Q & A With Dr. Justin Piasecki, Renowned Plastic Surgeon and Skin Cancer Doctor

What's the most important thing you should ask your plastic surgeon during a consultation?
Dr. Piasecki: Two answers to that question. The first part is that it's appropriate to do some homework on whomever you're meeting with. Choosing a plastic surgeon is not like shopping for groceries. You want somebody who has the right training ... [and] the gold standard in terms of training is to be board certified by the American Board of Plastic Surgery. And the reason for that is that surgery doesn't always go well and you want someone who has the rigors of training and board certification to get you from point A to point B when things don't go as planned. The second thing ... you need to feel comfortable that you trust the person, that you're comfortable spending time with them, that you're going to be comfortable calling them in the middle of the night if you have a problem -- and that they're going to be comfortable accepting your phone call.
What's the #1 most ignored symptom of skin cancer?
Dr. Piasecki: Melanoma gets lots of headlines because it's a very dangerous and deadly cancer if left untreated. And that typically will present as a brown or black spot that's changing. Most people are relatively cognizant or aware that if that was to show up, they would at least get it checked out.

The most common skin cancers -- 96% of them in fact -- don't look anything like that at all. They show up in a much more subtle fashion. In a manner that most people wouldn't recognize as being suspicious for a cancer. Those signs are something that's changing or an area of the skin that bleeds with minimal trauma.
What's the #1 fallacy with regards to skin cancer?
Dr. Piasecki: The biggest fallacy is that because basal cell carcinoma and squamous cell carcinoma [the most common types of skin cancer] rarely kill people, they're not a big deal. In fact, I would argue just the opposite. Simply because they won't take your life doesn't mean they won't ruin it. And by virtue of not taking your life, they also won't go away on their own and they're very destructive. They show up most commonly in the most cumulatively sun-exposed areas -- which means the face and the hands (the most cosmetically sensitive areas). If left untreated, they'll destroy your face. They'll eat through the nose, destroy the eyelids. That's an enormous inconvenience when it comes to daily life.
Is this where your surgical savvy comes in?
Dr. Piasecki: The standard of care for removal or cure of the cancer is the technique called Moh's surgery ... and that involves removing the cancer with microscopic margin control in real time. The cure rate is 99.2%. And that remains the standard for removal of the cancer. The problem is -- especially when you're removing a cancer on the face -- removing the cancer is only half the job. We trade one problem for another when we remove a cancer on the face. We trade a cancer for a big hole. Arguably, the defect created by the removal is more inconvenient to the patient that the cancer was. So we need to put people back together properly ... I developed essentially just an improvement on the standard ... We take it out, cure you of the cancer, but also put [you] back properly.
How often should someone with a skin cancer history see a skin doctor? How about someone without a history?
Dr. Piasecki: Great, great, great question. The reason that's such an important question is that these cancers are so common that if you have Caucasian skin and you live long enough, you will get one of these skin cancers. The trick is early surveillance and being sun smart ... Just like most people would get their teeth cleaned by a dentist once a year, an annual physical by your primary care doctor and an eye exam by your eye doctor, I would argue you should also have your skin checked once a year ... A certified dermatologist would be the gold standard for a good skin check.

If you've had skin cancer, I recommend moving it up to every six months. And for everybody, truthfully, I would recommend that on a monthly basis you spend another 5-10 minutes in the shower or in the bathroom becoming familiar with your own skin. So that if you have a mole on your elbow, you'll be able to recognize if it changes. Because change is the most sensitive indicator of something that deserves more investigation.
What's the most unnecessary up-sell that gets peddled in your industry?
Dr. Piasecki: First off, I think there are a couple of things worth mentioning that are peddled and are worth doing. I think sunscreen is one of the most recommended, but underutilized resources out there. Probably the thing that gets overdone with regards to sun protection is the variety of different sunscreens that are out on the market. There's no evidence that any one brand is better or worse than another. The best sunscreen on the market is the one you're going to wear.

In terms of things that are peddled out there, I think the multi-billion dollar cosmetic skin care industry -- I wouldn't go so far to say it's a misrepresentation, but when it comes to products that contain an SPF, I think sometimes there's an inference or an urban legend that just because people have some SPF on their skin -- either through a cosmetic or run-of-the-mill sunscreen -- they have a free pass to get a ton of sun exposure. And the truth is you're still getting radiation exposure when you're outdoors. The sunscreen doesn't give you a 'get out of jail free' card. The sunscreen is a good idea, it helps, but don't run around naked through the desert all day in the summertime. Use some common sense.
What would you like to see changed in terms of the use of language on sunscreen?
Dr. Piasecki: As a professional in this field, I would say that "water resistance" is misleading. Any product you put on your skin is going to be (to some extent) washed off when you get in the water. And the truth is, from a practical standpoint, none of these products are towel resistant. And nobody gets out of the water, lake, pool or ocean and just stands there. You put on clothing or apply a towel . You're wiping off the sunscreen and all of those agents ... You need to reapply it.
Isn't anti-aging an oxymoron of sorts? Aren't we all getting older as time passes?
Dr. Piasecki: It's a very much an oxymoron. Aging cannot be stopped. By surgery. By medicine. By technology. Or by any product out there. Aging is a function of time and we can't stop the clock. The appearance of aging is a function of time, gravity and the loss of elastic tissue and soft tissues, which we also can't stop. Yes, it's an oxymoron that we can stop aging ... but there are things we can do to slow down the rate of aging.
Is there such a thing as a "safe tanning bed"?
Dr. Piasecki: NO ... there isn't. And I would say that emphatically. There are three reasons to go into a tanning bed. One, that you have a death wish. Two is that you're crazy. Three is that you accidentally fell into a tanning bed.

All tanning beds will emit radiation. There's been some controversy in the field of the tanning bed industry that I believe is misleading -- that there are certain filters that protect you from certain types of UV radiation. The truth is we know that UVA and UVB radiation both will cause cancer. And now there's some good data out there that suggests that regular tanning bed use will increase your risk of melanoma by 75% ... Tanning beds are to skin cancer what cigarettes are to lung cancer.
What's not getting through to people?
Dr. Piasecki: In terms of the cosmetic appearance of a tan, which our society in many aspects reveres as looking healthy and attractive, it used to be that the only option you had was to lay out in the sun and get that "healthy glow". But you're putting yourself at risk. Or you could be pale and just pretend that you believe that is pretty. You can decide that pale is beautiful or tan is beautiful, but you don't need to radiate yourself to get there. Sunless tan creams and spray tans do a great job; they don't make people look orange anymore like they did in the 1980s -- and those products are safe. If you want to look tan, please go that route. Don't go radiate yourself -- it's just not worth the risk.
With "Skin Cancer Awareness Month" coming up, could you say what the one most surprising thing is that people don't realize about their sun exposure?
Dr. Piasecki: The most surprising thing is that most people presume that just because they're wearing clothing of some kind, that somehow that area of their body is safe. The average clothing or garment out there (shirts, pants or hats) only have a sun-protection factor of about 5. You really need to put sunscreen on your entire body -- and this is a good message for parents when you have kids. You really want to put sunscreen under their bathing suit because the bathing suit really isn't doing that much to protect them.
Dr. Justin Piasecki Pictured above: Dr. Justin Piasecki is the founder of the Harbor Plastic Surgery Center in Gig Harbor, Wash. He is the only doctor worldwide certified in the Moh's technique and board certified in plastic surgery and facial plastic surgery.

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