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Bill Klaproth (Host): Do you have bumps, moles or sun spots? Sun exposure can put at risk for serious medical problems. But how do you know when to consult with a doctor? Here to talk with us about lumps, bumps and moles, what you need to know about skin lesions is Dr. Nila Novotny, otolaryngology, head and neck surgery at Columbus Community Hospital. Dr. Novotny, thank you so much for your time. First off, can you tell me about your specialty? What is an otolaryngologist?

Nila Novotny, MD (Guest): Well otolaryngology head and neck surgery is often referred to as ear, nose and throat and so often you think oh tonsils or ear infections but I trained at the Mayo Clinic where we did a lot of head and neck cancer and that included a lot of skin cancer. So, I have treated skin cancer for many years here in Columbus and it’s been a really good specialty to do and I enjoy doing the skin cancers. We have a lot of it here, partly from like farmers that have been out in the sun a lot, so sun exposure is a big problem with causing skin cancer.

Bill: We all need to be careful of sun exposure, that’s for sure. So, what are the most common things you see when it comes to skin lesions?

Dr. Novotny: Well people often come in with a little sore that doesn’t heal. Now I mostly limit my treatment of skin cancers to the head and neck and it turns out that skin cancers mostly appear on the sun exposed areas. So, the head and neck is the biggest area that gets skin cancer so, it’s a really good fit. But they will often notice a little crusty patch or a little scaly area and when they are first just a little bit of scaling, they are usually not cancer yet. But as those get a little bit more then they develop a scab and eventually the patient kind of picks the scab off and it will bleed a little bit and then it gets another scab and they think oh well it’s healing and then they pick the scab off again, another week goes by and little by little, that lesion gets bigger and bigger. So, it’s really the ones that are crusting and bleeding that are pretty high-risk for having cancer in them. There are some types of skin cancers that are more like a nodule and can look just like a little mole without any pigment to it, just a nonpigmented mole and so sometimes you can’t tell for sure by looking at it but if it is something new, that’s never been there before, and it keeps growing; then those are the things that kind of point to the high-risk.

Bill: Great information Dr. Novotny. What are some other signs we should be paying attention to?

Dr. Novotny: Yeah, and the other one that of course a lot of people have heard about is melanoma. Fortunately, we don’t see as much melanoma as we do basal cell carcinoma and squamous cell carcinoma. Those are the common ones, but a melanoma is a black mole and those are quite often much more serious. They dig deep, they spread and those are the more serious types of skin cancers. The basal cell and squamous cell that we see commonly, those are easily treated with surgery. The melanomas need much wider excisions and they can really spread and be much more of a problem. But those are black moles and you look for those, you look for irregular pigmentation, so it might be darker and lighter brown or black and then it will have irregular borders to it. So, it is not a perfect circle and then it will be irregular levels. So, it’s raised but kind of bumpy. So, those are kind of the three things to look for when you are worried about melanoma.

Bill: And do those happen primarily on the neck area or can those happen on the face as well?

Dr. Novotny: Well you can get a melanoma anywhere, but sun exposed areas are more common, but people get them on their legs, they can get them even internally. I mean I have heard of them inside the intestines or inside the eye and so it isn’t strictly a sun exposed area. But it’s more common in the sun exposed area and the head and neck is one of the most sun exposed areas we have.

Bill: And will those start out small and grow over time, is that another warning sign?

Dr. Novotny: Yes, for sure. And there are patients I’ve seen that have had just a little dark mole ever since they were a child and they thought it was nothing and then at some point in their life, it all of the sudden started to grow and change and they come in and you find it to be a melanoma. But it probably wasn’t a melanoma when they were a child, but at some point, those cells started to change and became malignant.

Bill: So, how do you know when it’s time to see the doctor?

Dr. Novotny: Well for sure those lesions that keep getting a scab and crusting and bleeding. Those need to be checked. And things that are changing. So, a little brown mole that’s been sitting there for years and years unchanged; you don’t need to get that checked. Or just a little flakiness of the skin; that doesn’t necessarily need to be checked, but it’s when those get a scab and they start to bleed and they start to get bumpy and grow, those are the ones you need to get checked.

Bill: So, Dr. Novotny, how do we do this self-assessment? I mean I can’t see every area of my body. Do we need a partner to look us over regularly?

Dr. Novotny: Yeah, quite often patients will come in and they have just felt something behind their neck and they often will show it to their family doctor, their primary care provider will look at it and they often – often we get them as referrals from the family doctors, that the patient had something they were worried about and so the family doctor checked it. so, just when you go in for your routine physical, especially if there is some little spot, maybe in your scalp or around your neck or the back of your ear or whatever, you can just say heh could you check this for me and let the family doctors take a look at it and a person should be going in once a year for a check up anyway, but not everybody does that. But I would say most of the time, we see patients as referrals.

Bill: Alright, so let’s talk about treatment. What are the treatment options that are out there?

Dr. Novotny: Well there are a lot of different treatment options; 95% of basal cell and squamous cell are cured just by removing it. So, the small ones can sometimes be just frozen or scraped or cautery, you know burned a little bit and when they are very new and superficial, but as they start to get deeper and bigger; you can have them excised. And the way we do it in Columbus, it works really well, we have the pathologist just down the hall from my office, so I will take it off and just send it right down to the lab right there while you are still in the office and they look at it immediately and within about 10 or 15 minutes we have a answer. Is it cancer and then they can check all the margins and we mark it out, we map it like a face of a clock, 12 o’clock, 6 o’clock, so the pathologist knows that if there are cells that are extending let’s say from 3-6 o’clock, they will call us back and they will tell us what it is and they will say and we have positive margins in whatever area or deep margins and then we know to go take a little bit more and send those margins down. The pathologist then looks at those and until we get everything clear; so, then we can do it all in one setting and then go ahead and put stitches in and close it up and I have a lot of training in plastic surgery, facial plastic surgery and reconstruction and so we do a little rotation flaps and can reconstruct the ear and different things. So, it works out really well. Now some dermatologists will do what’s called Mohs and that’s a very similar thing where they essential shave a little layer off and again, they map it and they take it – the difference is the dermatologists look at it themselves with their own microscope and then they know same thing if it’s 3 - 6 o’clock or a deep margin wherever and they will go take a little bit more. And we have dermatologists around that do that and sometimes if the defects get too big; they will send them to me to close because of my experience with these flaps, rotation flaps and those kinds of things.

Bill: And how about the more serious kind? What about the treatment options for that?

Dr. Novotny: Well, most of the time, surgery is the option and there are some that will get treated with radiation, but there you have to go in repeatedly and it’s not as good of an option, at least that’s my opinion. I mean the radiation therapists might disagree with that. But so, radiation is another option. There are some ointments that can help kill some cancer cells. That only is useful in very early and more often in precancerous lesions, but there are – there are actually quite a few different things that have been tried, but really, surgery is kind of the mainstay of treatment for skin cancers and that includes melanomas and basal cell and squamous cell and those are by far the most common type of skin cancers.

Bill: Dr. Novotny, if you could wrap it up for us. It sounds like early detection is really important when it comes to skin lesions.

Dr. Novotny: Oh, for sure. I mean we see patients sometimes that just kind of ignored it and let them grow and we take out pretty large lesion sometimes and of course that’s much more difficult to get them closed and to get your margins clear. But of course, the really small ones are much easier, and we do them on the nose, and on the lips and anywhere on the face or the head and neck and even onto the shoulders sometimes. So, just mainly look for a lesion or a spot on the skin that might crust or bleed or keeps growing or that changes its color, getting darker. So those are sort of the things to watch for and of course, on the internet, there is lots of photographs of skin cancers, so a person has access to that and you can ask your family doctor too.

Bill: Really good information Dr. Novotny. Thank you so much for your time today. For more information about skin lesions visit www.columbushosp.org, that’s www.columbushosp.org. This is Columbus Community Hospital Health Cast from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.