Derm-it Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-it Trotter! Don't Swear About Skincare.
Skin Cancer Beyond Melanoma: The Silent but Treatable Threat
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.
Welcome to Dermot Trotter Don't Swear About Skin Care where host Dr Shannon C Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skin care experts to separate fact from fiction and simplify skin care. Let's get started.
Speaker 2:Welcome to the Dermot Trotter Don't Swear About Skin Care podcast. I have a great guest here with us today, dr Brent Moody. He's double board certified in dermatology and dermatologic surgery. He's a practicing Mohs surgeon who specializes in skin cancer. In fact, his practice is pretty much entirely dedicated to skin cancer and he's here today to really give us the skinny on skin cancer and help you understand it a little bit better and maybe treatment. So when you walk out of here you'll have just a better grasp on what we mean when we talk about skin cancer the most common cancer, just to let everyone know and remind you out there because it deserves attention. So welcome to the podcast, brent.
Speaker 3:Thanks, shannon, I really appreciate the opportunity.
Speaker 2:Well, you know, skin cancer. I think a lot of people stop, you know, probably if you know they're in the office talking with you and you've diagnosed them. Or maybe we're reaching out via phone and saying, yep, you have skin cancer, and immediately they stop listening because cancer is, you know, serious business. We know this in healthcare. When we think about skin cancer, do you mind talking a little bit about the more common types of skin cancer and why do they actually even form in the skin?
Speaker 3:Yeah, thanks for having this as a topic on your podcast. This is a big topic and, more likely than not, either you or a loved one or a friend at some point in their life is going to develop skin cancer. It is so common. And really, when we talk about skin cancer, while there is a huge, long list of types of skin cancer, most people are going to be dealing with one of the two most common types, that's, basal cell carcinoma and squamous cell carcinoma. So first question well, why do people get skin cancer?
Speaker 3:We know there are certain things that predispose people to developing skin cancers, although in some instances, to be honest, it just appears bad luck. We don't know why you got a skin cancer, you just got one. But we do know that people who've had greater sun exposure over their lives, people who have had tanning bed use, those type of behaviors, can predispose someone to a skin cancer, and there are certain medical conditions that can predispose people to skin cancer as well. We know the immune system is really important in keeping skin cancers in check. So folks who have either medical conditions or take medications that alter the immune system can lead to skin cancer. So those are some of the things we know that cause them, and so the first thing I like to tell people is we do have an idea what leads to this. So let's try to modify behaviors and avoid the sun, put on sunscreen, wear long sleeves, wear a hat.
Speaker 3:These are the simplest things, and as a while I do specialize in skin cancer, people also ask me just about skin in general and they'll say what can I do for my skin to look as good as it can? And so let's keep it simple. I'm not going to sell you any potions or lotions. I want you to put on a hat and wear sunscreen. So that's how strongly I feel about really patients taking control of their own skin and mitigating those risk factors.
Speaker 3:As far as how does it develop and what's the difference, I would say for the vast majority of the basal cell carcinomas and the squamous cell carcinomas, you know, for most people they're basically going to be the same. I mean it comes from the skin. It's a slightly different cell in the skin that turned into cancer, but for all practical purposes, the risk factors of getting it are similar. The treatments can be similar for the vast majority of skin cancers. It's really only when we start getting more advanced basal cell carcinomas or advanced squamous cell carcinomas that there can be dramatic differences in the two in the tube.
Speaker 2:I like what you comment on there too about the prevention piece, because I think a lot of people think, oh gosh, I've got a skin cancer and now what I'm going to do? That's very important, but circling back to maybe preventing them from getting another one, or even from the first place, important things to highlight. And then also, what I love about what you said is you're not telling people to live like a vampire and don't enjoy life. You know, I think sometimes we get a bad reputation as dermatologists that we hate the sun, and I always tell patients no, we don't hate the sun, the sun's good for you know health and mood and obviously you know all the environmental impact. But like anything else, moderation. Just do it smarter when you're out there and work on that prevention piece.
Speaker 2:And you mentioned basal cell and squamous cell. You know the two most common types of skin cancer we tend to deal with and kind of how they come from different cells in the skin and behave. You know somewhat similar until they kind of get advanced. And you touched a little bit on treatments being the same. Do you mind kind of describing a little bit more about what are some of the treatment options, because I think people probably know surgery and maybe touch a little bit on Mohs in particular, what you specialize in, because people don't even know what Mohs is and you know, for those folks that maybe think, well, surgery not for me, you know, what are some other options that I might be able to do?
Speaker 3:Well, the first thing I want to let people know is we have lots of great treatment options for skin cancer. So the vast majority of people who 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 that does have to deal with it, know that in the vast majority of instances we're going to be able to take care of that skin cancer one way or the other with great success. So you're more likely than not you're going to do just fine with great success. So you're more likely than not you're going to do just fine, I would say.
Speaker 3:Typically, surgery is sort of a mainstay. We've done it for decades and decades and decades. It's very effective. It's very cost effective. It's generally done in the office setting. We don't have to go to the hospital, you don't have to be put to sleep by an anesthesiologist. It's generally done in the dermatologist office. So so it's a very cost-effective way to treat a skin cancer and for many times you remove it, put in some stitches and that's going to be the end of the matter.
Speaker 3:You specifically asked about Mohs surgery, and Mohs surgery is a specialized form of surgery that makes sense for certain skin cancers it's not for every skin cancer is the cancer is removed in a stepwise fashion and allows the Mohs surgeon to prepare microscope slides and look for the roots of the cancer. While we go. I tell my patients that skin cancer is sort of like a weed there's what we see on the surface and there's roots. And if we just scrape the top off of a skin cancer just like if we just cut the top off of a skin cancer, just like if we just cut the top off of a weed but leave the roots it'll come back. So it allows us to find those roots and it's very effective. It's been around for many decades and there are many really great Mohs surgeons all over the country, so I think Present company included Brent.
Speaker 2:Present company included so.
Speaker 3:I think if you need Mohs surgery you should be able to find someone pretty close to you who offers this service. Now, that's not for every skin cancer. Many skin cancers can be just removed surgically without that instant microscope examination. That's very effective. So if your doctor recommends just a regular surgical procedure and not necessarily Mohs surgery, it's probably fine. So don't feel like, oh, I always have to have this Mohs surgery. But, as you said, surgery some people don't want surgery.
Speaker 3:Many skin cancers can be treated without a surgical procedure and so surgery works for many of them. And we have really good non-surgical options at the two extremes. We have great non-surgical options for really early skin cancers and we have some really great non-surgical options for more advanced skin cancers. Now, advanced ones in the past would have been treated with a really involved, large surgical procedure. We'll talk about those in a minute.
Speaker 3:But many early skin cancers, ones that are very small, very superficial, can be treated with topical medications. There are several creams that have been around for a long time that can be really effective for these early skin cancers. So your doctor may suggest you try one of these creams, and I use those routinely in my practice and they do a great job in the properly selected cancer. I mentioned roots, just like the weed. So generally we're going to use some sort of medicine, a cream, in ones that we don't think have very deep roots, because if you have deep roots it's hard to get the medicine down where it needs to get. So if you have a very early skin cancer your doctor may say let's just try this cream and they do great. Your skin might get a little irritating right while you're using it, but you'll do great with that.
Speaker 3:There are some procedures that are not full-blown surgeries that are also very effective for certain skin cancers. We can actually use liquid nitrogen and freeze it. I mean we just sort of freeze off the top layer of skin and that can take care of many early skin cancers. We usually do that for pre-cancers more than skin cancer, but in the right setting it may work for a skin cancer. The other thing we'll sometimes just numb the skin and kind of scrape the top of the skin off and cauterize it, and that works really well. So there's sort of minimally invasive procedures. So we've got creams, minimally invasive procedures. We have surgery, including Mohs surgery, and on the other end of the spectrum, if you are unfortunate and have a more advanced skin cancer.
Speaker 3:Whether it's basal cell carcinoma or squamous cell carcinoma, we have non-surgical options. In both of those instances they can be treated with radiation therapy. Radiation as a treatment for cancer has been around for many cancers for many decades. Works really well in the properly selected patient. The downsides to radiation is it is a series of treatments, so patients have to go back multiple times, so there's some inconvenience to it and it can be a very costly way to treat a cancer as well. Inconvenience to it and it can be a very costly way to treat a cancer as well. So we like to reserve that when the simpler, cheaper things may not work.
Speaker 3:And then for both basal cell and squamous cell we now have systemic medicines, either pills that you take or injections that you get, that work really well. Again, these come with some side effects because they are systemic medicines, but they work really well again, in the properly selected patient. For the basal cell, we primarily use pills. There's a couple of different pills available and you have to take those for a number of months. They do have some side effects but most people do well with them. They're not terrible side effects.
Speaker 3:For squamous cell carcinoma, most of our systemic therapies are going to be an IV infusion. That's where we are right now with those. It can be very effective for the advanced squamous cell carcinomas and by and large, we use medicines that harness our own immune system. I tell my patients who undergo this therapy that the actual medicine that we're giving you doesn't do anything to the cancer. It doesn't kill cancer cells. That's old-fashioned chemotherapy, right, we give people chemotherapy. They would have awful side effects because we were giving them a medicine that directly killed the cancer cells.
Speaker 3:With this new form of treatment called immunotherapy, we give you a medicine, or a patient a medicine, and it teaches the immune system. It turns the immune system on and lets your body's natural immune system attack the cancer. So it's a really novel way of treating cancer. We've been doing this for about a dozen years or so. Patients generally do quite well, but there can be side effects as well, and that's something you'd want to talk to your doctor about.
Speaker 3:So these are some really exciting things going on in the skin cancer space or realm that we didn't even have just again a dozen years ago. Cancer space or realm that we didn't even have just again a dozen years ago. And then, finally, there are times we have to do all of these things. We do surgery plus radiation or surgery plus medicine, or medicine. So if someone is dealing with a very difficult skin cancer and this is not common at all but it happens your doctor may recommend you do multiple things for that skin cancer Again, I would say most people watching your podcast are probably going to fall in that category of hey, a cream or relatively successful surgical procedure in the office.
Speaker 2:And you mentioned also the cream for early skin cancers too. Do you recommend, or sometimes do, electro desiccation and curatage as well, or you'll do that scraping you mentioned. They'll sometimes do that for the early skin cancers as well.
Speaker 3:That works great for early skin cancers. Again, you got to think about how deep it might be, because you can only sort of scrape, scrape so deep. So yeah, that works really well for a lot of skin cancers.
Speaker 2:So my view on these, and I think most of my colleagues view, is let's do the simplest, easiest treatment that will take care of your particular skin cancer. And that sounds like a good philosophy, because I think you showed for patients their treatment options too, especially maybe if their skin cancer is early. And you can include patients in that conversation, because I know preference of the patient plays a role sometimes if we're able to have choice, which is kind of the luxury with basal cell and squamous cell. But I know you've seen this and I've seen it too with my career, not so much on the basal cell and squamous cell, but I know you've seen this and I've seen it 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, systemic therapy.
Speaker 2:But I think the one I wanted to sort of tackle is squamous cell carcinoma because it seems to be, you know, an entity to we're learning a bit more about for those more aggressive cases where it has potential, you know, to spread or even cause death Cause. I think you know we, you know, kind of minimize. I think some people minimize skin cancer in general, thinking that, oh, most of it's curative by surgery, which very well, true, but we do see those bad cases too. Do you mind talking about some of your experience, especially with squamous cell? You know when you're worried about could this be a really bad actor? And you know, are there any tests or new technology that can really help us identify those squamous cells so that maybe we can approach that patient differently?
Speaker 3:Sure. So squamous cell carcinoma is the second most common type of skin cancer and more people die of squamous cell carcinoma than they do of melanoma. Now, most people have heard of melanoma. There are occasionally celebrities will get melanoma and we hear that they end up passing from that, but more people will die of squamous cell carcinoma than melanoma. So, despite some of my earlier statements that most people do really well, unfortunately there was some cancers that can be quite significant. And so your question well, how do we figure out? Is this particular squamous cell carcinoma more or less likely to become a big problem? And there are a few factors or things that we need to think about. The first thing we need to think about is the actual cancer itself, that actual tumor we call it, and so that cancer will have certain features, it will have a size, it will have a depth. There will be certain things that we see under the microscope that a pathologist will tell us, certain features that we know are aggressive for squamous cell carcinoma. So these are things that we're all going to look for. What does it look like under the microscope? How big is it? You know, what does it look like under the microscope? How big is it, how deep is it going and where is it located? You know we might approach a cancer on someone's lip very differently than the middle of their back. So those are some of the the the tumor features that are important in figuring out, well, what's the best way to treat this particular situation.
Speaker 3:Then there are patient factors that we need to think about. As you said, patient preference is really important. Some patients have a feeling, one direction they might like to go in, and that's very important. But there are other things that influence how we think about this. One is the status of the immune system, and I mentioned that some of the medicines we use are designed to turn on the immune system, because the immune system can help get rid of a skin cancer. So if someone has a medical condition or takes a medicine that depresses their immune system, we know that the cancer may behave more aggressively. So we may need to be more aggressive in our thinking if we're approaching someone, and this might be someone who has had a heart transplant or a kidney transplant and they have to take immunosuppressive medicines, or it may be someone who has a medical condition. There are some blood cancers that can be really common. That might not kill the person but depress their immune system. So those are patient things we think about and then finally, we have to just build the whole picture and we have to look at what's the person's overall health, what's their life expectancy? Do they have other major medical problems that might be life limiting? So these are all things that we have to put together.
Speaker 3:There are some new things and I've been really lucky I've been able to work with some of the people that have developed these tools where we can look at a cancer's genetic profile. So cancers have a genetic profile. Just like all of us, we have a genetic profile that was given to us by the DNA we got from our parents. But these cancers will have a genetic profile as well, and the cancer genetic profile has nothing to do with the person's genes.
Speaker 3:It's unique to that cancer and what we've discovered, or scientists who look into this, is that certain profiles of gene expression are associated with cancers that tend to be more aggressive. So if you have a squamous cell carcinoma that's on the more aggressive side, your doctor may order some additional tests, some of these genetic tests, to provide some more information. And we don't do that for sort of less significant skin cancers, because we want to use all of our medical resources, you know, judiciously. We don't want to, you know, make things more complicated than they need to be so many times. Most surgeons and dermatologists and oncologists will use what we call a gene profile to help figure out is this cancer more or less likely to be aggressive? And, if so, we may opt for a little more aggressive treatment, knowing that that cancer warrants that treatment.
Speaker 2:Well, that gives a really, I think, good overview, you know, for patients to understand that, because I think you know, in general for squamous cell, like we talked about, people don't think about the other factors that might put them at risk, especially the things you know. A patient coming in may not even realize, if their immune system isn't working very well, that maybe that puts them at higher risk for squamous cell carcinoma potentially spreading or being more of a nuisance of what they might've thought if they didn't have a weakened immune 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 and helping us. Is there anything else that you feel like with basal cell, squamous cell that you want to share with our audience you think is important, you know, in their understanding of those skin cancers and where we are moving forward into the future?
Speaker 3:Well, the great news is our ability to treat these has just gotten better and better with time.
Speaker 3:There have been really major advances again in the systemic treatment of these cancers really in the last dozen years or so, both for basal cell carcinoma and squamous cell carcinoma, so we can successfully treat tumors that even again, 15 years ago would not be able to be treated at all.
Speaker 3:So there's lots of excitement. I think where we're heading is taking these systemic therapies that we give intravenously or by pills and figuring out a way to apply that same idea, that same technology in a local way. So not specific to skin cancer, but some of these immunotherapy medicines that turn on the immune system that we've been giving IV we can now give just by a shot, and so the idea that we're going to again go from this treatment everywhere just to the local area I think is really exciting. We call that interlesional therapy and there are certain there are still some interlesional therapies that exist, that have existed for a long time. But I think some of these more advanced treatments are going to become more directly into the tumor 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 that this might work.
Speaker 2:Yeah, I think that's really attractive to patients. Patients are always alarmed, and rightly so, about systemic medicines. That they have to take something a pill by mouth or do something by IV, that, you know, does cause for concern. The side effects would be very interesting to see if we can have good local control and minimize that exposure. That could be a double, a double win-win, if you will.
Speaker 2:Well, thank you, brent, so much for coming on the podcast. You know I really appreciate the information you provided because this grave, you know, I think really excuse me gives us really a great sort of just perspective on skin cancer that I think a lot of people aren't familiar with. I think people hear a basal cell. They kind of have familiarity with that squamous cell. You know you survey people. They're kind of not sure melanoma they know about, but this really highlights, you know, where skin cancer is important to us as dermatologists, but more important to the public, as we see how much people are affected by it. And you're right, odds are one of us is going to have it, maybe more than once, although we'll have 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:No, I avoid it.
Speaker 2:You beat me on that one. You beat me on that one. So that was the college trend back in the day and we really didn't know the risks. But you know, skin cancer is something we all probably encountered some way shape or form in our lives ourselves, personally or somebody else and this gave a great taste of that. You know, for our listeners, if they want to find you, where can they locate you and learn more about you? Brian?
Speaker 3:Well, I, um, I have a practice website, heritage medicalcom. All one word Heritage Medical. I'm part of a group called Heritage Medical Associates in Nashville, tennessee. I'm not overly active on social media, but I occasionally will post things related to skin cancer on my ex account, which is at Brent Moody, tn. So if there's something really interesting about skin cancer, I'll sometimes post that. Or if you like 1980s new wave music, you can. You can check as well, but you know, that's that's certainly how people can can find either my practice website, heritage Medical Associates in Nashville Tennessee or at Brent Moody TN.
Speaker 2:Well, thank you again for sharing your expertise. It's been great to have you on. We'll definitely have to bring you 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 for the next episode of Dermot Trotter. Don't Swear About Skin Care.
Speaker 1:Thanks for listening to Dermot Trotter. For more about skin care, visit dermottrottercom. Don't forget to subscribe, leave a review and share this podcast with anyone who needs a little skin care sanity. Until next time, stay skin smart.
