Episode #159: Your Mole Could Be Cancer And You Wouldn’t Know… Featuring EXPERT Board Certified Dermatologist and DERMOSCOPIST Dr. Michael Christopher!!

The Dylan Gemelli Podcast

In Episode #159 of The Dylan Gemelli Podcast, host Dylan Gemelli sits down with Dr. Michael Christopher, a board-certified dermatologist and expert dermoscopist, to discuss the critical role

Key takeaways

• Melanomas can appear completely normal to the naked eye and are often missed during standard visual skin exams.
• Dermoscopy significantly improves early melanoma detection by revealing internal skin structures invisible to the unaided eye.

Main topics

• Dermoscopy as a standard tool in skin cancer screening
• Limitations of visual skin exams in detecting melanoma

Notable quotes

"I find between 150 and 215 melanomas a year. The average dermatologist in Arizona finds around 20 a year."

"If you're just doing a visual exam, you cannot see those structures I just outlined... You need another tool, and the dermatoscope is that tool."

Conclusion

Dr. Michael Christopher underscores that dermoscopy is essential for accurate skin cancer screening and should be standard practice in

Transcript preview

Speaker 1 (0:00) I find between 150 and 250 melanomas a year. The average dermatologist in Arizona finds around 20 a year. Of the roughly 8,000 to 10,000 people that die a year, they are actually diagnosed with what we consider early stage melanoma. How often do you find something that looks normal that is an actual melanoma? Almost every week. Oh, shit. I find so many skin cancers every day that you would not be able to see without using a dermatoscope. So are there other ways to develop skin cancer melanomas without it being sun related oh 100 and what are some of those Speaker 1 (0:34) Your biology may not be the same in your 40s as it was in your 20s, but your standards and goals can be even bigger. We're at a time where we have more tools and methods to not just live longer, but also healthier with better results as we age. Aging is no longer viewed as a decline. It's about optimization and time efficiency. Training smarter and more efficient is a new standard, and we now know how to get more from the workouts we are already doing. Now, chances are your supplement stack is missing a much healthier foundation. Speaker 1 (1:12) Not just energy production. Protein builds muscle. Creatine supports power. Mitopyr helps support the cellular engines that power both. When your cells thrive, everything follows. So claim your free aging muscle protocol guide and free sample of Mitopyr gummies from Timeline at timeline.com slash Dylan. It's the science-backed breakdown of exactly what's happening to your muscles as you age and how to fight back. All right, everybody. Welcome back to the Dylan Gemelli podcast. So... I am pumped today because I have a very well-educated, well-rounded guest that I hit it off with right away. But we're going to talk about something that I have not talked about yet. And I'm really happy to get into it because there are so many people that put content out on the sun and people that have. Speaker 1 (2:01) put the fear of God into some people and then told others that everything out there is nonsense. And we don't get into the nitty gritty about that and talk to somebody that's just straight science. But then the other aspects of what my guest does, especially when it comes to identifying melanomas and his way of going about it that I've never heard of and never seen. And so this is going to be a learning experience for everybody today, which I am just. I'm ecstatic to bring this to light because the goal on the podcast is to always to bring new concepts and a good down the middle approach to giving everybody the best knowledge possible. So my guest today is a board certified dermatologist and expert dermoscopist recognized for his work in early melanoma detection. Speaker 1 (2:47) And he has been using evidence-based use of dermoscopy. And he identifies between 150 and 250 melanomas annually. And that is just, with the discussion we had back and forth, far more than you see on national state averages. So he's doing incredible work. He's doing something special. And I am super excited to introduce you guys, Dr. Michael Christopher. It's a pleasure. Thank you for having me on. I appreciate it. I am stoked, like I said, to have you here. And we had a good discussion prior, and the things that you were telling me were... Speaker 1 (3:25) startling troubling but also i'm grateful that i met you so that we can get this out there and get people aware and start talking about things that i think they're not aware about that you do so let's get into the dermoscopy because i i'm still having trouble saying that because i've never heard of it could you kind of get into what that is yeah absolutely so i brought a tool with me I'm not sponsored. I don't work for any company. I just want people to be aware of that. Not that other people do. Okay. But me personally, I don't work with anybody. This is what we call a dermatoscope. And so if you see a board certified dermatologist or say an MP or PA, and you get a skin exam, when they're looking over your skin. Speaker 1 (4:09) they shouldn't be just doing a visual exam. They should look at every single mole and every pink spot and every sun spot that you have on your body with a dermatoscope. Because things that can look normal, like that little mole on your hand, and I'm not saying that is harmful. It looks round, regular, looks like it has even borders. But if I were just to look at that with my eye, I cannot tell you, and this is as an expert in dermoscopy and a board-certified dermatologist. that that is normal. The only way that we can tell that it's normal is if I put a dermatoscope on it. And if people are not using a dermatoscope, what does that create? That creates melanomas that are identified much later in their course, and there is a mortality association with it. In Arizona, you kind of stated some statistics. I find between 150 and 215 melanomas a year. Speaker 1 (4:58) The average dermatologist in Arizona finds around 20 a year. And that's kind of on the national average. So if there's that large of a gap, you can imagine how many people go in to get a skin check. And it's not that people are not trying. They are looking at your skin thoroughly. They are just missing stuff that is not obvious to your naked eye. And that's due to training and lack of utilization of this tool. Why do so many people eyeball it? and do that approach? I've never even heard of the scope and the tool that you have until I met you. Yeah, great question. And I can't answer that, to be honest with you. Dermoscopy, the discipline, which is the study of the structures that you see within when you're using that tool, was invented in 1989. I was born in 1984, right? So my whole medical career, actually, what got me very interested in dermatology was Speaker 1 (5:53) the potential intervention at the earliest stage of cancer within dermatologic disease, and that is through dermoscopy. So it was foundational for my interest in the field, and I can't tell you why other people don't use it because I think it is the most important thing. When we give a skin check and we're doing a cancer screening, it's like women getting their annual mammogram. After 40, that's what's recommended. Speaker 1 (6:19) And if you didn't do a mammogram, you just had a woman do a self breast exam. How are we going to know that there is disease that is potentially there? There are many breast cancers that don't present as a lump, right? So women, when a woman would not be able to find it, well, same as melanoma, they're not all irregular. They, they don't have symptoms, meaning they're not itchy, painful. They don't bleed. And we may not be able to see it and we can see it when we utilize that tool. Yeah. Because. Speaker 1 (6:48) Everything I've ever learned and when I go in, it's a eyeball approach. And if it doesn't look irregular or doesn't show any of the things that you've talked about or that we kind of know in general, it's like, okay, move on. Now, when you use that tool, what does it show? Like in particular that you can't see with the naked eye? What we see within a dermatoscope, you can see structures that you cannot see with your eye. One of them is the pigment architecture. So that mole right there, which I'm just going to lay my dermatoscope on just to, I've looked at it enough times just to make sure it's fine. But it can show me the network that is present within it. And if that is regular or irregular, it can show me angiogenic structures. So structures of. Speaker 1 (7:33) blood vessels and signs that there is a increased vascular density within a mole, which is a sign of a melanoma. It shows me structures that we see within the skin. So you can actually, you're not just looking at the surface, you're actually looking within the dermis, which is the middle portion of your skin. And some of those structures, like shiny white lines, orthogonal lines, those are features that you can see within an invasive melanoma, even though from the outside it looks like a completely normal mole. Okay. Speaker 1 (8:02) So it's almost like an x-ray vision tool, so to speak. Correct, right. It's a secondary imaging to where, think about it like this. You get an x-ray, say you come in and you have a knee injury. Your knee's sore. Maybe you feel like you tore your ACL. You go get an x-ray of it. The x-ray's actually not gonna show you you tore your ACL because it can't see it. And that is kind of what we want to do, a visual skin exam. If we're just doing it visually, you cannot see those structures I just outlined to you within the scope, the pigment architecture, the blood vessels that are present within it, the structures that are in the middle portion of the skin in the dermis. You need another tool, and the dermatoscope is that tool. As you're assessing, say, your knee for an ACL tear, well, the x-ray is not going to show you if the ACL is torn. You need an MRI. Speaker 1 (8:55) And the MRI will be able to actually assess those structures and will be able to say, oh, yeah, clearly there's an ACL tear or the ACL is intact. You wouldn't try to assess an ACL tear with just an x-ray. Right. Here's a question for you. On a normal person, and obviously everybody's differentiating here, how many moles does a person tend to carry? Oh, God. Great question. Some people have very few. Maybe I need to look into the literature on that exactly because it is so varied. Most people have moles. It's just how many do they have? One of the risk factors actually for melanoma is the number of moles you have and not just the number of moles you have, but if you also harbor atypical moles. And that is a component when we look at risks of melanoma that tie into familial or genetic risk factors. Speaker 1 (9:48) Not all melanoma is just created from the sun. Most of it is from the sun. But there are familial traits, we call them germline mutations, that increase your risk and odds of developing melanoma. Okay. So one of the things I've noticed on myself after too much time in the sun, as I've gotten older, is a few more popping up. Like the one you see here, that was not always there. And I've had certain ones, they all kind of look the same. Speaker 1 (10:17) I know that doesn't mean anything. What causes that to happen? Is it something that you age from being in the sun too long? Moles are sun-induced, right? You can have genetic moles, but moles absolutely can be sun-induced. And getting new moles does not always mean that there is trouble associated with it, right? Until you're about 40 years of age, once you hit 40, if you're getting a new mole, even if it looks normal, it should be evaluated. But there is a... an association with sun exposure and the number of moles that somebody does develop. So that is an important thing to pay attention to. I noticed after long vacations on the beach that they popped up. That's when it happened. Yeah. Two weeks straight of three and a half, four hour layouts. That's when I noticed. What about tanning, like in a tanning bed? Terrible. Speaker 1 (11:06) Yeah. So you tanning, uh, tanning beds are actually UVA, right? So when we get, when you're looking at getting sunlight, you're looking at obviously all spectrums, visible infrared. Um, UVC is actually thankfully filtered out. He's extremely toxic, but UVA is what you're getting through the tanning bed and it is highly concentrated. And we have a multitude of studies that show. what the increased risks are of melanoma associated with sun, with using a tanning bed. So it's highly enhanced. It is highly associated. And that is why places that have very good data on melanoma and melanoma prevention have actually outlawed tanning beds like Australia. It is not allowed there. When I was in high school, when they started to get popular, I spent a lot of time in them, a lot, you know, like teenage years. How much? Speaker 1 (11:58) oh, I don't know, two or three times a week for a while. And then I owned a bed in Vegas. I didn't, and it's funny, I owned it. I used it less than when I had a membership somewhere. I just sat there. But I haven't, you know, I stopped using tanning beds well over 12 or 13 years ago probably. But I definitely, it was a prevalent thing back then and not a lot of data. Yeah, absolutely. And in particular, tanning beds were, you know, you're large into fitness and health. Yeah. It is heavily, you know, people tan like. Crazy because they want their to have tone and definition in particular for them on shows. Right. But the big issue with tanning burning in general is acute intense UV. Right. That acute intense UV is highly toxic and you want to avoid that at all cost. What about like the craze of red light beds and therapies? Does that have a negative effect? Speaker 1 (12:51) So no, it does not. That is not going to induce skin cancer. So for my scope of area of expertise, I have no concern with it. I do think that there are some benefits of using red light therapy in infrared, but you have to know the manufacturer. You need to look at the studies. A lot of people will say, oh, it's good for your mood. It's going to help with your muscles. It's going to help with your skin. Well, what is the dose? What were the studies done that showed? that dose was helpful and are these companies and devices actually administering that dose? And so it's a, there is a dosometry that is associated with red light therapy. So if you're using it and I actually use it on my hat, on my head to keep my hair nice and full. So, so I do think that it is helpful, but you, you need to know the science behind the company that you are deciding to invest in. So. Speaker 1 (13:46) And I don't know the answer to this, and I don't know how many different options there are or levels of this, but you hear UVA, UVB. How many different types of UV rays are there, and what are the negative ones, and what are the good ones, and what should we avoid, and what should we try to get? So UVA and UVB are the two forms of UV that you're going to be getting from the sun, right? UVC is filtered out by our ozone, which is extremely toxic. UVA and UVB, and I will say this with just understand that the dose matters, right, of everything. UVB is definitely of the two much more carcinogenic. So meaning it is one that has. Speaker 1 (14:33) is heavily associated with melanoma, tumor genesis, looking at basal cell or squamous cell carcinoma and the development of skin cancer. UVA is also associated with it. It's just that we get more, the amount of UVB that we get, the intensity of it is more and it is more toxic. Now, as a dermatologist, you know, getting any dose of UV, because UV, ultraviolet radiation, is a class one carcinogen. And we know that it is a carcinogen across the board. So we know that it induces mutations in our body. But is there some dose to where it is, I don't want to say not harmful, but the dose makes a poison, right? A little bit of UVA. So for me, if the UV is less than two, I don't wear sunscreen. I don't need to wear sunscreen. I am not worried about getting a skin cancer. Speaker 1 (15:26) based on a UV index of less than two. But as soon as UV index is above two, based on my Fitzpatrick skin type, it means the color of my skin, I'm a Fitzpatrick two, I absolutely make sure that I have sunscreen. Not only is that important of blocking UV radiation, but it also is helpful for photoaging, which photoaging is something that I also would like to prevent. How do you know the level of UV that's in the sun? Is it just something that's measured that you can look up online? You can look up online or pretty much every weather app will have that. So if you go to your, I have an iPhone. If you open up your iPhone, go to the weather app and it'll show you, say, you