Hugh Jackman: When Sunscreen Alone Will Not Keep The Skin Cancer Away

Hugh Jackman as of May of this year has had three skin cancers treated. He is realistic that he will have more.

Jackman, who plays Logan and Wolverine, wore a bandage on his nose after having a basal cell carcinoma removed last week. Basal cell carcinoma is a slow-growing form of skin cancer and Jackman was treated for the same disease last year.

He told The Associated Press: “I’m realistic about the future and it’s more than likely that I’ll have at least one more but probably many more, which is not uncommon for an Aussie particularly from English stock growing up in Australia where I don’t remember ever being told to put sunscreen on.”

Source: http://www.foxnews.com/entertainment/2014/05/13/hugh-jackman-expects-skin-cancer-will-return/

Don’t take it personally Hugh, my kids don’t listen much when I encourage their use of sunscreen. I am known to embarrass at baseball games, etc. :)

Jackman correctly attributes the skin cancer to sun exposure and his heritage. What is not mentioned in the Fox piece is that there are other preventative therapies for skin cancer useful in people who have had them already. When you have already had three skin cancers just wearing sunscreen is probably not enough to keep them from returning. Hopefully he is looking into some of the alternatives now.

Best Regards,

John Di Saia MD

Related:
Wanna See a Nodular Basal Cell Cancer?

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Large skin cancer arm after removal before #plasticsurgery #goryMonday

Large skin cancer arm after removal before <a href='http://twitter.com/search?q=plasticsurgery'>#plasticsurgery</a> <a href='http://twitter.com/search?q=goryMonday'>#goryMonday</a>

Originally posted 2013-08-26 08:17:30.

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Skin cancer arm after removal and 1 month after #plasticsurgery #goodplasticsurgery

Skin cancer arm after removal and 1 month after <a href='http://twitter.com/search?q=plasticsurgery'>#plasticsurgery</a> <a href='http://twitter.com/search?q=goodplasticsurgery'>#goodplasticsurgery</a>

Originally posted 2013-09-18 15:30:47.

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Woundscare.org & Infected Sternal Wire From Previous Cardiac Surgery

WoundsCare.org logo

Not all surgery that a surgeon (even a plastic surgeon) performs is particularly glorious. In this case a patient had had cardiac surgery prior to his admission to the hospital at which I saw him. This involved the division and later repair of his breast bone (the sternum.) The patient had had a delayed healing of his chest incision and a few months later the infection showed extension to one of the wires that had been used to repair his chest wound. In this case, the wound kept getting infected intermittently until the wire was identified and removed.

As usual the image will be placed after the page break for those who would rather not go there. :)

Best Regards,

John Di Saia MD

Originally posted 2014-01-15 07:30:58.

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Northwest Pharmacy Experience from Hell

Looking to obtain a break on my practice’s botulinum toxin of choice (Myobloc) I yielded to curiosity and ordered from a Canadian Pharmacy…Northwest Pharmacy.com. I figured we would try to break the price point of this popular product. Thankfully I used my credit card.

Botulinum toxin must be kept cold to retain its potency. We traditionally receive this product on dry ice and have never had much of a problem with effectiveness. I was promised by the pharmacy rep that this product would arrive cold within 2-5 days of shipping. Only after I gave her my credit card information did she share with me that the product would be coming from Great Britain. This was not welcome news. I was reassured that the product would be cold and usable.

The product arrived ten days later at room temperature, a completely questionable situation. The pharmacy rep said to go ahead and use it. I said nope. As I was summarizing the dispute, it occurred to me one more reason why patients having their botulinum toxin elsewhere sometimes describe such a variation in their experiences. Other practices might actually use this rotten Botox. Mine doesn’t.

For other docs thinking of ordering from Northwest Pharmacy: They were way too Type B for me. You have been warned.

Best Regards,

John Di Saia MD

Originally posted 2011-01-13 07:30:09.

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Dr D’s “Does A Plastic Surgeon Ever Say No?”

“Extreme Makeover,” “The Swan” and similar media have increased the number of potential cosmetic surgery clients. These people are not always good candidates for surgery however. Some need to come “Down to Earth” before they can have surgery.

“Reasonable Expectations” Still Reign Supreme

The vast majority of patients want to have a pleasant encounter with cosmetic surgery. The problem is trying to figure what patients expect. Communication is important. The problem is magnified when their potential surgeon doesn’t care to inquire or doesn’t make time to evaluate.

Face it. Surgeons Get Paid To Operate.

In my local practice environment, I have amongst the longest cosmetic surgery consultations and I meet all my potential surgical patients personally. This has been the source of grief between prior office mates and me (I am now in solo practice). Most of my prior office mates were primarily fixated on the bottom line. Many plastic surgeons simply do not make the time to talk with their potential patients for more than a few minutes. This makes it pretty hard to figure a patient’s options, motivations or expectations. I don’t claim to have a 100% success rate, but the vast majority of my patients are happy. Then again if I get the impression that a patient is set up for disappointment, I will not recommend surgery.

Why would I say “NO?”

When patients seem fixated upon operations which will lead down a path of complications or problems, I tend to say “No.” When patients have had too much surgery and appear distorted or strange, I say “No.” What one patient finds undesirable, however another will want. I operate if it seems I can deliver what the patient will want and I will be OK with it after I am done. Every surgeon draws his or her own line here. Being one of the few that will lose money in recommending against an operation makes me pretty unusual in my locale. To many of the surgeons practicing in Southern California, this is akin to heresy. I look at this as having integrity and proving myself trustworthy. Having predominantly happy patients makes my patient referral rate very high. My practice grows by referrals. I do very little advertising compared to other surgeons.

Be Very Careful Of Looking Too Hard

When an honest surgeon says he doesn’t feel that he can help you, it is not the end of the world. It does complicate things a bit however. You have to worry that if another surgeon offers you surgery, that he may be simply operating for the money. I have had patients for whom I recommended other than what they said they wanted. Some have come back after they had surgery elsewhere and looked pretty awful. Sometimes I can fix these things, but not always. In Southern California, there are so many plastic surgeons that even a poor surgical candidate will find one willing to operate if he or she keeps looking. Caveat emptor.

Best Regards,

John Di Saia MD

I originally wrote this for my web site a few years ago. It still applies to this day however. :)

Originally posted 2013-01-14 07:30:12.

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Plug Ear Lobe Repairs for Military and Police Academy Recruits

In the office, we have had an increase in military and police academy candidates with ear plugs for repair. It seems these men are being told to have the holes repaired before they apply.

Plug ear hole repairs are a bit more involved than standard ear lobe repairs due to the size of the holes and the degree to which the stretched ear lobe tissue has become lax, thinned and/or droopy. In most cases we are able to do them under local (numbing shots only) in the office. Complicated cases need to be done in portions over time and can have some deformity afterward.

Come to think of it, I can’t remember the last serviceman or policeman I saw with ear rings much less plugs.

Best Regards,

John Di Saia MD

Originally posted 2011-07-05 07:30:19.

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Repeal ObamaCare Petition Signing

Shopping this weekend we saw a “Repeal ObamaCare” petition. Gotta sign that one.

Best Regards,

John Di Saia MD

Originally posted 2010-09-20 10:00:36.

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Tanning Salon Owners Mislead Clients

Many tanning salons are downplaying the health risks associated with indoor tanning while claiming that time in a tanning bed offers an array of health benefits, according to an investigative report from Democrats on the House Energy and Commerce Committee. Committee investigators, posing as fair-skinned teenage girls, called 300 tanning salons across the country, and found that 90% said that the use of tanning beds did not pose a health risk. When pressed about skin cancer risks, some salon employees said the link to indoor tanning was “hype” or “a big myth.”
Source: skinandallergynews.com/newsletter/the-skinny/singleview40946
/tanning-salons-mislead-teens-congressional-probe-
finds/4aaea3a6b8.html

Studies showing tanning bed use is associated with increased risk of skin cancer and even melanoma skin cancer are now plentiful. It is funny though to expect businesses outside of medicine to discuss risk much. Does it really surprise anyone that tanning salon management downplays the risk of the services they provide?

As far as I am concerned tanning salons are cancer traps. They should have warnings similar to those on cigarette packages proclaiming the absolute foolishness their patrons have in using their services. I will even donate to the hypothetical copy of such a statement:

“To our Clients,
While we appreciate your patronage please be advised that tanning beds have been associated with increased risk of skin cancer and premature aging. The money you are pouring into our pockets might be better spent on sunscreens and sun avoidance clothing. By using these facilities you have decided to go against your better interest and as such the ownership takes no responsibility for the cavernous wrinkles, cancer and even death you might receive in the bargain.
Thank you.”

Best Regards,

John Di Saia MD

Originally posted 2012-02-09 07:30:06.

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Dr D’s “Cheap Plastic Surgery”

Most people looking into cosmetic surgery soon realize that it is not cheap, but why? Why is it so expensive? There are many reasons. Most of them have to do with overhead. The discussion below is meant to give you some insight into the way plastic surgery is practiced. It varies quite a bit. Bargain Basement plastic surgery may not be the best idea when you look at the big picture.

Some of you out there are thinking: “Gimme a break! I have this ad right here saying that breast implants are only $3000. How can this be?”

You are correct. There are those that do this operation for less than it costs me to render the service. Then there are those who use ads to get you into the office and the story changes when you get there. How can they do this? Below we will lay out some possibilities. These may seem quite familiar to some of you:

Say you walk with ad in hand to see the doctor. You notice that the doctor’s name doesn’t seem to be listed in the advertisement. This is called a Bait and Switch Scam.

SCENARIO 1: “All things are not as they seem”

You find yourself in an examination room with a nurse who tells you that the doctor only meets with patients after they have signed up for surgery. This saves the practice money, but wouldn’t you rather meet your surgeon before you decide to make him your surgeon? She then explains that the price you saw in the advertisement is just the surgeon’s fee. The full price with anesthesia, the facility fee and implants is several thousand dollars more.

SCENARIO 2: “The surgeon and facility are not as they seem”

You meet the doctor and ask him about his training. You find that he trained as an Obstetrician or Head and Neck Surgeon. He started doing cosmetic surgery years ago. He is not board eligible or board certified in Plastic Surgery, but he is board certified in “Cosmetic Surgery.” He operates in his office, but hasn’t bothered to have it certified by any ambulatory care agency, so there is no facility fee. He does the procedure under “twilight sleep,” so there is no anesthesia fee.

I am not trying to say that you have to pay a fortune to have cosmetic surgery, but contrary to popular belief most plastic surgeons are not trying to rip you off. They have legitimate costs of doing business and pass these on to their clientele. By the same token if you see a few doctors and one has a “sky-high” fee, don’t think that an operation here is a guaranteed success. My suggestion is that you consider seeing a few surgeons. Take your cosmetic surgery fee quotations and throw out the really high and really low ones. Then choose one of the remaining surgeons.

When you go to have a cosmetic operation, you are paying for the expertise of your surgeon. You are also paying for every patient who has ever sued a plastic surgeon in Southern California, because this is how malpractice insurance premiums are charged. Malpractice insurance is one of the highest overhead items that plastic surgeons pay. Non-plastic surgeons who perform cosmetic surgery often do so without specific malpractice coverage meaning they pay cheaper malpractice premiums than I do. Finally, in choosing cosmetic surgery with a particular surgeon you are choosing a Level of Service. This often changes dramatically with the price tag.

Best Regards,

John Di Saia MD

I originally wrote this for my web site a few years ago. It still applies to this day however. :)

Originally posted 2013-04-22 07:30:37.

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