Transcript: Skin Conditions | Oct 08, 2003

(music plays)

Against a blurry background of blue and pink pills, a video reel displays pictures of medical gear such as a needle, a scan of a human body and heart rate monitors.

The title of the show slides in: “Mini-Med School.”

Then, Gary Sibbald stands on a stage in a university auditorium giving a lecture. He’s in his mid-forties, with short blond hair and clean-shaven. He’s wearing a brown suit jacket, a light shirt, a striped brown tie and glasses.

Behind him, a computer screen is projected on a tall white wall.

Gary says YOU REALLY
HAVE TO BE A VISUAL LEARNER TO
PRACTICE DERMATOLOGY.

A caption appears on screen. It reads “R. Gary Sibbald. University of Toronto. Skin Conditions.”

Gary continues BUT YOU HAVE TO USE ALL YOUR
SENSES IN TERMS OF COMING UP
WITH THE RIGHT DIAGNOSIS.
SO, I'D LIKE YOU TO COME ON A
JOURNEY WITH ME AND DO EXACTLY
THAT.
AND HERE'S AN INDIVIDUAL THAT
REALLY IS PRESENTING WITH SCALE
AND VERY ROUGH APPEARING,
SLIGHTLY RED SPOTS ON THE BACK
OF THE HAND.
AH, THESE ARE CALLED ACTINIC OR
SUN INDUCED KERATOSIS.

He runs a PowerPoint presentation.

He continues THEY INDICATE TO A
DERMATOLOGIST, THAT WE'RE
REALLY LOOKING AT AN INDIVIDUAL
THAT'S HAD TOO MUCH SUN
EXPOSURE FOR THEIR SKIN TYPE
OVER A NUMBER OF YEARS.
AND WE'D BETTER START LOOKING
FOR SKIN CANCERS AND OTHER
THINGS.
NOW, WE HAVE THIS LITTLE
BALLPINO APPEARING IN ONE PART
OF THE HAND.
IT'S A CUTANEOUS CORN.
BUT ON BIOPSY, THIS IS ACTUALLY
A SQUAMOUS CELL CANCER.
AND A CUTANEOUS CORN IS A
CLINICAL DESCRIPTION FOR WHICH
YOU MAY HAVE MANY THINGS UNDER
THE SURFACE.
AND THE SKIN IS THE LARGEST
ORGAN IN THE BODY.
BUT ON BIOPSY, THIS IS ACTUALLY
A SQUAMOUS CELL CANCER.
AND A CUTANEOUS CORN IS A
CLINICAL DESCRIPTION FOR WHICH
YOU MAY HAVE MANY THINGS UNDER
THE SURFACE.
AND THE SKIN IS THE LARGEST
ORGAN IN THE BODY.
IT'S MADE UP OF SCALE ON THE
OUTSIDE, WHICH IS THE END STAGE
OF THE OUTER LAYER OF CELLS,
YOUR EPIDERMAL CELLS, THAT TAKE
ABOUT 28 DAYS TO MIGRATE FROM
THE BASE UP TO THE TOP AND THEN
THE SCALE IS LOST OFF THE
SURFACE OF THE SKIN.
BUT THE KEROTIN IN THE SCALE
GIVES US PROTECTION.

He points at the slide with a laser pointer and continues THE SECOND LAYER IS THE DERMAS,
AND WITHIN THE DERMAS, WE
REALLY HAVE BLOOD VESSELS.
WE HAVE COLLAGEN, WHICH WHEN IT
GOES ASTRAY IT LEADS TO
WRINKLES.
AND IT LEADS TO A LOT OF THE
DAMAGE.
ULTRA VIOLET A GETS DEEPER IN
OUR SKIN AND ACTUALLY CHANGES
THE COLLAGEN.
IT ALSO CHANGES OUR PIGMENT OR
OUR SKIN COLOUR, BECAUSE IT
DISRUPTS THE JUNCTION BETWEEN
THE TWO LAYERS OF SKIN, AND THE
MILLANISITES GET DISTURBED.
AND SO WE MAY GET TOO MUCH OR
TOO LITTLE PIGMENT.
MILLANISITES ARE CELLS THAT
PRODUCE PIGMENT IN OUR SKIN.
THIS IS ONE DAY IN THE LIFE OF
A DERMATOLOGIST, AFTER WINTER
LIKE WE'VE JUST HAD.

A picture shows a woman with her chest sunburned.

He continues IF YOU CAN IMAGINE THE FIRST
LONG WEEKEND THAT'S SUNNY, WE
GET EVERYBODY OUT LOOKING FOR
THE RAYS.
AND IN ONE DAY, I CAN SEE TEN
OR TWELVE SUNBURNS.
AND IT CAN BE PATIENTS THAT ARE
TRYING TO COVER UP OR OTHERS
THAT ACTUALLY NEED SYSTEMIC
STEROIDS LIKE THIS ONE TO TREAT
THIS.
AND YOU HAVE TO REMEMBER THE
REDNESS FROM A SUNBURN DOESN'T
BECOME MAXIMUM TILL FOUR TO SIX
HOURS AFTER.
AND THIS JUST SHOWS FOUR
DIFFERENT INDIVIDUALS INCLUDING
A CHILD WITH A BLISTERING BURN
IN ONE DAY IN A DERMATOLOGIST'S
OFFICE.
AND BESIDES THE BURN, WHICH IS
OBVIOUS DAMAGE TO THE SKIN, NO
TAN IS A SAFE TAN.
A TAN IS A RESPONSE TO INJURY.
SO THAT IT IS THE BODY TRYING
TO INCREASE ITS PROTECTION.
AND WE LOOK AT SUN PROTECTION
AT FOUR LEVELS, AND EVERYBODY
THINKS OF SUNSCREEN, BUT IT'S
REALLY NUMBER FOUR.
NUMBER ONE IS TO AVOID DIRECT
EXPOSURE BETWEEN ELEVEN AND
FOUR.
NUMBER TWO IS TO WEAR
PROTECTIVE CLOTHING.
NUMBER THREE IS A HAT, AND TO
PROTECT YOUR EARS AND THE TIP
OF YOUR NOSE YOU NEED A BRIM OF
7.5 CENTIMETRES, OR THREE
INCHES ALL THE WAY AROUND.
AND A SUNSCREEN OF 15 OR
HIGHER.
SO, SLIP, SLAP AND SLOP.
AND I THINK YOU HAVE TO BEWARE
OF SUNLAMPS.
SUNLAMPS ARE ULTRA VIOLET A.
THEY ARE GOING TO ADD TO THE
PHOTO DAMAGE YOU ALREADY HAVE.
IF YOU DON'T TAN IN NATURAL
SUN, YOU'RE NOT GOING TO TAN
MORE READILY UNDER A SUNLAMP.
IT IS NOT GOING TO GIVE YOU
PROTECTION BEFORE YOU GO DOWN
SOUTH.
AND THEY'LL OFTEN TELL YOU NOT
TO WEAR THE GOGGLES, AND IF YOU
DON'T WEAR THE GOGGLES, EYE
INJURIES CAN SEND YOU TO AN
EMERGENCY DEPARTMENT.

Slides display a woman wearing goggles and a baby on the beach.

He continues AND I THINK YOU HAVE TO BE
AWARE OF UNPROTECTED SKIN, AND
JUST LIKE THIS BABY AND EXPOSED
BUTTOCKS.
WE DON'T OFTEN IN OUR SOCIETY
USUALLY EXPOSE OUR BUTTOCKS TO
THE SUN.
BUT YOU WANT TO SEE HOW MUCH
DAMAGE YOU'VE GOT ON YOUR SKIN,
YOU CAN LOOK IN THE MIRROR, AND
YOU CAN LOOK AT YOUR CHEEKS.
BUT REMEMBER, YOU HAVE TWO SETS
OF CHEEKS.

[Audience laughs]

Gary continues SO, WHAT
YOU CAN DO IS WITH A HAND HELD
MIRROR YOU CAN LOOK AT THE
OTHER ONES.
AND THOSE WILL SHOW YOU AGING.
THE DIFFERENCE BETWEEN THE
CHEEKS YOU SIT ON AND THE
CHEEKS THAT YOU EXPOSE EVERY
DAY WILL GIVE YOU YOUR PHOTO
AGING.
OKAY?
OR WHAT AMOUNT OF AGING HAS
OCCURRED BECAUSE OF SUN
EXPOSURE LIFE LONG.
AND REMEMBER THE SKIN IS LIKE
AN ELEPHANT?
IT NEVER FORGETS.
AND ALL OF LIFE LONG SUN
EXPOSURE IS CUMULATIVE.
AND ONE BLISTERING, BURN CAN
LEAVE YOU WITH THESE DARK SPOTS
OR SOLAR LINTINGANIES.
AND WHEN I SEE A PATIENT WITH
THIS I CAN SAY, WHEN DID YOU
GET YOUR BLISTERING BURN?
AND THEY SAY WELL, HOW DO YOU
KNOW?
WELL, IT'S PRETTY EASY.
AND THAT KIND OF FRECKLE
DOESN'T FADE IN THE WINTER.
AND THE LONG TERM CHANGES
REALLY REFLECT WRINKLING, WHICH
IS MORE PRONOUNCED IN THE SUN
EXPOSED AREAS, AND IF YOU LOOK
UNDER THE CENTER OF THE CHIN
IT'S NOT AS DRAMATIC.

Photographs of elderly women appear.

He continues AND YOU ALSO START TO GET
NUMEROUS, SMALL, NET LIKE BLOOD
VESSELS ON THE SURFACE OF THE
SKIN, AND THESE ARE CALLED
TILANGGETASIAS.
AND THOSE ARE VERY TINY, THREAD
LIKE BLOOD VESSELS THAT BECOME
MORE PROMINENT AS WE'VE GOT
CHRONIC SUN DAMAGE.
AND YOU CAN SEE THAT YOU CAN
GET VERY DEEP WRINKLES EVEN IN
THE BACK OF THE NECK.
AND THE ULTRA VIOLET A THAT MAY
BE RESPONSIBLE FOR A LOT OF
THIS CAN GO THROUGH OUR CAR
WINDOWS.
SO, THAT EVEN IN THE WINTER
MONTHS, EVEN THOUGH WE MAY NOT
BE OUT FOR LONG PERIODS OF
TIME, IF YOU'RE SITTING IN
TRAFFIC LIKE THERE'S BEEN IN
TORONTO THIS WEEK, YOU MAY HAVE
GOT A LOT THROUGH YOUR CAR
WINDOW.

A slide reads “Sun Protection Factor.”

He continues WHEN WE LOOK AT A SUNSCREEN, A
SUNSCREEN IS MARKETED WITH A
SUN PROTETION FACTOR, SPF.
THERE IS AN INDIVIDUAL WITH A
RATHER RED AND SCALEY FACE, AND
THIS REPRESENTS THE SUN DAMAGE
FROM LIVING IN THE TROPICS ON A
PLANTATION FOR 40 YEARS.
HE'S HAD MANY SKIN CANCERS.
AND THESE ARE CALLED THE
ACTINIC OR SUN INDUCED
KERATOSIS OR SCALIARIES.
AND THEY REPRESENT SUN DAMAGE
TO THE EPIDERMAL CELLS, AND
THESE CELLS BECOME IRREGULAR.
AND THEY HAVE PRE-CANCEROUS
CHANGE.
THEY'RE ACTUALLY CLUSTERED AT
THE BASE OF THE EPIDERMUS, AND
IN AN IRREGULAR WAY.
SO, THAT AS THEY MIGRATE UP,
THEY PRODUCE A VERY IRREGULAR
SURFACE SCALE OR KERATIN, AND
YOU GET A LOT OF INFLAMMATION.
WHAT IS IMPORTANT IS IT'S MORE
COMMON IN INDIVIDUALS WITH BLUE
EYES AND A LIGHT COMPLEXION.
IF YOU'RE CELTIC.
IF YOU HAVE RED HAIR OR BLONDE
HAIR.
IF YOU'VE HAD A LOT OF OUTDOOR
EXPOSURE, FARMERS OR FISHERMEN
OR PEOPLE WORKING ON THE HYDRO
LINES.
PREVIOUS BURNS, OR IF YOU TAN
POORLY, AND WE SHOULD BE
EXAMINING THESE INDIVIDUALS FOR
SKIN CANCERS.
AND I THINK THAT'S THE
IMPORTANT MESSAGE.
ABOUT ONE IN A THOUSAND PER
YEAR WILL CONVERT TO A SKIN
CANCER.
AND THE KIND THEY CONVERT TO IS
CALLED A SQUAMOUS CELL.
ABOUT 25 percent OF THEM MAY
SPONTANEOUSLY GO INTO
REMISSION.
AND THERE HAVE BEEN GOOD,
CONTROLLED STUDIES.
RANDOM CONTROLLED STUDIES, THAT
SHOW THAT IF YOU USE A
SUNSCREEN, VERSUS A VEHICLE
CONTROL, AND IN THE NEW ENGLAND
JOURNAL OF MEDICINE, THAT YOU
DECREASE THE NUMBER OF ACTINIC
KERATOSIS ON YOUR EXPOSED SKIN
IN THE STUDY, WITH REGULAR USE
OF SUNSCREEN OVER SIX MONTHS.
AND VERY INTERESTING, AND I
DON'T KNOW THE EXPLANATION FOR
THIS.
INGESTION OF A LOW FAT DIET
DECREASED THE DEVELOPMENT OF
NEW LESIONS OVER A 24 MONTH
PERIOD.
AND I'M NOT SURE THE REASON.
AND OFTEN THESE OBSERVATIONS
ARE MADE IN MEDICINE AND THEN
WE HAVE TO COME ALONG AND TRY
TO EXPLAIN IT.
THE DERMATOLOGIST WILL OFTEN
USE LIQUID NITROGEN, WHICH IS A
VERY COLD PHYSICAL DESTRUCTION
METHOD, AND YOU OFTEN SEE
DERMATOLOGISTS SPRAYING THE
LIQUID NITROGEN ON THE SPOTS.
THE ONES THAT DON'T RESPOND, OR
IF WE FEEL THEM AND THEY'RE
DEEPER, OR THEY HAVE SOME PAIN,
WE'LL OFTEN BIOPSY THEM.
WHAT YOU DON'T WANT IS IF YOU
HAVE 50 OF THESE FOR ME TO
BIOPSY EVERY ONE OF THEM.
WE WANT TO BIOPSY THE ONES THAT
DON'T RESPOND TO LIQUID
NITROGEN.
A TOPICAL, ANTI CANCER DRUG,
CALLED TOPICAL 5 FLUROURACL.
OR A TOPICAL DRUG THAT
STIMULATES INTERFERON IN YOUR
OWN IMMUNE SYSTEM TO PRODUCE A
GREATER RESPONSE.
THIS IS THE SQUAMOUS CELL
CARCINOMA, THAT PRESENTED AS A
CUTANEOUS CORN ON THE BACK OF
THE HAND.
AND CUTANEOUS CORNS IN 61 percent OF
CASES HAVE A COMPLETELY BENIGN
LESION AT THE BASE.
EITHER A SEVERY KERATOSIS OR A
WART, FROM A VERY GOOD STUDY
WITH BIOPSIES.
23 percent HAD PRE-CANCEROUS CHANGE OR
THE ACTINIC.
AND 16 percent HAD A SQAUMOUS CELL
CANCER.
AND SOMETIMES WE CAN'T TELL,
AND WE REALLY NEED TO TAKE THEM
OFF TO SEE UNDER THE MICROSCOPE
WHAT'S HAPPENED.
AND USUALLY REMOVAL WILL BE
CURATIVE IN THIS KIND OF
CANCER.
THE SQUAMOUS CELL CANCER HAS
ABOUT A ONE TO TWO PERCENT RISK
OF SPREADING ELSEWHERE, OR
HAVING A METASASIZE.

Slides continue to run.

He continues THOSE LESIONS ON THE LIPS,
EARS, ARE MORE LIKELY TO DO
THAT.
AND IF A PATIENT IS IMMUNE
SUPPRESSED, SO IF THEY'RE ON
ANTI CANCER THERAPY, THEY'RE ON
LONG TERM PREDNISONE.
THEY MIGHT BE ON METHOTREXATE
FOR RHEUMATOID ARTHRITIS, OR
THEY MIGHT HAVE HAD AN ORGAN
TRANSPLANT.
AND IF THE NERVE IS INVOLVED ON
THE BIOPSY, IT ALSO HAS AN
INCREASED RISK, AND THE
TREATMENT IS REALLY SURGICAL
REMOVAL.
ALTHOUGH VERY OCCASIONALLY WHEN
WE CAN'T DO THAT, WE MAY USE
RADIO THERAPY.
PATIENTS WITH ORGAN
TRANSPLANTS, ARE ON LONG TERM
IMMUNAL SUPPRESSION IN HIGH
DOSES, AND THEY MAY BE VERY
PRONE TO THIS KIND OF CANCER.
IN FACT THEIR RELATIVE RISK IS
250 TIMES, TIMES GREATER THAN
SOMEBODY WITHOUT AN ORGAN
TRANSPLANT OR AN IMMUNO
SUPPRESSION.
WHEREAS THE INCIDENCE OF THE
OTHER COMMON SKIN CANCER, A
BASAL CELL CARCINOMA IS ONLY
TEN TIMES THE NORMAL
POPULATION.
HERE WE SEE A SKIN CANCER, A
BASAL CELL.
IT'S THE MOST COMMON SKIN
CANCER.
IT MAKES UP ABOUT ONE IN SEVEN
CANADIANS WILL HAVE A BASAL
CELL AT SOMETIME IN THEIR
LIFETIME.
SO, IF THERE ARE 14 OF YOU IN
THE ROW, TWO OF YOU WILL
DEVELOP A BASAL CELL AT SOME
TIME IN YOUR LIFE.
AND LOOK AT THE INCREASED
INCIDENTS.
IN 1983, 20,000 CANADIANS HAD A
BASAL CELL REMOVED WITHIN THAT
CALENDAR YEAR.
1988, 40,000, 93, 50,000, 98,
60,000, AND IN 2003, IT'S
PREDICTED IT'LL BE OVER 80,000.
AND THAT'S NOT BECAUSE OF WHAT
WE DID YESTERDAY, TODAY OR LAST
SUMMER.
THE SKIN'S LIKE AN ELEPHANT, AS
I MENTIONED EARLIER.
AND IT REPRESENTS THE SKIN
DAMAGE THAT WE'VE INFLICTED
THROUGH ULTRA VIOLET OVER 20 TO
50 YEARS OF OUR LIFETIME.
SO, IT'S LONG TERM CHANGE.
BUT STAYING OUT OF THE SUN
HELPS US TO REVERSE SOME OF
THIS.
OTHER POST FACTORS THAT ARE
ASSOCIATED WITH AN INCREASED
RISK ARE SKIN THAT TANS POORLY
AND BURNS EASILY.
PREVIOUS, BLISTERING, SUNBURNS.
OR SOMEBODY WITH RED, BLONDE,
OR LIGHT BROWN HAIR, BLUE EYES,
FAIR SKIN, AND IF YOU FRECKLE.
IF YOU FRECKLE EASILY, THAT
MEANS THAT YOU'RE TANNING IN AN
IRREGULAR WAY.
AND THAT'S AN INCREASED RISK
OVER A NORMAL TAN, WHICH IS
STILL A RISK FACTOR, BUT NOT AS
GREAT AS A BURN.
PERSONS DIAGNOSED WITH A NON-
MELANOMA SKIN CANCER ARE AT
INCREASED RISK OF DEVELOPING A
SECOND ONE.
35 percent RISK OF ONE OR MORE BY YEAR
THREE AND 50 percent BY YEAR FIVE.
AND THE SECOND CANCER SEEMS TO
BE THE SAME AS THE FIRST ONE.
HOW DO WE TREAT THEM?
DERMATOLOGISTS OFTEN REMOVE
THEM WITH A CURETTE, AND USE
ELECTRIC NEEDLE TO DESTROY THE
TISSUE THAT'S LEFT.
AND THIS TAKES AWAY AS LITTLE
OF THE SURROUNDING NORMAL SKIN
AS POSSIBLE.
FOR CERTAIN CANCERS, WE HAVE TO
ACTUALLY SURGICALLY REMOVE
THEM, AND THAT'S CALLED AN
EXCISION.
FOR OTHERS THERE IS A
CONTROLLED SURGICAL TECHNIQUE
OF REMOVING THE CANCER IN
LAYERS, AND TAKING IT OFF
LITTLE BY LITTLE.
STILL IN OTHER CASES, RADIO
THERAPY AND SENDING THEM TO A
CANCER HOSPITAL WHERE IT'S TOO
BIG, OR IT'S IN AN AREA WHERE
IT MAY SACRIFICE THE EYE OR A
VITAL ORGAN.
OR THE INDIVIDUAL IS MEDICALLY
UNFIT TO UNDERGO SURGERY.
CERTAINLY CRYOSURGERY, BUT IT'S
A CONTROLLED CRYOSURGERY.
IT'S NOT WHAT YOUR
DERMATOLOGIST MIGHT DO OR THE
FAMILY DOCTOR IN THEIR OFFICE.
INTRA-LESIONAL INTERFERON IS A
CHEMICAL WAY.
PHOTODYNAMIC THERAPY IS ONE OF
THE NEW THINGS COMING ALONG,
BUT FOR VERY SUPERFICIAL
LESIONS.
AND TOPICAL IMIQUIMOD IS A
TOPICAL AGENT THAT STIMULATES
THE BODY'S INTERFERON.
UM, THIS IS A LINTINGANIES OR A
FRECKLE THAT DOESN'T GO AWAY IN
THE WINTER, VERUS THE KIND OF
FRECKLE THAT YOU SEE ON THE
YOUNG CHILD.
BUT THAT ALSO REPRESENTS
DAMAGE.
AND NORMAL MOLES OFTEN CAN BE
ELEVATED ABOVE THE SURFACE.
DYSPLASTIC MOLES ARE MORE
IRREGULAR.
BUT WHAT WE LOOK FOR IS THE
ASYMMETRY.
ONE SIDE OF A MOLE NOT LOOKING
LIKE THE OTHER.

A new slide shows colourful round shapes.

He continues THE IRREGULAR BORDER, UP AND
DOWN LIKE A SKI SLOPE.
THE VARIATION IN COLOUR.
BLACK REALLY REFLECTS A
CONCENTRATION OF MELANON.
RED IS INFLAMMATION.
BLUE BY THE TINDEL EFFECT, IS
REALLY PIGMENT DEEPER DOWN, AND
WHITE, AREAS OF REGRESSION.
THE BODY IS TRYING TO FIGHT
THIS OFF.
AND D IS THE DIAMETER.
SOMETHING GREATER THAN SIX
MILLIMETRES, WHICH IS ROUGHLY
AN ERASER ON THE END OF A
PENCIL.
THESE ARE THE DYSPLASTIC MOLES,
AND THEY'RE MUCH MORE
IRREGULAR.

A picture appears. It shows the back of a person with groups of dark malls.

He continues DIFFERENT, THERE'S THE FRIED
EGG APPEARANCE.
DARKER COLOUR, A LITTLE BIT
MORE NOTCHING, A LITTLE BIT
MORE IRREGULAR, AND CERTAINLY
THIS INDIVIDUAL HAS MORE THAN A
HUNDRED ON THEIR WHOLE BODY.
YOU CAN PROBABLY COUNT 50 IN
THAT PHOTOGRAPH.
AND A LOT OF THEM LOOK AWFULLY
FUNNY, AND ALL OF THE ONES
CIRCLED WERE TAKEN OFF FOR
BIOPSY.
THESE FUNNY LOOKING OR
DYSPLASTIC MOLES, WHICH REALLY
HAVE MORE IRREGULARITY.
BUT THE CELLS ARE CONCENTRATED
IN THE MOLE, BUT THEY'RE ALL
OVER THE BODY.
THEY'RE USUALLY GREATER THAN
FIVE MILLIMETRES IN DIAMETER.
THEY'RE DARKER.
THEY'RE MORE IRREGULARLY
PIGMENTED WITH RANDOM
DISTRIBUTION OF MULTIPLE SHADES
OF BROWN, PINK.
IRREGULAR BORDERS, SINGLE OR
MULTIPLE.
SUN EXPOSED AREAS, BUT
ESPECIALLY THE BACK, THE SCALP,
THE BREAST AND THE BUTTOCKS.
IF YOU HAVE THESE MOLES YOUR
RISK OF MELANOMA IS INCREASED
131 FOLD.
AND YOU SHOULD BE DOING A
REGULAR SELF-EXAMINATION OF
YOUR SKIN MONTHLY.
IF YOU'VE GOT THESE MOLES AND
TWO CLOSE RELATIVES WITH
MELANOMA, THE RELATIVE RISK OF
MELANOMA IN GOOD, CONTROLLED
STUDIES IS 800 TIMES.
AND TRANSLATED THAT MEANS, IF
YOU'RE FOLLOWED 25 YEARS, YOU
HAVE ABOUT 100 percent CHANCE OF
DEVELOPING A MELANOMA.
SO, IT'S IMPORTANT TO RECOGNIZE
THEM AND TO TREAT THEM.

A picture of a person with a large dark area on the cheek appears.

He continues THIS IS A FUNNY LOOKING MOLE ON
THIS GENTLEMAN'S FACE.
IT TOOK 20 YEARS TO GET TO THAT
STAGE.
LOOK AT THE ASYMMETRY, THE
IRREGULAR BORDER.
THE COLOUR VARIABILITY AND THE
SIZE.
THAT'S A LENTICLE MALIGNANT
MELANOMA, AND IN THIS MELANOMA
YOU OFTEN DON'T HAVE THE
DYSPLASTIC MOLES.
AND THE SUN ACTS AS BOTH THE
PROMOTER AND THE INITIATOR OF
THE SKIN CANCER.
SO, “A,” “B,” “C” AND “D.”
ASYMMETRY, BORDER, COLOUR AND
DIAMETER.
RISK FACTORS.
IF YOU'VE GOT DYSPLASTIC MOLES,
THAT IS A GENE KNOWN AND MAPPED
TO A CHROMOSONE.
IT'S AUTOZOMAL DOMINANT, SO
YOUR KIDS HAVE A 50 percent CHANCE OF
HAVING THAT SAME GENE.
IF YOU'VE GOT MORE THAN 100
MOLES, EVEN IF THEY'RE NOT THE
FUNNY LOOKING MOLES LIKE THE
ONE PATIENT I SHOWED YOU, THAT
INCREASES YOUR RISK, AS DOES A
POSTIVE FAMILY HISTORY FOR
MELANOMA.
ENVIRONMENTAL FACTORS,
ULTRAVIOLET EXPOSURE.
WHEREAS DYSPLASTIC NEBI ARE 131
FOLD, ULTARVIOLET IS TWO TO
FOUR FOLD.
IN THIS CASE, GENETICS IS MORE
IMPORTANT THAN THE ENVIRONMENT.
BUT CERTAINLY BLISTERING,
SUNBURNS WILL DOUBLE YOUR RISK
OF MELANOMA.
THIS IS ROSACEA, THE BLUSHING
AND FLUSHING.

A slide under the title “Acne Rosacea” appears. It shows the pictures of two women with red areas on their faces.

He continues WE'VE ALL SEEN THOSE
INDIVIDUALS, AND WITH TIME, YOU
CAN ACTUALLY AN ENLARGEMENT OF
THE NOSE, WHICH IS CALLED
RHINOPHYMA.
WHY DO DERMATOLOGISTS HAVE SUCH
BIG TERMS?
BUT CERTAINLY LIGHT COMPLEXION
INDIVIDUALS, AND ROSACEA'S
AGGRAVATED BY ANYTHING THAT
MAKES YOU FLUSH.
ALCOHOL IS A GREAT VASO-
DILATOR.
IT FLUSHES.
SO DOES HOT, SPICY, FOODS.
CAFFEINE, PARTICULARLY IF IT'S
REALLY HOT.
IF YOU DRINK YOUR CAFFEINE
COOLER, IT'S MUCH EASIER ON
PERSONS WITH ROSACEA.
THE HEAT, THE COLD, THE WIND
AND SUN.
SO, ALL OF THE FLUSHING
RESPONSES.
AND WE TREAT THE INFLAMMATION
WITH TOPICAL METRANIDOZALE.
AND THERE ARE IF YOU HAVE OILY
SKIN, GELS AVAILABLE.
AND IF YOU DRY SKIN, THERE ARE
CREAMS AVAILABLE.
FOR THE DEEPER INVOLVEMENT WE
USE ANTIBIOTICS, BUT ONLY
CERTAIN ONES THAT HAVE ANTI-
INFLAMMATORY PROPERTIES.
WE TRY TO MAXIMIZE THE TOPICAL
THERAPY, SO WE'RE NOT ON
ANTIBIOTICS FOR ANY LONGER THAN
WE HAVE TO BE.
FOR THE FLUSHING, CLONIDINE,
HAS BEEN VERY USEFUL, AND DRUGS
CALLED DIXARIT, OR IN HIGHER
DOSES CATAPRES.
AND IT REALLY HELPS THE
FLUSHING RESPONSE, AND IT'S
IMPORTANT TO DISTINGUISH
WHETHER IT'S PIMPLES OR
FLUSHING, AND TO TREAT THE
RIGHT PART.
IF YOU LEAVE THE FLUSHING
WITHOUT TREATING IT, WITH TIME
YOU'LL OFTEN DEVELOP TINY,
BLOOD VESSELS.
AND THIS IS WHERE
ELECTROCAUTERY, OR MORE
RECENTLY LASER TREATMENT CAN
HELP REMOVE THOSE BLOOD
VESSELS.
AND CERTAINLY IF YOU GET THE
LARGE NOSE, LASER SURGERY IS
USEFUL.
THIS IS DRY SKIN, OR ECXEMA
CRACKOLAY.
SO, IT'S LIKE MUCH OF THE
PAVEMENT AROUND TORONTO RIGHT
NOW, WITH ALL THE CRACKS AND
FISSURES, IN THE SKIN.
AND THIS IS INFLAMED, AND IT
LEADS TO WINTER ITCH.
AND AS WE GET OLDER, WE DON'T
HAVE SO MUCH NATURAL OIL ON OUR
SKIN.
AND OUR HOMES ARE OVERHEATED.
THEY'RE VERY DRY.
IT'S LIKE THE DESERT.
AND THE SKIN NEEDS A TEN
PERCENT MOISTURE CONTENT TO BE
INTACT.
AND WHEN WE DIP BELOW THAT TEN
PERCENT, WE START TO BREAK DOWN
AND GET THIS KIND OF CHANGE.

He raises his hands in the air and continues IN OUR HANDS, AND IF YOU WANT
TO SEE IT IN LIVING COLOUR YOU
CAN COME AND LOOK AT MY HANDS
AND I'M WASHING THEM ALL THE
TIME.
AND I, I ALWAYS WALK AROUND
WITH A LITTLE BIT OF HANDEX ON.
AND YOU CAN SEE THE DRYNESS ON
THE PALMS IS REALLY A CONTACT
IRRITATION, AND THIS IS FROM
SOAP AND WATER, AND WHERE YOU
GET MOST OF THAT SOAP AND WATER
CONTACT, AND ONTO THE DISCAL
PART OR THE TIPS OF THE
FINGERS.
AND THE STRATUM CORIAUM JUST
DOESN'T HAVE ENOUGH MOISTURE.
WHEN WE GET OLDER OUR SKIN
THINS.
AND FREQUENT BATHING, YOU KNOW,
IF YOU'RE ITCHY AND DRY, YOU GO
AND HAVE A GOOD BATH.
WELL, WHAT DO YOU DO?
YOU'RE TAKING MORE OF THE
NATURAL OILS OFF, ESPECIALLY IF
YOU REALLY SCRUB THE SKIN AS
WELL, AND YOU STAY IN THERE FOR
A LONG TIME, BECAUSE IT FEELS
GOOD.
IT'S ALMOST SHORT GAIN FOR LONG
TERM GAIN, WHICH IS KIND OF THE
WRONG WAY AROUND.
AND YOU SHOULD EITHER APPLY A
LUBRICATING CREAM TO YOUR SKIN
AFTER YOU COME OUT, AND YOU
SHOULD PAT THE SKIN IN WELL
DAMP.
AND IT'S BETTER TO TAKE SHORT
SHOWERS, NOT TOO HOT AND NOT
TOO MUCH PRESSURE, AND USE A
LUBRICATING CREAM.
AND CERTAINLY AVOIDING PERFUMES
IF YOU HAVE ALLERGIES.
THERE IS A DIFFERENT WAY.
YOU CAN ALSO HYDRATE THE SKIN,
RATHER THAN LUBRICATING IT.
AND UREA OR LACTIC ACID CREAMS
CAN BE APPLIED TO THE SKIN AND
THEY TRAP MOISTURE.
THESE TWO CHEMICALS WILL BIND
WATER ON THE SURFACE OF THE
SKIN.
INSTEAD OF PUTTING AN OIL ON
THE SURFACE, AND PREVENTING
INSENSIBLE, LOSSES.
AND URAMOL, DERMAL THERAPY,
LACTIC ACID, LACHYDRIN OR
DERMALAC.

A slide shows the picture of a young blond woman.

He continues AND WE HAVE TO REMEMBER MANY OF
US ASK ABOUT THE WRINKLING AND
THE SUN DAMAGE, AND THIS IS THE
CHEEK ANALOGY AGAIN.
AND THERE ARE ALPHA HYDROXY
ACIDS THAT DO IMPROVE THE
TEXTURE.
THEY WON'T TAKE AWAY DEEP
WRINKLES, BUT THEY DO HELP THE
TEXTURE, AS DOES VITAMIN A
ACID.
THEN WE HAVE TO FOR DEEPER
WRINKLES, LOOK AT LASERS AND
FACE LIFTS.
WE REALLY NEED MORE EVIDENCE,
AND THE SYSTEMATIC REVIEWS HAVE
NOT SHOWN VITAMIN C, VITAMIN E,
COLLAGEN, OTHER ANTIOXIDANT
INGREDIENTS, HAVE REALLY BEEN
SUCCESSFUL IN TREATING THIS
PHOTOAGING IN AN EVIDENCE BASED
WAY THAT WAS DESCRIBED TO YOU
AT THE BEGINNING.
ONE OF THE MOST COMMON ECXEMAS,
AND I HAVE THIS IS ATOPIC
ECXEMA.
WHEN WE'RE INFANTS IT AFFECTS
OUR ELBOWS AND KNEES.
WHEN WE'RE IN THE CHILDHOOD
PHASE IT'S IN THE CREASES.
WHEN WE START TO WALK THERE'S
MORE STRESS IN THE CREASE OF
THE ARM AND THE CREASE OF THE
KNEE.
AND AS AN ADULT, WE MAY BE
STUCK WITH HAND ECZEMA, OR
BEING PRONE TO CONTACT
ALLERGIES TO NICKEL, RUBBER AND
PERFUMES.
AND THERE IS THE CHILDHOOD
PHASE OF ATOPIC ECZEMA.
THERE IS THE HAND ECZEMA IN AN
ADULT.

Slides show the cases he mentions.

He continues AND THE CONTACT ALLERGIC
DERMATITIS ON THE BACK OF THE
HANDS WHERE THE SKIN IS
THINNER, AND EXTERNAL ALLERGENS
PENETRATE BETTER AS OPPOSED TO
IRRITANTS ON THE PALMS.
AND WE DO PATCH TESTS, AND
THESE ARE APPLIED FOR 48 HOURS.
SO, IF YOU HAVE A SKIN ALLERGY
FROM ECZEMA YOU DON'T USE WHAT
THE ALLERGIST DOES, THE PRICK
TEST.
THAT IDENTIFIES ASTHMATIC
TRIGGERS, OR DIFFERENT TYPE ONE
TRIGGERS.
IT DOES NOT IDENTIFY ECZEMA,
WHICH IS A TYPE FOUR REACTION
LIKE A TUBERCULINE TEST, AND WE
USE PATCH TESTS.
AND THIS IS ALL BECAUSE OF THE
LANGERHANS CELL, AND WHEN I WAS
IN MEDICAL SCHOOL WE DIDN'T
KNOW WHAT IT WAS.
AND THIS CELL, WILL ACTUALLY
PROCESS THE ANTIGEN, INTERACT
WITH THE LYMPHISITES IN OUR
SKIN AND THEN MIGRATE TO THE
REGIONAL LYMPH NODE, AND
RECRUIT MORE CELLS TO FIGHT THE
ANTIGEN OFF.
AND SO WE CAN START WITH A
REALLY BAD ECZEMA OR POISON IVY
IN ONE SPOT ON OUR SKIN, AND
THE NEXT THING WE KNOW WE WAKE
UP A FEW DAYS LATER AND IT'S
ALL OVER.
AND IT'S NOT BECAUSE WE TOUCHED
THE SKIN.
IT'S BECAUSE THE BODY HAS
PROCESSED THAT ANTIGEN,
RECRUITED LYMPHOSITES AND IS
REALLY SENDING OUT IMMUNE CELLS
ALL OVER THE WHOLE BODY.
THE SKIN IS A VERY EFFECTIVE
IMMUNE SYSTEM.
OFTEN WITH ATOPIC ECZEMA WE
HAVE A FAMILY HISTORY, AND THAT
FAMILY HISTORY MAY BE OF
ASTHMA, HAY FEVER, ECZEMA, ALL
OR COMBINATIONS.
AND THERE IS AN INCREASED
INCIDENCE OF FOOD AND
ENVIRONMENTAL ALLERGIES IN
THESE PEOPLE.
DERMATOLOGISTS AND FAMILY
DOCTORS WILL USE TOPICAL
STEROIDS.
WE ALSO HAVE STEROID SPARING
CREAMS.
REGULAR MOISTURIZERS OR
EMMOLIENTS.
PROTOPIC IS ACTUALLY AN IMMUNE
RESPONSE MODIFIER THAT WE USE,
AND ORAL AGENTS ARE SOMETIMES
NEEDED WHEN ALL ELSE FAILS.
OKAY, IN SUMMARY, THE SKIN IS
THE LARGEST ORGAN IN THE BODY.
REMEMBER THAT YOU DO HAVE TWO
SETS OF CHEEKS.
INSPECT THEM.
BUT INSPECT YOUR SKIN REGULARLY
LOOKING AT SUN CHANGE VERSUS
AGING.
LOOKING FOR DRY SKIN, SWELLING
OF YOUR LEGS OR SORES AND CUTS.
AND WE HAVE ASSESSED PRE-
CANCEROUS ENHANCERS CHANGED,
AND LOOKED AT PHOTOAGING,
SCALING, LEG SWELLING, SORES
AND CUTS.
AND HOPEFULLY SOON, WE'LL SEE
SOMETHING LIKE THIS.
THANK YOU.

[Audience applauding]

A slate pops up. It reads “For more information about Mini-Med School at the University of Toronto visit us on the web at: www.tvo.org.”

The end credits roll.

Mini-Med School Producer, Wodek Szemberg.

Executive Producer, Dan Dunsky.

Logos: CEP Local 72 M and Canadian Media Gold.

A Production of TVO Ontario.

Copyright The Ontario Educational Communications Authority 2003.

Watch: Skin Conditions