mypractice and they do a great job
(09:11):
in the properly selected cancer.
I mentioned roots, just likethe weed.
So generally we're going to usesome sort of medicine, a cream,
in ones that we don't thinkhave very deep roots, because if
you have deep roots it's hardto get the medicine down where
it needs to get.
So if you have a very earlyskin cancer your doctor may say
(09:33):
let's just try this cream andthey do great.
Your skin might get a littleirritating right while you're
using it, but you'll do greatwith that.
There are some procedures thatare not full-blown surgeries
that are also very effective forcertain skin cancers.
We can actually use liquidnitrogen and freeze it.
(09:55):
I mean we just sort of freezeoff the top layer of skin and
that can take care of many earlyskin cancers.
We usually do that forpre-cancers more than skin
cancer, but in the right settingit may work for a skin cancer.
The other thing we'll sometimesjust numb the skin and kind of
scrape the top of the skin offand cauterize it, and that works
(10:16):
really well.
So there's sort of minimallyinvasive procedures.
So we've got creams, minimallyinvasive procedures.
We have surgery, including Mohssurgery, and on the other end
of the spectrum, if you areunfortunate and have a more
advanced skin cancer.
Whether it's basal cellcarcinoma or squamous cell
carcinoma, we have non-surgicaloptions.
(10:39):
In both of those instances theycan be treated with radiation
therapy.
Radiation as a treatment forcancer has been around for many
cancers for many decades.
Works really well in theproperly selected patient.
The downsides to radiation isit is a series of treatments, so
(11:00):
patients have to go backmultiple times, so there's some
inconvenience to it and it canbe a very costly way to treat a
cancer as well.
Inconvenience to it and it canbe a very costly way to treat a
cancer as well.
So we like to reserve that whenthe simpler, cheaper things may
not work.
And then for both basal cell andsquamous cell we now have
(11:20):
systemic medicines, either pillsthat you take or injections
that you get, that work reallywell.
Again, these come with someside effects because they are
systemic medicines, but theywork really well again, in the
properly selected patient.
For the basal cell, weprimarily use pills.
(11:41):
There's a couple of differentpills available and you have to
take those for a number ofmonths.
They do have some side effectsbut most people do well with
them.
They're not terrible sideeffects.
For squamous cell carcinoma,most of our systemic therapies
are going to be an IV infusion.
That's where we are right nowwith those.
(12:02):
It can be very effective forthe advanced squamous cell
carcinomas and by and large, weuse medicines that harness our
own immune system.
I tell my patients who undergothis therapy that the actual
medicine that we're giving youdoesn't do anything to the
cancer.
It doesn't kill cancer cells.
(12:22):
That's old-fashionedchemotherapy, right, we give
people chemotherapy.
They would have awful sideeffects because we were giving
them a medicine that directlykilled the cancer cells.
With this new form of treatmentcalled immunotherapy, we give
you a medicine, or a patient amedicine, and it teaches the
immune system.
It turns the immune system onand lets your body's natural
(12:45):
immune system attack the cancer.
So it's a really novel way oftreating cancer.
We've been doing this for abouta dozen years or so.
Patients generally do quitewell, but there can be side
effects as well, and that'ssomething you'd want to talk to
your doctor about.
So these are some reallyexciting things going on in the
skin cancer space or realm thatwe didn't even have just again a
(13:06):
dozen years ago.
Cancer space or realm that wedidn't even have just again a
dozen years ago.
And then, finally, there aretimes we have to do all of these
things.
We do surgery plus radiation orsurgery plus medicine, or
medicine.
So if someone is dealing with avery difficult skin cancer and
this is not common at all but ithappens your doctor may
recommend you do multiple thingsfor that skin cancer Again, I
(13:31):
would say most people watchingyour podcast are probably going
to fall in that category of hey,a cream or relatively
successful surgical procedure inthe office.
Speaker 2 (13:48):
And you mentioned also the cream for early skin
cancers too.
Do you recommend, or sometimesdo, electro desiccation and
curatage as well, or you'll dothat scraping you mentioned.
They'll sometimes do that forthe early skin cancers as well.
Speaker 3 (14:00):
That works great for early skin cancers.
Again, you got to think abouthow deep it might be, because
you can only sort of scrape,scrape so deep.
So yeah, that works really wellfor a lot of skin cancers.
Speaker 2 (14:26):
So my view on these, and I think most of my
colleagues view, is let's do thesimplest, easiest treatment
that will take care of yourparticular skin cancer.
And that sounds like a goodphilosophy, because I think you
showed for patients theirtreatment options too,
especially maybe if their skincancer is early.
And you can include patients inthat conversation, because I
know preference of the patientplays a role sometimes if we're
able to have choice, which iskind of the luxury with basal
cell and squamous cell.
But I know you've seen this andI've seen it too with my career
(14:48):
, not so much on the basal celland squamous cell, but I know
you've seen this and I've seenit too with my career, not so
much on the basal cell front,although it can happen where
they can be more aggressive,locally aggressive that we
mentioned in treatment, systemictherapy.
But I think the one I wanted tosort of tackle is squamous cell
carcinoma because it seems to be, you know, an entity to we're
learning a bit more about forthose more aggressive cases
where it has potential, you know, to spread or even cause death
(15:10):
Cause.
I think you know we, you know,kind of minimize.
I think some people minimizeskin cancer in general, thinking
that, oh, most of it's curativeby surgery, which very well,
true, but we do see those badcases too.
Do you mind talking about someof your experience, especially
with squamous cell?
You know when you're worriedabout could this be a really bad
actor?
And you know, are there anytests or new technology that can
(15:31):
really help us identify thosesquamous cells so that maybe we
can approach that patientdifferently?
Speaker 3 (15:36):
Sure.
So squamous cell carcinoma isthe second most common type of
skin cancer and more people dieof squamous cell carcinoma than
they do of melanoma.
Now, most people have heard ofmelanoma.
There are occasionallycelebrities will get melanoma
and we hear that they end uppassing from that, but more
people will die of squamous cellcarcinoma than melanoma.
(15:57):
So, despite some of my earlierstatements that most people do
really well, unfortunately therewas some cancers that can be
quite significant.
And so your question well, howdo we figure out?
Is this particular squamouscell carcinoma more or less
likely to become a big problem?
And there are a few factors orthings that we need to think
(16:18):
about.
The first thing we need tothink about is the actual cancer
itself, that actual tumor wecall it, and so that cancer will
have certain features, it willhave a size, it will have a
depth.
There will be certain thingsthat we see under the microscope
that a pathologist will tell us, certain features that we know
are aggressive for squamous cellcarcinoma.
(16:41):
So these are things that we'reall going to look for.
What does it look like underthe microscope?
How big is it?
You know, what does it looklike under the microscope?
How big is it, how deep is itgoing and where is it located?
You know we might approach acancer on someone's lip very
differently than the middle oftheir back.
So those are some of the thethe tumor features that are
important in figuring out, well,what's the best way to treat
(17:02):
this particular situation.
Then there are patient factorsthat we need to think about.
As you said, patient preferenceis really important.
Some patients have a feeling,one direction they might like to
go in, and that's veryimportant.
But there are other things thatinfluence how we think about
this.
One is the status of the immunesystem, and I mentioned that
(17:24):
some of the medicines we use aredesigned to turn on the immune
system, because the immunesystem can help get rid of a
skin cancer.
So if someone has a medicalcondition or takes a medicine
that depresses their immunesystem, we know that the cancer
may behave more aggressively.
So we may need to be moreaggressive in our thinking if
(17:46):
we're approaching someone, andthis might be someone who has
had a heart transplant or akidney transplant and they have
to take immunosuppressivemedicines, or it may be someone
who has a medical condition.
There are some blood cancersthat can be really common.
That might not kill the personbut depress their immune system.
(18:08):
So those are patient things wethink about and then finally, we
have to just build the wholepicture and we have to look at
what's the person's overallhealth, what's their life
expectancy?
Do they have other majormedical problems that might be
life limiting?
So these are all things that wehave to put together.
(18:35):
There are some new things andI've been really lucky I've been
able to work with some of thepeople that have developed these
tools where we can look at acancer's genetic profile.
So cancers have a geneticprofile.
Just like all of us, we have agenetic profile that was given
to us by the DNA we got from ourparents.
But these cancers will have agenetic profile as well, and the
(18:57):
cancer genetic profile hasnothing to do with the person's
genes.
It's unique to that cancer andwhat we've discovered, or
scientists who look into this,is that certain profiles of gene
expression are associated withcancers that tend to be more
aggressive.
So if you have a squamous cellcarcinoma that's on the more
(19:20):
aggressive side, your doctor mayorder some additional tests,
some of these genetic tests, toprovide some more information.
And we don't do that for sortof less significant skin cancers
, because we want to use all ofour medical resources, you know,
judiciously.
We don't want to, you know,make things more complicated
than they need to be so manytimes.
(19:42):
Most surgeons anddermatologists and oncologists
will use what we call a geneprofile to help figure out is
this cancer more or less likelyto be aggressive?
And, if so, we may opt for alittle more aggressive treatment
, knowing that that cancerwarrants that treatment.
Speaker 2 (20:05):
Well, that gives a really, I think, good overview,
you know, for patients tounderstand that, because I think
you know, in general forsquamous cell, like we talked
about, people don't think aboutthe other factors that might put
them at risk, especially thethings you know.
A patient coming in may noteven realize, if their immune
system isn't working very well,that maybe that puts them at
higher risk for squamous cellcarcinoma potentially spreading
(20:28):
or being more of a nuisance ofwhat they might've thought if
they didn't have a weakenedimmune system.
I think what you showed us,though, is this really has
opened the doors for, you know,being more aware of who those
high risk patients are andhelping us.
Is there anything else that youfeel like with basal cell,
squamous cell that you want toshare with our audience you
think is important, you know, intheir understanding of those
(20:49):
skin cancers and where we aremoving forward into the future?
Speaker 3 (20:53):
Well, the great news is our ability to treat these
has just gotten better andbetter with time.
There have been really majoradvances again in the systemic
treatment of these cancersreally in the last dozen years
or so, both for basal cellcarcinoma and squamous cell
carcinoma, so we cansuccessfully treat tumors that
(21:16):
even again, 15 years ago wouldnot be able to be treated at all
.
So there's lots of excitement.
I think where we're heading istaking these systemic therapies
that we give intravenously or bypills and figuring out a way to
(21:38):
apply that same idea, that sametechnology in a local way.
So not specific to skin cancer,but some of these immunotherapy
(22:01):
medicines that turn on theimmune system that we've been
giving IV we can now give justby a shot, and so the idea that
we're going to again go fromthis treatment everywhere just
to the local area I think isreally exciting.
We call that interlesionaltherapy and there are certain
there are still someinterlesional therapies that
exist, that have existed for along time.
But I think some of these moreadvanced treatments are going to
(22:23):
become more directly into thetumor itself and rather than
circulating to the whole body,and I think that's really
exciting Glimpse into the future.
Now remains to be seen.
We do have some evidence thatthis might work.
Speaker 2 (22:39):
Yeah, I think that's really attractive to patients.
Patients are always alarmed,and rightly so, about systemic
medicines.
That they have to takesomething a pill by mouth or do
something by IV, that, you know,does cause for concern.
The side effects would be veryinteresting to see if we can
have good local control andminimize that exposure.
That could be a double, adouble win-win, if you will.
(23:01):
Well, thank you, brent, so muchfor coming on the podcast.
You know I really appreciatethe information you provided
because this grave, you know, Ithink really excuse me gives us
really a great sort of justperspective on skin cancer that
I think a lot of people aren'tfamiliar with.
I think people hear a basalcell.
They kind of have familiaritywith that squamous cell.
You know you survey people.
They're kind of not suremelanoma they know about, but
(23:22):
this really highlights, you know, where skin cancer is important
to us as dermatologists, butmore important to the public, as
we see how much people areaffected by it.
And you're right, odds are oneof us is going to have it, maybe
more than once, although we'llhave to have a contest who's
better with the sunscreen?
I don't know.
We'll have to go back and look.
Did you use the tanning band,brad ever.
Speaker 3 (23:41):
No, I avoid it.
Speaker 2 (23:43):
You beat me on that one.
You beat me on that one.
So that was the college trendback in the day and we really
didn't know the risks.
But you know, skin cancer issomething we all probably
encountered some way shape orform in our lives ourselves,
personally or somebody else andthis gave a great taste of that.
You know, for our listeners, ifthey want to find you, where
can they locate you and learnmore about you?
Brian?
Speaker 3 (24:03):
Well, I, um, I have a practice website, heritage
medicalcom.
All one word Heritage Medical.
I'm part of a group calledHeritage Medical Associates in
Nashville, tennessee.
I'm not overly active on socialmedia, but I occasionally will
post things related to skincancer on my ex account, which
(24:25):
is at Brent Moody, tn.
So if there's something reallyinteresting about skin cancer,
I'll sometimes post that.
Or if you like 1980s new wavemusic, you can.
You can check as well, but youknow, that's that's certainly
how people can can find eithermy practice website, heritage
Medical Associates in NashvilleTennessee or at Brent Moody TN.
Speaker 2 (24:49):
Well, thank you again for sharing your expertise.
It's been great to have you on.
We'll definitely have to bringyou back on and get a little bit
more detailed into skin cancer,because there's so much more we
could definitely talk about.
And everyone, stay tuned forthe next episode of Dermot
Trotter.
Don't Swear About Skin Care.
Speaker 1 (25:08):
Thanks for listening to Dermot Trotter.
For more about skin care, visitdermottrottercom.
Don't forget to subscribe,leave a review and share this
podcast with anyone who needs alittle skin care sanity.
Until next time, stay skinsmart.
Welcome to Dermot Trotter Don't Swear About Skin
Care where host Dr Shannon CTrotter, a board-certified
dermatologist, sits down withfellow dermatologists and skin
care experts to separate factfrom fiction and simplify skin
care.
Let's get started.
Speaker 2 (00:20):
Welcome to the Dermot Trotter Don't Swear About Skin
Care podcast.
I have a great guest here withus today, dr Brent Moody.
He's double board certified indermatology and dermatologic
surgery.
He's a practicing Mohs surgeonwho specializes in skin cancer.
In fact, his practice is prettymuch entirely dedicated to skin
cancer and he's here today toreally give us the skinny on
(00:44):
skin cancer and help youunderstand it a little bit
better and maybe treatment.
So when you walk out of hereyou'll have just a better grasp
on what we mean when we talkabout skin cancer the most
common cancer, just to leteveryone know and remind you out
there because it deservesattention.
So welcome to the podcast,brent.
Speaker 3 (01:00):
Thanks, shannon, I really appreciate the
opportunity.
Speaker 2 (01:04):
Well, you know, skin cancer.
I think a lot of people stop,you know, probably if you know
they're in the office talkingwith you and you've diagnosed
them.
Or maybe we're reaching out viaphone and saying, yep, you have
skin cancer, and immediatelythey stop listening because
cancer is, you know, seriousbusiness.
We know this in healthcare.
When we think about skin cancer, do you mind talking a little
bit about the more common typesof skin cancer and why do they
(01:27):
actually even form in the skin?
Speaker 3 (01:37):
Yeah, thanks for having this as a topic on your
podcast.
This is a big topic and, morelikely than not, either you or a
loved one or a friend at somepoint in their life is going to
develop skin cancer.
It is so common.
And really, when we talk aboutskin cancer, while there is a
huge, long list of types of skincancer, most people are going
to be dealing with one of thetwo most common types, that's,
(02:00):
basal cell carcinoma andsquamous cell carcinoma.
So first question well, why dopeople get skin cancer?
We know there are certain thingsthat predispose people to
developing skin cancers,although in some instances, to
be honest, it just appears badluck.
We don't know why you got askin cancer, you just got one.
(02:21):
But we do know that peoplewho've had greater sun exposure
over their lives, people whohave had tanning bed use, those
type of behaviors, canpredispose someone to a skin
cancer, and there are certainmedical conditions that can
predispose people to skin canceras well.
(02:42):
We know the immune system isreally important in keeping skin
cancers in check.
So folks who have eithermedical conditions or take
medications that alter theimmune system can lead to skin
cancer.
So those are some of the thingswe know that cause them, and so
the first thing I like to tellpeople is we do have an idea
(03:02):
what leads to this.
So let's try to modifybehaviors and avoid the sun, put
on sunscreen, wear long sleeves, wear a hat.
These are the simplest things,and as a while I do specialize
in skin cancer, people also askme just about skin in general
and they'll say what can I dofor my skin to look as good as
it can?
And so let's keep it simple.
(03:23):
I'm not going to sell you anypotions or lotions.
I want you to put on a hat andwear sunscreen.
So that's how strongly I feelabout really patients taking
control of their own skin andmitigating those risk factors.
As far as how does it developand what's the difference, I
(03:43):
would say for the vast majorityof the basal cell carcinomas and
the squamous cell carcinomas,you know, for most people
they're basically going to bethe same.
I mean it comes from the skin.
It's a slightly different cellin the skin that turned into
cancer, but for all practicalpurposes, the risk factors of
(04:04):
getting it are similar.
The treatments can be similarfor the vast majority of skin
cancers.
It's really only when we startgetting more advanced basal cell
carcinomas or advanced squamouscell carcinomas that there can
be dramatic differences in thetwo in the tube.
Speaker 2 (04:26):
I like what you comment on there too about the
prevention piece, because Ithink a lot of people think, oh
gosh, I've got a skin cancer andnow what I'm going to do?
That's very important, butcircling back to maybe
preventing them from gettinganother one, or even from the
first place, important things tohighlight.
And then also, what I loveabout what you said is you're
not telling people to live likea vampire and don't enjoy life.
You know, I think sometimes weget a bad reputation as
dermatologists that we hate thesun, and I always tell patients
(04:49):
no, we don't hate the sun, thesun's good for you know health
and mood and obviously you knowall the environmental impact.
But like anything else,moderation.
Just do it smarter when you'reout there and work on that
prevention piece.
And you mentioned basal cell andsquamous cell.
You know the two most commontypes of skin cancer we tend to
deal with and kind of how theycome from different cells in the
(05:12):
skin and behave.
You know somewhat similar untilthey kind of get advanced.
And you touched a little bit ontreatments being the same.
Do you mind kind of describinga little bit more about what are
some of the treatment options,because I think people probably
know surgery and maybe touch alittle bit on Mohs in particular
, what you specialize in,because people don't even know
what Mohs is and you know, forthose folks that maybe think,
well, surgery not for me, youknow, what are some other
(05:34):
options that I might be able todo?
Speaker 3 (05:37):
Well, the first thing I want to let people know is we
have lots of great treatmentoptions for skin cancer.
So the vast majority of peoplewho get a skin cancer granted
you don't want to have one right, you'd rather not have to deal
with it at all.
But if you are someone thatdoes have to deal with it, know
that in the vast majority ofinstances we're going to be able
to take care of that skincancer one way or the other with
(06:00):
great success.
So you're more likely than notyou're going to do just fine
with great success.
So you're more likely than notyou're going to do just fine, I
would say.
Typically, surgery is sort of amainstay.
We've done it for decades anddecades and decades.
It's very effective.
It's very cost effective.
It's generally done in theoffice setting.
We don't have to go to thehospital, you don't have to be
(06:23):
put to sleep by ananesthesiologist.
It's generally done in thedermatologist office.
So so it's a verycost-effective way to treat a
skin cancer and for many timesyou remove it, put in some
stitches and that's going to bethe end of the matter.
You specifically asked aboutMohs surgery, and Mohs surgery
is a specialized form of surgerythat makes sense for certain
(06:45):
skin cancers it's not for everyskin cancer is the cancer is
removed in a stepwise fashionand allows the Mohs surgeon to
(07:11):
prepare microscope slides andlook for the roots of the cancer
.
While we go.
I tell my patients that skincancer is sort of like a weed
there's what we see on thesurface and there's roots.
And if we just scrape the topoff of a skin cancer just like
if we just cut the top off of askin cancer, just like if we
just cut the top off of a weedbut leave the roots it'll come
back.
So it allows us to find thoseroots and it's very effective.
(07:32):
It's been around for manydecades and there are many
really great Mohs surgeons allover the country, so I think
Present company included Brent.
Speaker 2 (07:40):
Present company included so.
Speaker 3 (07:42):
I think if you need Mohs surgery you should be able
to find someone pretty close toyou who offers this service.
Now, that's not for every skincancer.
Many skin cancers can be justremoved surgically without that
instant microscope examination.
That's very effective.
So if your doctor recommendsjust a regular surgical
(08:03):
procedure and not necessarilyMohs surgery, it's probably fine
.
So don't feel like, oh, Ialways have to have this Mohs
surgery.
But, as you said, surgery somepeople don't want surgery.
Many skin cancers can be treatedwithout a surgical procedure
and so surgery works for many ofthem.
And we have really goodnon-surgical options at the two
(08:27):
extremes.
We have great non-surgicaloptions for really early skin
cancers and we have some reallygreat non-surgical options for
more advanced skin cancers.
Now, advanced ones in the pastwould have been treated with a
really involved, large surgicalprocedure.
We'll talk about those in aminute.
(08:48):
But many early skin cancers,ones that are very small, very
superficial, can be treated withtopical medications.
There are several creams thathave been around for a long time
that can be really effectivefor these early skin cancers.
So your doctor may suggest youtry one of these creams, and I
use those routinely in mypractice and they do a great job
(09:11):
in the properly selected cancer.
I mentioned roots, just likethe weed.
So generally we're going to usesome sort of medicine, a cream,
in ones that we don't thinkhave very deep roots, because if
you have deep roots it's hardto get the medicine down where
it needs to get.
So if you have a very earlyskin cancer your doctor may say
(09:33):
let's just try this cream andthey do great.
Your skin might get a littleirritating right while you're
using it, but you'll do greatwith that.
There are some procedures thatare not full-blown surgeries
that are also very effective forcertain skin cancers.
We can actually use liquidnitrogen and freeze it.
(09:55):
I mean we just sort of freezeoff the top layer of skin and
that can take care of many earlyskin cancers.
We usually do that forpre-cancers more than skin
cancer, but in the right settingit may work for a skin cancer.
The other thing we'll sometimesjust numb the skin and kind of
scrape the top of the skin offand cauterize it, and that works
(10:16):
really well.
So there's sort of minimallyinvasive procedures.
So we've got creams, minimallyinvasive procedures.
We have surgery, including Mohssurgery, and on the other end
of the spectrum, if you areunfortunate and have a more
advanced skin cancer.
Whether it's basal cellcarcinoma or squamous cell
carcinoma, we have non-surgicaloptions.
(10:39):
In both of those instances theycan be treated with radiation
therapy.
Radiation as a treatment forcancer has been around for many
cancers for many decades.
Works really well in theproperly selected patient.
The downsides to radiation isit is a series of treatments, so
(11:00):
patients have to go backmultiple times, so there's some
inconvenience to it and it canbe a very costly way to treat a
cancer as well.
Inconvenience to it and it canbe a very costly way to treat a
cancer as well.
So we like to reserve that whenthe simpler, cheaper things may
not work.
And then for both basal cell andsquamous cell we now have
(11:20):
systemic medicines, either pillsthat you take or injections
that you get, that work reallywell.
Again, these come with someside effects because they are
systemic medicines, but theywork really well again, in the
properly selected patient.
For the basal cell, weprimarily use pills.
(11:41):
There's a couple of differentpills available and you have to
take those for a number ofmonths.
They do have some side effectsbut most people do well with
them.
They're not terrible sideeffects.
For squamous cell carcinoma,most of our systemic therapies
are going to be an IV infusion.
That's where we are right nowwith those.
(12:02):
It can be very effective forthe advanced squamous cell
carcinomas and by and large, weuse medicines that harness our
own immune system.
I tell my patients who undergothis therapy that the actual
medicine that we're giving youdoesn't do anything to the
cancer.
It doesn't kill cancer cells.
(12:22):
That's old-fashionedchemotherapy, right, we give
people chemotherapy.
They would have awful sideeffects because we were giving
them a medicine that directlykilled the cancer cells.
With this new form of treatmentcalled immunotherapy, we give
you a medicine, or a patient amedicine, and it teaches the
immune system.
It turns the immune system onand lets your body's natural
(12:45):
immune system attack the cancer.
So it's a really novel way oftreating cancer.
We've been doing this for abouta dozen years or so.
Patients generally do quitewell, but there can be side
effects as well, and that'ssomething you'd want to talk to
your doctor about.
So these are some reallyexciting things going on in the
skin cancer space or realm thatwe didn't even have just again a
(13:06):
dozen years ago.
Cancer space or realm that wedidn't even have just again a
dozen years ago.
And then, finally, there aretimes we have to do all of these
things.
We do surgery plus radiation orsurgery plus medicine, or
medicine.
So if someone is dealing with avery difficult skin cancer and
this is not common at all but ithappens your doctor may
recommend you do multiple thingsfor that skin cancer Again, I
(13:31):
would say most people watchingyour podcast are probably going
to fall in that category of hey,a cream or relatively
successful surgical procedure inthe office.
Speaker 2 (13:48):
And you mentioned also the cream for early skin
cancers too.
Do you recommend, or sometimesdo, electro desiccation and
curatage as well, or you'll dothat scraping you mentioned.
They'll sometimes do that forthe early skin cancers as well.
Speaker 3 (14:00):
That works great for early skin cancers.
Again, you got to think abouthow deep it might be, because
you can only sort of scrape,scrape so deep.
So yeah, that works really wellfor a lot of skin cancers.
Speaker 2 (14:26):
So my view on these, and I think most of my
colleagues view, is let's do thesimplest, easiest treatment
that will take care of yourparticular skin cancer.
And that sounds like a goodphilosophy, because I think you
showed for patients theirtreatment options too,
especially maybe if their skincancer is early.
And you can include patients inthat conversation, because I
know preference of the patientplays a role sometimes if we're
able to have choice, which iskind of the luxury with basal
cell and squamous cell.
But I know you've seen this andI've seen it too with my career
(14:48):
, not so much on the basal celland squamous cell, but I know
you've seen this and I've seenit too with my career, not so
much on the basal cell front,although it can happen where
they can be more aggressive,locally aggressive that we
mentioned in treatment, systemictherapy.
But I think the one I wanted tosort of tackle is squamous cell
carcinoma because it seems to be, you know, an entity to we're
learning a bit more about forthose more aggressive cases
where it has potential, you know, to spread or even cause death
(15:10):
Cause.
I think you know we, you know,kind of minimize.
I think some people minimizeskin cancer in general, thinking
that, oh, most of it's curativeby surgery, which very well,
true, but we do see those badcases too.
Do you mind talking about someof your experience, especially
with squamous cell?
You know when you're worriedabout could this be a really bad
actor?
And you know, are there anytests or new technology that can
(15:31):
really help us identify thosesquamous cells so that maybe we
can approach that patientdifferently?
Speaker 3 (15:36):
Sure.
So squamous cell carcinoma isthe second most common type of
skin cancer and more people dieof squamous cell carcinoma than
they do of melanoma.
Now, most people have heard ofmelanoma.
There are occasionallycelebrities will get melanoma
and we hear that they end uppassing from that, but more
people will die of squamous cellcarcinoma than melanoma.
(15:57):
So, despite some of my earlierstatements that most people do
really well, unfortunately therewas some cancers that can be
quite significant.
And so your question well, howdo we figure out?
Is this particular squamouscell carcinoma more or less
likely to become a big problem?
And there are a few factors orthings that we need to think
(16:18):
about.
The first thing we need tothink about is the actual cancer
itself, that actual tumor wecall it, and so that cancer will
have certain features, it willhave a size, it will have a
depth.
There will be certain thingsthat we see under the microscope
that a pathologist will tell us, certain features that we know
are aggressive for squamous cellcarcinoma.
(16:41):
So these are things that we'reall going to look for.
What does it look like underthe microscope?
How big is it?
You know, what does it looklike under the microscope?
How big is it, how deep is itgoing and where is it located?
You know we might approach acancer on someone's lip very
differently than the middle oftheir back.
So those are some of the thethe tumor features that are
important in figuring out, well,what's the best way to treat
(17:02):
this particular situation.
Then there are patient factorsthat we need to think about.
As you said, patient preferenceis really important.
Some patients have a feeling,one direction they might like to
go in, and that's veryimportant.
But there are other things thatinfluence how we think about
this.
One is the status of the immunesystem, and I mentioned that
(17:24):
some of the medicines we use aredesigned to turn on the immune
system, because the immunesystem can help get rid of a
skin cancer.
So if someone has a medicalcondition or takes a medicine
that depresses their immunesystem, we know that the cancer
may behave more aggressively.
So we may need to be moreaggressive in our thinking if
(17:46):
we're approaching someone, andthis might be someone who has
had a heart transplant or akidney transplant and they have
to take immunosuppressivemedicines, or it may be someone
who has a medical condition.
There are some blood cancersthat can be really common.
That might not kill the personbut depress their immune system.
(18:08):
So those are patient things wethink about and then finally, we
have to just build the wholepicture and we have to look at
what's the person's overallhealth, what's their life
expectancy?
Do they have other majormedical problems that might be
life limiting?
So these are all things that wehave to put together.
(18:35):
There are some new things andI've been really lucky I've been
able to work with some of thepeople that have developed these
tools where we can look at acancer's genetic profile.
So cancers have a geneticprofile.
Just like all of us, we have agenetic profile that was given
to us by the DNA we got from ourparents.
But these cancers will have agenetic profile as well, and the
(18:57):
cancer genetic profile hasnothing to do with the person's
genes.
It's unique to that cancer andwhat we've discovered, or
scientists who look into this,is that certain profiles of gene
expression are associated withcancers that tend to be more
aggressive.
So if you have a squamous cellcarcinoma that's on the more
(19:20):
aggressive side, your doctor mayorder some additional tests,
some of these genetic tests, toprovide some more information.
And we don't do that for sortof less significant skin cancers
, because we want to use all ofour medical resources, you know,
judiciously.
We don't want to, you know,make things more complicated
than they need to be so manytimes.
(19:42):
Most surgeons anddermatologists and oncologists
will use what we call a geneprofile to help figure out is
this cancer more or less likelyto be aggressive?
And, if so, we may opt for alittle more aggressive treatment
, knowing that that cancerwarrants that treatment.
Speaker 2 (20:05):
Well, that gives a really, I think, good overview,
you know, for patients tounderstand that, because I think
you know, in general forsquamous cell, like we talked
about, people don't think aboutthe other factors that might put
them at risk, especially thethings you know.
A patient coming in may noteven realize, if their immune
system isn't working very well,that maybe that puts them at
higher risk for squamous cellcarcinoma potentially spreading
(20:28):
or being more of a nuisance ofwhat they might've thought if
they didn't have a weakenedimmune system.
I think what you showed us,though, is this really has
opened the doors for, you know,being more aware of who those
high risk patients are andhelping us.
Is there anything else that youfeel like with basal cell,
squamous cell that you want toshare with our audience you
think is important, you know, intheir understanding of those
(20:49):
skin cancers and where we aremoving forward into the future?
Speaker 3 (20:53):
Well, the great news is our ability to treat these
has just gotten better andbetter with time.
There have been really majoradvances again in the systemic
treatment of these cancersreally in the last dozen years
or so, both for basal cellcarcinoma and squamous cell
carcinoma, so we cansuccessfully treat tumors that
(21:16):
even again, 15 years ago wouldnot be able to be treated at all
.
So there's lots of excitement.
I think where we're heading istaking these systemic therapies
that we give intravenously or bypills and figuring out a way to
(21:38):
apply that same idea, that sametechnology in a local way.
So not specific to skin cancer,but some of these immunotherapy
(22:01):
medicines that turn on theimmune system that we've been
giving IV we can now give justby a shot, and so the idea that
we're going to again go fromthis treatment everywhere just
to the local area I think isreally exciting.
We call that interlesionaltherapy and there are certain
there are still someinterlesional therapies that
exist, that have existed for along time.
But I think some of these moreadvanced treatments are going to
(22:23):
become more directly into thetumor itself and rather than
circulating to the whole body,and I think that's really
exciting Glimpse into the future.
Now remains to be seen.
We do have some evidence thatthis might work.
Speaker 2 (22:39):
Yeah, I think that's really attractive to patients.
Patients are always alarmed,and rightly so, about systemic
medicines.
That they have to takesomething a pill by mouth or do
something by IV, that, you know,does cause for concern.
The side effects would be veryinteresting to see if we can
have good local control andminimize that exposure.
That could be a double, adouble win-win, if you will.
(23:01):
Well, thank you, brent, so muchfor coming on the podcast.
You know I really appreciatethe information you provided
because this grave, you know, Ithink really excuse me gives us
really a great sort of justperspective on skin cancer that
I think a lot of people aren'tfamiliar with.
I think people hear a basalcell.
They kind of have familiaritywith that squamous cell.
You know you survey people.
They're kind of not suremelanoma they know about, but
(23:22):
this really highlights, you know, where skin cancer is important
to us as dermatologists, butmore important to the public, as
we see how much people areaffected by it.
And you're right, odds are oneof us is going to have it, maybe
more than once, although we'llhave to have a contest who's
better with the sunscreen?
I don't know.
We'll have to go back and look.
Did you use the tanning band,brad ever.
Speaker 3 (23:41):
No, I avoid it.
Speaker 2 (23:43):
You beat me on that one.
You beat me on that one.
So that was the college trendback in the day and we really
didn't know the risks.
But you know, skin cancer issomething we all probably
encountered some way shape orform in our lives ourselves,
personally or somebody else andthis gave a great taste of that.
You know, for our listeners, ifthey want to find you, where
can they locate you and learnmore about you?
Brian?
Speaker 3 (24:03):
Well, I, um, I have a practice website, heritage
medicalcom.
All one word Heritage Medical.
I'm part of a group calledHeritage Medical Associates in
Nashville, tennessee.
I'm not overly active on socialmedia, but I occasionally will
post things related to skincancer on my ex account, which
(24:25):
is at Brent Moody, tn.
So if there's something reallyinteresting about skin cancer,
I'll sometimes post that.
Or if you like 1980s new wavemusic, you can.
You can check as well, but youknow, that's that's certainly
how people can can find eithermy practice website, heritage
Medical Associates in NashvilleTennessee or at Brent Moody TN.
Speaker 2 (24:49):
Well, thank you again for sharing your expertise.
It's been great to have you on.
We'll definitely have to bringyou back on and get a little bit
more detailed into skin cancer,because there's so much more we
could definitely talk about.
And everyone, stay tuned forthe next episode of Dermot
Trotter.
Don't Swear About Skin Care.
Speaker 1 (25:08):
Thanks for listening to Dermot Trotter.
For more about skin care, visitdermottrottercom.
Don't forget to subscribe,leave a review and share this
podcast with anyone who needs alittle skin care sanity.
Until next time, stay skinsmart.
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