Draper, UT | Melanoma | Jerry Chidester, MD
Dr. Jerry Chidester: Hey, everybody. Today we have a special topic, and we're talking about skin cancer detection, specifically melanoma. I actually have one of our wonderful patients here today. Stephanie is here with us, and she actually has a personal experience with this. So I'm going to ask her if it's okay. Maybe could you share a little bit about your story and your background?
Stephanie: I went to an annual checkup with my OB-GYN, and she went over my body and was concerned about some places that I never thought anything of. She asked me to go in and get them checked out by a dermatologist, and I never did. And just kind of ignored it and went back, I think it was a year later, to my OBG and finally she had enough. So she made them call me to schedule. Sure enough, I went in and right away they were like, "This is definitely melanoma." So within a week, I had scheduled surgery and they took seven places that time.
Dr. Jerry Chidester: And there's this kind of the perception, or their misperception, I should say, about dermatology and plastic surgery is we also treat skin lesions all the time. And a lot of people will come to plastic surgeons because it is in a cosmetically sensitive area. And just with the plastic surgery background and training, the principal base in terms of not just treating the cancer, which is important, but also make sure the closure looks nice and as thin a scar as possible, especially in cosmetically sensitive areas, the places on the face, on the body, and all these other things. Now if there's ever lesions that we're really concerned about or we know they've been biopsied and they've been shown to be cancer, there are other ways to actually remove skin cancers as well that minimize the amount of tissue we have to take out.
Dr. Jerry Chidester: So make those scars are not so big, but also make sure that we get it out. It's always a balance. Taking out the cancer, but also making sure we can make it look nice. With melanoma, there's certain things, though, that we should also talk about in terms of detection. You may have heard of the A,B,C,D,E's. Ever heard of this alphabet thing? So it's kind of an easy way to remember. Okay. What are the features about melanoma, specifically, that we should look out for?
Dr. Jerry Chidester: A stands for asymmetry. So if you're looking at it, it looks asymmetric, meaning the shape of it is not either perfectly oval or not round, or kind of looks like a splosh or like someone hit you with a paintball gun or something, if it has irregular asymmetry to it, that's one thing to maybe keep an eye out for. B is kind of looking at the border of it. Again, just looking at the shape and the border. C is for the color. So if there's any color change, or if there's any color irregularities, like there's more red to it or changing brown colors, brown, black pigments.
Dr. Jerry Chidester: But then so D is the diameter of it. So if it's more than six millimeters, it's not very big, but if it's more than six millimeters, it's a higher chance of being something more that we should be concerned about. And then E is evolution of it, or change in it. So like I said, it looks one way and then all of a sudden it looks differently a couple months later. If it is evolving or changing, that's something we should keep an eye on. So those are the A,B,C,D,E's of melanoma.
Dr. Jerry Chidester: So now we're going to go ahead. We're going to go back. We have a few areas I know you wanted to address. And so we're going to do that today. We're going back to the operating room.
Dr. Jerry Chidester: All right, so we are going to do some numbing here. So I use a numbing solution that has a few things in it. So it has lidocaine, which acts pretty quickly, but fades out pretty quickly, about an hour or so. Then we also use marcaine, which takes a little bit longer to kick in, but it can last eight to 10 hours for pain control. So it's great. And then the third thing I put, the secret concoction, is sodium bicarb. So that helps decrease the acidity of the lidocaine and the marcaine so it doesn't burn so much as we're injecting it. She did say... What did you say earlier, though, out of all the times you've had it done, what about it?
Stephanie: It hurt the least.
Dr. Jerry Chidester: Okay. See, that's good. So it hurts a little bit, but the least. That's what we're going for. So again, we're going to inject these couple of areas here and we're using Goldie today. This is a new technique for this, but if we can distract the nerves, distract her a little bit with that, that would help. And that's why. I don't know. So anyway, we're going to just do a little poke here again. Okay, once in here. It's okay if it's puffy like this. I'm happy with that. Okay, did great. And I always just gently pinch. You're going to feel a little pressure. Not like dentist pressure. It's just a little pulling maybe when I put the stitches.
Dr. Jerry Chidester: So I always check to make sure she doesn't feel anything sharp. Because these are kind of... The [inaudible 00:04:42] are there to grab tissue. So the goal for these is to remove, obviously, the entirety of what you can see for it, but I'll be able to close it, make it look nice, too. This one's out. One of your friends is gone.
Speaker 3: Look it up.
Dr. Jerry Chidester: Check it here.
Speaker 3: Sorry, a little [inaudible 00:05:23] here.
Stephanie: Oh, no worries.
Dr. Jerry Chidester: Okay. So we're done here at the neck, and I just want to show we're doing something here where we have permanent stitches in, but they're under the skin. And I just want to show you what that is. So I have these little knots hanging on both ends. So there are dissolving stitches underneath here and in her neck. But then I run underneath this skin, this permanent blue suture called a proline, and I tie the ends out. So what we'll do is we'll come back in about five to seven days or once it's healed, and we'll just snip these out and just gently pull them out. So there's no retained, permanent suture.
Dr. Jerry Chidester: We're all done. So we did a few places on your neck, right? Like four here, four spots. Then we do one on your tummy and then a couple on her side. So how do it go?
Dr. Jerry Chidester: Is it okay?
Stephanie: Yeah, it's great.
Dr. Jerry Chidester: She didn't cry at all. Only at the beginning.
Stephanie: Only a little bit.
Dr. Jerry Chidester: Awesome. Nice job. Okay. So I just want to talk quickly about skin protection. Though there's different ways, you mentioned sunscreen, sunscreen is great. There's UVA and UVB rays that you hear about, and sunscreen and most of the majority ones protect against the UVB. And then there's actually some products that protect against UVA rays now, too. So the thought is actually initially that UVA is like no big deal, but actually UVA, the more we study it, the more we think that actually, because the penetration's a little bit different, that we should protect against it, too. Cool. All right.
Dr. Jerry Chidester: (singing)