PREVENTION IS KEY
Robert H. Zax, MD and Janelle Willoughby, LE
I
t is 5pm and I just completed another day
of back-to-back Mohs surgeries. My last
patient of the day happens to be return-
ing for a third time to my surgical chair:
this time to remove a basal cell carcino-
ma off his ear. His question at the fore-
front of my mind, “How can I keep from
getting another one, doc?” It seems three
skin cancers in two years was just too many for this patient. My
unfortunate answer to him, and to many of my patients in the
same situation, is prevention.
A day doesn’t go by where I don’t have a patient ask me how
they can keep from getting more skin cancers. While performing
Mohs surgery five days a week in my practice, I often see many of
the same patients returning with additional skin cancers needing
treatment. They want to know why they keep occurring and unfor-
tunately, most of the damage was done in their youth. Prevention
is key and we just don’t always think about using sun protection
when we are young. That doesn’t mean there isn’t hope though.
Many patients not only want to prevent future damage but to also
correct and reverse the signs of that damage. Through advanced
technologies like laser, intense pulsed light (IPL), radiofrequency
and medical grade skin care, we can make a difference in our pa-
tients’ skin health, medically and cosmetically.
We try to encourage all of our patients to incorporate a quality
SPF in their daily routine. Men and women alike need to apply
and reapply when exposed directly. With all the advancements in
formulations, there is something for everyone. Many brands are
starting to offer more user-friendly options like sticks and pow-
ders with sun protection factors that you can cover any part of
your body and ensure not only ultraviolet (UV) protection but
also the blue light (HEV), infrared radiation and pollution de-
fense. Consumers are starting to look more closely at the specif-
ic active ingredients in sunscreens, like chemical versus physical.
New study findings published by the Food and Drug Administra-
tion in the Journal of the American Medical Association found,
“After a single application, a total of seven chemicals common-
ly found in sunscreens can be absorbed into the bloodstream at
levels that exceed safety thresholds.” That being said, sunscreens
remain critical in our defense against keratinocytic skin cancers.
Until further studies are performed, consumers have a vast array
of “all physical” sun protection options available to them—cov-
er-ups of various kinds abound.
The other frequent question I am asked is, “How do I repair all
this sun damage?” This time, I am excited to answer and introduce
them to my aesthetic team. We have many tools to correct and
actually turn back time before the damage was done. IPL is one
of our most highly sought after aesthetic procedures performed
in my practice. It can address excess reds and browns on the skin,
and is a great choice for patients with sun damage on any part of
the body.
My Medical Aesthetician, Janelle Willoughby, prepares our pa-
tients with clear expectations and ensures that they understand
that protecting their investment is as important as the procedure
itself. It is with her that they can explore all the other avenues and
options available to them to repair their damaged skin. Often,
our patients are looking to correct the loss of collagen and elastin
caused from too much sun damage. New advancements with de-
vices like radiofrequency afford us the opportunity to turn back
time and firm the skin that has lost its youthfulness from age, sun
and other intrinsic and extrinsic factors.
Laser resurfacing is another option that offers wonderful im-
provements on the outward texture of the skin. We can address
concerns from surgical scars, acne scars, fine lines and wrinkles,
aged skin, striae, pore size and overall texture. One former Mohs
patient decided to have the scar on her cheek lasered. It had been
one year since her surgery and she had healed well but wanted
to try to improve upon it cosmetically to address the texture and
the redness. We combined therapies of the IPL and laser over the
course of several sessions. The patient saw such improvement with
that one area that she decided to begin treatments on her entire
face for anti-aging benefits.
As with anything in the aesthetics field, clear expectations are
needed. Patients should be evaluated and educated on the appro-
priate options available to them. If I could tell every young patient
that walked through my practice doors one thing, it would be: pre-
vention is key! Enjoy the sun, but be smart and wear SPF!
Dr. Robert H. Zax practices dermatology & Mohs surgery at The Skin Group.
Janelle Willoughby, Licensed Aesthetician, practices aesthetics at The Skin Group
(non-member).
APRIL 2020
27