WEBVTT

NOTE duration: "00:04:35.626"


NOTE Confidence: 0.9853499

00:00:04.720 --> 00:00:06.240
The epidermis is very, very

NOTE Confidence: 0.9853499

00:00:06.240 --> 00:00:07.919
thin. It's only about the

NOTE Confidence: 0.9853499

00:00:07.919 --> 00:00:08.880
thickness of a sheet of

NOTE Confidence: 0.9853499

00:00:08.880 --> 00:00:10.160
paper, so less than one

NOTE Confidence: 0.9853499

00:00:10.160 --> 00:00:11.679
millimeter thick. And there's a

NOTE Confidence: 0.9853499

00:00:11.679 --> 00:00:12.559
lot of cells that are

NOTE Confidence: 0.9853499

00:00:12.559 --> 00:00:13.840
packed in there doing this

NOTE Confidence: 0.9853499

00:00:13.840 --> 00:00:15.765
important job of protecting your

NOTE Confidence: 0.9853499

00:00:15.765 --> 00:00:17.305
body from the external environment.

NOTE Confidence: 0.9853499

00:00:17.605 --> 00:00:18.585
There are keratinocytes

NOTE Confidence: 0.9351196

00:00:19.525 --> 00:00:20.965
which are the most common

NOTE Confidence: 0.9351196

00:00:20.965 --> 00:00:23.845
cells and they start at

NOTE Confidence: 0.9351196

00:00:23.845 --> 00:00:24.505
the bottom,

NOTE Confidence: 0.98696

00:00:24.965 --> 00:00:26.965
the basal layer. And then

NOTE Confidence: 0.98696

00:00:26.965 --> 00:00:28.165
as the cells move up

NOTE Confidence: 0.98696

00:00:28.165 --> 00:00:29.205
into the upper layers of

NOTE Confidence: 0.98696

00:00:29.205 --> 00:00:29.865
the epidermis,

NOTE Confidence: 0.99921876

00:00:30.300 --> 00:00:31.760
they do what's called differentiation

NOTE Confidence: 0.93408203

00:00:32.220 --> 00:00:33.840
and they change their function.

NOTE Confidence: 0.9841761

00:00:34.300 --> 00:00:35.500
They become more and more

NOTE Confidence: 0.9841761

00:00:35.500 --> 00:00:36.960
plate like or squamous.

NOTE Confidence: 0.9965376

00:00:37.899 --> 00:00:39.180
To become more of an

NOTE Confidence: 0.9965376

00:00:39.180 --> 00:00:40.699
effective barrier to the external

NOTE Confidence: 0.9965376

00:00:40.699 --> 00:00:41.199
environment.

NOTE Confidence: 0.9984267

00:00:41.900 --> 00:00:43.260
And the third type of

NOTE Confidence: 0.9984267

00:00:43.260 --> 00:00:44.460
cell that you see in

NOTE Confidence: 0.9984267

00:00:44.460 --> 00:00:45.199
the epidermis

NOTE Confidence: 0.99077696

00:00:45.815 --> 00:00:46.715
is the melanocyte,

NOTE Confidence: 0.973999

00:00:47.175 --> 00:00:48.875
the pigment producing cell.

NOTE Confidence: 0.98960656

00:00:49.495 --> 00:00:51.415
And the melanocyte is obviously

NOTE Confidence: 0.98960656

00:00:51.415 --> 00:00:52.395
extremely important

NOTE Confidence: 0.8852539

00:00:52.854 --> 00:00:53.354
because

NOTE Confidence: 0.9716797

00:00:53.815 --> 00:00:56.395
it provides protection against ultraviolet

NOTE Confidence: 0.9716797

00:00:56.615 --> 00:00:57.115
radiation,

NOTE Confidence: 0.9991048

00:00:57.815 --> 00:00:59.175
which is damaging to the

NOTE Confidence: 0.9991048

00:00:59.175 --> 00:00:59.675
skin.

NOTE Confidence: 0.98388267

00:01:00.110 --> 00:01:01.870
The sun exposure causes the

NOTE Confidence: 0.98388267

00:01:01.870 --> 00:01:04.270
UV damages, and while our

NOTE Confidence: 0.98388267

00:01:04.270 --> 00:01:05.790
body does its job to

NOTE Confidence: 0.98388267

00:01:05.790 --> 00:01:08.030
repair those damages, chronic sun

NOTE Confidence: 0.98388267

00:01:08.030 --> 00:01:10.370
exposure or intense sun exposure

NOTE Confidence: 0.98388267

00:01:10.590 --> 00:01:12.050
can lead to more damages.

NOTE Confidence: 0.99234444

00:01:12.505 --> 00:01:14.425
Over time, if those basal

NOTE Confidence: 0.99234444

00:01:14.425 --> 00:01:15.545
cells that live in the

NOTE Confidence: 0.99234444

00:01:15.545 --> 00:01:16.685
basement of the skin

NOTE Confidence: 0.98885536

00:01:16.985 --> 00:01:19.245
develop mutations in their DNA,

NOTE Confidence: 0.98885536

00:01:19.385 --> 00:01:20.584
these are gonna get passed

NOTE Confidence: 0.98885536

00:01:20.584 --> 00:01:22.905
along as they're reproducing and

NOTE Confidence: 0.98885536

00:01:22.905 --> 00:01:24.285
repopulating the skin.

NOTE Confidence: 0.9753165

00:01:24.630 --> 00:01:26.630
More mutations will develop. That

NOTE Confidence: 0.9753165

00:01:26.630 --> 00:01:28.229
cell will then lose all

NOTE Confidence: 0.9753165

00:01:28.229 --> 00:01:30.069
of its control and continue

NOTE Confidence: 0.9753165

00:01:30.069 --> 00:01:31.670
to grow and destroy the

NOTE Confidence: 0.9753165

00:01:31.670 --> 00:01:33.430
surrounding tissue. And that is

NOTE Confidence: 0.9753165

00:01:33.430 --> 00:01:35.050
the definition of cancer.

NOTE Confidence: 0.98766273

00:01:40.575 --> 00:01:43.055
Skin cancer is typically categorized

NOTE Confidence: 0.98766273

00:01:43.055 --> 00:01:44.975
into non melanoma skin cancer

NOTE Confidence: 0.98766273

00:01:44.975 --> 00:01:46.275
as well as the melanoma.

NOTE Confidence: 0.9943499

00:01:46.655 --> 00:01:48.735
Non melanoma skin cancers are

NOTE Confidence: 0.9943499

00:01:48.735 --> 00:01:50.755
most commonly squamous cell carcinoma

NOTE Confidence: 0.9943499

00:01:51.055 --> 00:01:52.650
and basal cell carcinoma.

NOTE Confidence: 0.99383545

00:01:53.189 --> 00:01:55.189
Basal cell skin cancer tends

NOTE Confidence: 0.99383545

00:01:55.189 --> 00:01:56.250
to grow slowly.

NOTE Confidence: 0.97772545

00:01:56.790 --> 00:01:58.869
It is unlikely to spread

NOTE Confidence: 0.97772545

00:01:58.869 --> 00:02:00.549
or metastasize to other areas

NOTE Confidence: 0.97772545

00:02:00.549 --> 00:02:01.590
in the body. So that's

NOTE Confidence: 0.97772545

00:02:01.590 --> 00:02:03.189
good news. But it is

NOTE Confidence: 0.97772545

00:02:03.189 --> 00:02:04.815
very persistent in its growth.

NOTE Confidence: 0.97772545

00:02:04.895 --> 00:02:06.015
And so while it grows

NOTE Confidence: 0.97772545

00:02:06.015 --> 00:02:06.515
slowly,

NOTE Confidence: 0.9996338

00:02:06.895 --> 00:02:08.014
it can grow to a

NOTE Confidence: 0.9996338

00:02:08.014 --> 00:02:09.155
very large size

NOTE Confidence: 0.9938965

00:02:09.455 --> 00:02:11.055
and be very destructive to

NOTE Confidence: 0.9938965

00:02:11.055 --> 00:02:12.735
surrounding tissues over a period

NOTE Confidence: 0.9938965

00:02:12.735 --> 00:02:13.315
of years.

NOTE Confidence: 0.98836744

00:02:14.415 --> 00:02:16.255
Unlike basal cell, squamous cell

NOTE Confidence: 0.98836744

00:02:16.255 --> 00:02:18.415
skin cancer can spread outside

NOTE Confidence: 0.98836744

00:02:18.415 --> 00:02:20.409
of the skin and can

NOTE Confidence: 0.98836744

00:02:20.409 --> 00:02:21.310
cause metastasis

NOTE Confidence: 0.9992676

00:02:21.769 --> 00:02:23.549
and mortality for patients.

NOTE Confidence: 0.9741821

00:02:24.730 --> 00:02:26.730
Melanoma, while being much less

NOTE Confidence: 0.9741821

00:02:26.730 --> 00:02:27.230
common,

NOTE Confidence: 0.99609375

00:02:27.609 --> 00:02:29.049
is more concerning because it

NOTE Confidence: 0.99609375

00:02:29.049 --> 00:02:30.250
has a higher rate of

NOTE Confidence: 0.99609375

00:02:30.250 --> 00:02:30.750
spread.

NOTE Confidence: 0.98482424

00:02:31.129 --> 00:02:32.889
And melanoma, of course, has

NOTE Confidence: 0.98482424

00:02:32.889 --> 00:02:35.444
historically been a very lethal

NOTE Confidence: 0.98482424

00:02:35.504 --> 00:02:37.284
disease in the advanced stages.

NOTE Confidence: 0.98482424

00:02:37.504 --> 00:02:38.784
However, the good news, and

NOTE Confidence: 0.98482424

00:02:38.784 --> 00:02:40.564
I can't emphasize this enough,

NOTE Confidence: 0.9982422

00:02:41.105 --> 00:02:42.805
that the majority of melanomas

NOTE Confidence: 0.9995117

00:02:43.105 --> 00:02:43.924
are discovered

NOTE Confidence: 0.9793091

00:02:44.385 --> 00:02:46.224
at an early treatable stage,

NOTE Confidence: 0.9793091

00:02:46.224 --> 00:02:47.364
ninety six percent.

NOTE Confidence: 0.9903231

00:02:48.489 --> 00:02:50.410
Skin cancer can really look

NOTE Confidence: 0.9903231

00:02:50.410 --> 00:02:52.569
like many things and can

NOTE Confidence: 0.9903231

00:02:52.569 --> 00:02:53.069
mimic

NOTE Confidence: 0.9843038

00:02:53.370 --> 00:02:55.069
benign conditions of the skin.

NOTE Confidence: 0.9843038

00:02:55.129 --> 00:02:56.010
And so this is why

NOTE Confidence: 0.9843038

00:02:56.010 --> 00:02:57.450
it's really important to have

NOTE Confidence: 0.9843038

00:02:57.450 --> 00:02:59.610
your annual screening exam with

NOTE Confidence: 0.9843038

00:02:59.610 --> 00:03:01.069
a board certified dermatologist

NOTE Confidence: 0.9926369

00:03:01.895 --> 00:03:03.495
because their trained eye will

NOTE Confidence: 0.9926369

00:03:03.495 --> 00:03:04.615
be able to pick up

NOTE Confidence: 0.9926369

00:03:04.615 --> 00:03:05.815
what is, you know, a

NOTE Confidence: 0.9926369

00:03:05.815 --> 00:03:06.935
skin cancer that needs to

NOTE Confidence: 0.9926369

00:03:06.935 --> 00:03:07.595
be biopsied.

NOTE Confidence: 0.9658067

00:03:13.014 --> 00:03:15.000
So most skin cancers, especially

NOTE Confidence: 0.9658067

00:03:15.000 --> 00:03:16.200
basal cell and squamous cell

NOTE Confidence: 0.9658067

00:03:16.200 --> 00:03:17.980
skin cancer, can be cured

NOTE Confidence: 0.9658067

00:03:18.280 --> 00:03:19.580
with surgical removal.

NOTE Confidence: 0.9859755

00:03:20.200 --> 00:03:22.700
We have various surgical approaches

NOTE Confidence: 0.9859755

00:03:22.919 --> 00:03:24.220
to treat skin cancer,

NOTE Confidence: 0.9695963

00:03:24.520 --> 00:03:26.280
which include a standard excision

NOTE Confidence: 0.9695963

00:03:26.280 --> 00:03:27.639
where the skin cancer is

NOTE Confidence: 0.9695963

00:03:27.639 --> 00:03:29.260
removed, sent off to pathology.

NOTE Confidence: 0.99890137

00:03:30.195 --> 00:03:31.815
If it's a lesion

NOTE Confidence: 0.97350466

00:03:32.275 --> 00:03:33.794
on the body that has

NOTE Confidence: 0.97350466

00:03:33.794 --> 00:03:35.415
a pattern under the microscope

NOTE Confidence: 0.97350466

00:03:35.475 --> 00:03:36.775
or it has little roots,

NOTE Confidence: 0.97350466

00:03:36.835 --> 00:03:38.435
then the Mohs technique, which

NOTE Confidence: 0.97350466

00:03:38.435 --> 00:03:39.955
allows us to excise the

NOTE Confidence: 0.97350466

00:03:39.955 --> 00:03:41.715
tumor in the office and

NOTE Confidence: 0.97350466

00:03:41.715 --> 00:03:43.075
study it while the patient

NOTE Confidence: 0.97350466

00:03:43.075 --> 00:03:45.095
waits, is the preferred approach.

NOTE Confidence: 0.9745206

00:03:45.920 --> 00:03:48.480
It allows us to assess

NOTE Confidence: 0.9745206

00:03:48.480 --> 00:03:50.080
the margins better. The margins

NOTE Confidence: 0.9745206

00:03:50.080 --> 00:03:50.580
meaning

NOTE Confidence: 0.967513

00:03:50.880 --> 00:03:52.480
around the skin cancer as

NOTE Confidence: 0.967513

00:03:52.480 --> 00:03:53.440
well as the base of

NOTE Confidence: 0.967513

00:03:53.440 --> 00:03:55.140
it. We're able to visualize

NOTE Confidence: 0.97188526

00:03:55.440 --> 00:03:57.040
theoretically a hundred percent of

NOTE Confidence: 0.97188526

00:03:57.040 --> 00:03:58.400
the margins and be more

NOTE Confidence: 0.97188526

00:03:58.400 --> 00:04:00.045
confident that we had removed

NOTE Confidence: 0.97188526

00:04:00.045 --> 00:04:01.345
all the skin cancers.

NOTE Confidence: 0.98741317

00:04:01.805 --> 00:04:03.165
So most skin cancers will

NOTE Confidence: 0.98741317

00:04:03.165 --> 00:04:04.225
start in the epidermis,

NOTE Confidence: 0.9939453

00:04:04.605 --> 00:04:06.865
but once they become cancerous,

NOTE Confidence: 0.9939453

00:04:07.085 --> 00:04:09.265
they invade into deeper tissues.

NOTE Confidence: 0.9777832

00:04:09.805 --> 00:04:11.485
Mohs surgery allows us to

NOTE Confidence: 0.9777832

00:04:11.485 --> 00:04:13.165
be as precise as possible

NOTE Confidence: 0.9777832

00:04:13.165 --> 00:04:14.365
when we're doing this because

NOTE Confidence: 0.9777832

00:04:14.365 --> 00:04:15.540
we can track that tumor

NOTE Confidence: 0.9777832

00:04:15.620 --> 00:04:16.979
tumor under the microscope as

NOTE Confidence: 0.9777832

00:04:16.979 --> 00:04:18.339
we go. And it allows

NOTE Confidence: 0.9777832

00:04:18.339 --> 00:04:19.940
us to achieve that highest

NOTE Confidence: 0.9777832

00:04:19.940 --> 00:04:21.220
cure rate of making sure

NOTE Confidence: 0.9777832

00:04:21.220 --> 00:04:22.660
we're removing all of the

NOTE Confidence: 0.9777832

00:04:22.660 --> 00:04:23.960
tumor that we can detect,

NOTE Confidence: 0.9777832

00:04:24.180 --> 00:04:25.699
as well as preserving any

NOTE Confidence: 0.9777832

00:04:25.699 --> 00:04:27.560
normal tissues that are nearby

NOTE Confidence: 0.9777832

00:04:27.699 --> 00:04:29.220
and not removing anything more

NOTE Confidence: 0.9777832

00:04:29.220 --> 00:04:30.440
than what we need to.