Time to learn our ABCD’s

photo credit: bettergov.org

photo credit: bettergov.org


The ABC’s. It’s one of the first things we learn as kids right? We even have a catchy little song to help make the alphabet easier to remember. It seems pretty simple….until it isn’t. In the field of dermatology the alphabet is used as an acronym for the clinical detection criteria of melanoma, the deadliest form of skin cancer. The conventional ABCDE’s of melanoma are Asymmetry, Border, Color variegation, Diameter >6mm, and Evolution [any change in morphology or symptoms of the lesion]. A recent study conducted through the University of California, San Francisco, has demonstrated that we need to learn some new ABCD’s. This retrospective study evaluated patients diagnosed before the age of 20, during the time period from 1984-2009. 60 pediatric patients with melanoma as well as 10 pediatric patients with ambiguous melanocytic tumors treated as melanoma (i.e. lesions had atypical clinical presentations and ambiguous microscopic features). The study patients were divided into group A for ages 0-10 and group B for ages 11-19. The conventional clinical ABCDE detection criteria was absent in sixty percent of group A patients and 40 percent of group B patients. What emerged from the study was a new set of ABCD’s common to diagnosis including Amelanosis (lack of pigment), Bleeding and “bumps”, uniform Color, variable Diameter and De novo development. Not only were the clinical features different from the conventional, but it was also found that current microscopic subtypes of melanoma could not be applied to 44 percent of cases.

What does this all mean? It means that more research will need to be done to expand upon this research to help determine the most appropriate clinical and microscopic detection criteria for melanoma as it relates to the pediatric population. The good news, is that it means that the field of dermatology continues to evolve and change as new information reaches the forefront to best diagnose and manage our patients. It also means that as parents and caregivers of children we need to have a heightened awareness of bleeding lesions, bumps and lumps both colored and colorless that have newly developed or recently changed and have them evaluated. It means we need to learn our ABCD‘s.

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Time to celebrate!

Camp Korey

Today is a day of celebration. We celebrate our country. We celebrate the freedoms we enjoy as a result of our forefathers declaration of independence. We celebrate the special memories we get to create with family and friends as we gather around picnic tables, bonfires and watch Technicolor fireworks illuminate the sky in honor of this declaration. Sure, we celebrate a day off work and throw in some good sales too, why not? In the spirit of celebration and honoring amazing things, I wanted to share my adoration for Camp Korey. What is Camp Korey? I am so glad you asked! Camp Korey is an amazing haven that provides recreational programs for children and young adults with serious medical conditions who are unable to attend traditional enrichment programs due to their high medical needs. Camp Korey is a place that provides kids the opportunity to build self-esteem, meet friends that can relate to similar challenges and empower them to try new things rather than feeling isolated or limited as they might elsewhere. It is the place where pure joy is palpable.

I had the privilege of volunteering at Camp Korey as medical staff this past week. On a larger scale, the camp is part of the Serious Fun Children’s Network and in partnership with the American Academy of Dermatology hosts Camp Reflection, which is a camp specifically geared towards children with skin disorders and is held on the Camp Korey campus. As a dermatologist, I had the opportunity to oversee the medical care of children with both relatively common skin conditions such as atopic dermatitis to rare entities that most of us only read about during our training. The diversity of skin disorders at camp may have been vast, but the love of fun, camaraderie, mutual respect and unwavering support was homogenous. The kids had a blast, and no one was left behind or left out. From the beginning of camp where a young woman had such severe social anxiety that she wouldn’t utter a word to me, to the end of camp where she bestowed upon me a smile that could light up the darkest of skies, it was magical. Although I was there to serve in a professional capacity as a physician, I was gifted a profound personal re-awakening. Today is a day of celebration of our nation’s independence, but I would suggest that every day should be a celebration. The kids at Camp Korey reminded me that we can and should celebrate our abilities, but we should also celebrate our limitations to help catapult us beyond them to achieve true bliss. Happy 4th everyone!

Did you smell that?

photo credit: Zazzle.com

photo credit: Zazzle.com


Depending on what it is you may hope you didn’t right? Well as a Mom of two kids and two dogs, needless to say there are some er..um, unpleasant odors permeating the house on a not so infrequent basis. Now I realize that offensive smells are not directly related to skin care, but the fragrances and products used to camouflage said scents can be irritating if they come in contact with your skin so I thought this would be a good segue, yes? Bad smells are not the kind of thing most people like to talk about at the bus stop, in the coffee shop, or in the grocery checkout lane (although quite frankly it may help pass the time when you’re stuck behind the person with 50 items in the express 15 item limit line, did she not see the sign?), but I’m not like most people. So bear with me.

I wouldn’t say I have a huge nose by most standards but it’s certainly not petite. Not one of those cute button noses. Any hopes of having a “cute” nose washed out at sea when I got kicked playing water polo at the beach as a kid. I know, I know, who plays water polo in the ocean with strong undercurrents right? Exactly, so I get pulled underwater by the current, get kicked in the nose, blood everywhere….The good news was that my nose wasn’t “broken” per-se, more like “adjusted to the right slightly”, but the end result is that my nose doesn’t quite work like it used to, making breathing a bit more difficult. What I lack in breathing prowess however, I make up for with olfaction. It’s like my sense of smell went into overdrive after that fateful day at the beach. There are many times I wish this was not the case, believe me…I am constantly asking people, “Do you smell that?” and of course they don’t so I am left to endure the stink in solitude. Spending more time indoors since our move to the perpetually soggy Northwest, my inner voice is still yapping away, and she says she’s had it with all the over-chemicaled, synthetic, “can’t pronounce a single ingredient on the bottle”, skin irritating air fresheners, so I have indulged her again and found a solution for my lonely sniffer…homemade air freshener spray!

I have come across recipes that use only water or only vodka, but I have found that an equal ratio of both works best for me, but feel free to experiment. The alcohol will break down the oil while leaving the scent intact, allowing you to mix it with water. The added bonus is that alcohol has anti-bacterial, anti-viral and anti-fungal properties, so if the spray gets on any surfaces, you can pat yourself on the back for multi-tasking…disinfecting and deodorizing!

So here are the basics:
4 ounce spray bottle (I prefer glass. Essential oils are stored in glass to prevent degradation, so I figured why mess with it, I can’t afford to have the good smell go away!)
2 ounces distilled water
2 ounces vodka (Any kind will do, but the cheaper the better because you may go through it fast if you get spritz happy.)
20-40 drops essential oils (The potency of oils vary so you can tailor the amount used to your preference. Also, several oils have anti-bacterial properties so in case you really do want to multi-task you may want to try: lavender, maleluca oil(tea tree), geranium and lemon.)

My favorite combinations are:
a. lavender and rosemary
b. lavender and sweet orange
c. cedar wood, rosemary, rose geranium, lavender (I know, I know, I can’t help it, I really like lavender)
d. eucalyptus and spearmint (seriously refreshing)

So the next time someone asks you, “Did you smell that?”, you can be armed and ready with your homemade air freshener. And who knows, you may actually enjoy talking about bad smells to total strangers once you find your olfactory bliss like me!

What’s the big deal?

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Skin cancer is a big deal. More than 3.5 million cases of nonmelanoma skin cancer in over two million people and over 70,000 cases of melanoma are reported each year, which makes skin cancer the most commonly diagnosed cancer the United States. This means that on an annual basis there are more new cases of skin cancer than the incidence of cancers of the breast, prostate, lung and colon combined. To break this down further, one in five Americans (one in three Caucasians) will develop skin cancer during the course of a lifetime. Bottom line…skin cancer is a big deal. In my skin cancer and sun safety basics post I go over a lot of the facts, so please refer back to it for a more in-depth discussion, and please feel free to reach out if you have any questions. Also check out skincancer.org for a wealth of great information and photos of all of the different types of skin cancers.

So if I already talked about these facts in a previous post, why am I all riled up and repeating myself you might ask? Contrary to what my kids may say (and my husband and possibly the neighbors, but who likes nosy neighbors anyway?) I have not lost my mind, but my mind is most certainly boggled. A recent study reported that greater than 27% of melanoma survivors never put on sunscreen when spending more than an hour in the sun. Researchers at Yale also found that 15.4% of skin cancer survivors rarely or never sought shade from the sun, and 2.1% used tanning beds. This is insanity. Tanning beds? Evidence from several studies has shown that exposure to UV radiation from indoor tanning beds is linked with an increased risk of melanoma, the deadliest form of skin cancer, and non-melanoma skin cancer. In fact, studies have demonstrated a 75 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning. 75 percent! This evidence is the basis for championing the passage of legislation to ban the use of tanning beds for minors (currently 33 states have restricted teen’s access to tanning beds). So if these are the facts, and people who have already been diagnosed with skin cancer have been educated about these facts, and believe me, as dermatologists we tell our patients, over and over again, then why are skin cancer patients still ignoring them? This is a dilemma. This is my dilemma and I want to help change these statistics. But I need your help to do it.

We know that protecting your skin from the damaging UVA and UVB rays of the sun is imperative to minimizing your risk of developing skin cancer. Sun protection is a multi-faceted process: practicing sun avoidance during the hottest parts of the day, seeking shade (I promise you can find bliss there), wearing sunscreen (daily and reapplying often) and wearing clothing that has a UPF rating greater than 30, are all important to keeping you safe in the sun.

Based on the staggering number of skin cancers diagnosed annually and the results of the recent study noted above, it would appear that telling people this information isn’t enough. It would appear that a cultural shift, a “shade revolution” if you will, is in order. For starters, we need to embrace vintage times, go retro…what’s old is new again. It works for current fashion trends (hello neon and leg warmers!) and toys (yes, cabbage patch kids I’m talking about you!) so why can’t we embrace the way we used to behave in the sun. Back in the day our ancestors spent plenty of time outdoors, but clothing protected the majority of their body. Being pale was in vogue, whereas having a tan was undesirable. We can do this! You don’t have to give up that Caribbean vacation or frolic on the beach, just be sun savvy! Tap into your sun-conscious and take the necessary steps to protect your skin. Together we can change the perception of what’s “hot” in the sun and you will find your shaded bliss, I promise!

Chocolate Almond goodness

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These little nuggets of goodness are made from a recipe adapted from an inspiring and beautiful blog I have come across (thank you Caitlin-roostblog.com)  It was originally made as a dinner biscuit, but I tweeked it make it an after dinner treat. Depending on which of my adaptations you try, you can make it more like a biscuit(less sweet) or more like a true dessert….a girls got to have her chocolate right?

Over the last few months, as I have jumped, I mean seriously, like off the high dive right into the deep end of a pool (and I’m afraid of heights mind you…another wonderful bonus of getting older, but I digress) into the gluten-free realm, I have tried to nudge my family, especially the kids into the “shallow water” of gluten-free eating. So when my son, the pickiest eater of us all gives something a thumbs up, believe me, I am going to shout the recipe out to anyone willing to listen. (just turn down the volume if I’m being too loud).

I have now made this 3 ways, using either butter or coconut oil for variety. Choose whichever one sounds good to you!

Chocolate Almond Goodness: Subtle sweetness for a mini-biscuit

  • 2 1/2 cups almond flour
  • 1/2 tsp salt
  • 1/2 tsp baking soda
  • 2 eggs
  • 1/4 cup melted organic coconut oil or butter (Note: coconut oil will impart a somewhat “tropical” flavor and butter will provide a true biscuit flavoring)
  • 1/4 cup brown rice syrup
    3 Tb organic cacao powder

Preheat oven to 350F. Line a baking sheet with parchment paper or a silpat (or whatever you’ve got so things don’t stick to pan).

In a large bowl, combine the almond flour, salt, cacao and baking soda. In a medium bowl, whisk together the coconut oil, brown rice syrup and eggs. Stir the wet ingredients into the flour mixture until thoroughly combined. With a spoon or if you are willing to get dirty (which is more fun in my opinion) scoop up some dough in your hands and make small/medium blobs (very technical term) probably equivalent to 2 teaspoons or tablespoon size depending on your blob preference.

Bake for 15 minutes (give or take depending on your oven) so that a toothpick inserted into the center of a biscuit comes out clean. Let cool briefly on the baking sheet. Serve warm. ( I have also frozen the leftovers and they keep well!)

Makes about 25-28

The one below is the sweet treat version and my favorite one so far. Not too sweet, but just enough to satisfy my cravings…and hopefully yours too!

Chocolate Almond Goodness: my version of an “Almond Joy”

  • 2 1/2 cups almond flour
  • 1/2 tsp salt
  • 1/2 tsp baking soda
  • 2 eggs
  • 1/4 c organic melted organic coconut oil
  • 1/2 c organic light brown sugar
    1/4 c organic cacao powder

The mixing and cooking directions are the same as above but instead of brown rice syrup use the brown sugar and add it to your dry ingredients. Enjoy!

Gluten-free waffles

kid tested, kid approved

gluten-free waffles

We were running late in our morning routine for school as usual. I swear I try to be on time, but somehow with kids I am in a time warp where no matter what I do I am always late. At one point in my life, pre-kids that is, I was early and being on time was considered late for me. Now with kids, my timing consists of either being late (truly late), later and you know what….we better call it a day because this isn’t gonna happen. But, despite running behind schedule my son was in the mood for waffles and insisted that I had “time” to make them for him. Of course, how can I resist those big blue eyes pleading with me, so I caved and threw caution to the wind. What’s another tardy at school right? These kids need good nutrition.
So here was my experiment this morning. To my surprise the kids gave it raves reviews! Now, of course I take this with a grain of salt. I am new to this cooking thing, and I think the kids don’t want to discourage me (I really do love them!) so hopefully you will enjoy them too. But don’t worry, I won’t be insulted if they aren’t your thing. But feel free to add comments/suggestions. I can use all the help I can get.

1 cup almond flour
1 cup quinoa flour
3 tablespoons baking powder
1/2 teaspoon salt
Mixed these dry ingredients all together in a bowl and set aside

2 eggs
1 1/3 cups milk
4 tablespoons organic pumpkin
1 1/2 tablespoons vanilla ( I like vanilla but you can use less)
organic cinnamon (I forgot to measure)
1 tablespoon brown rice syrup
1 teaspoon light brown sugar (organic fair trade)
Whisk these together, then add to your dry ingredients
Grease waffle iron with either melted butter or coconut oil (for added flavor)
Voila! Enjoy!

The sunny side of rainy days

We recently moved from Northern California to the Pacific Northwest. Days of endless sunshine have been replaced by gray skies punctuated by rain showers with only glimpses of the sun. The weather folk on tv call these “sun breaks”.  It is an odd concept to wrap my head around, but I am getting used to it. At least I keep telling myself that.

I admit that seeing the sun peek out from the clouds at the end of long wet day, feels like being greeted by a warm smile when you enter an unfamiliar room. It immediately lifts my spirits. I know sunshine has this effect on many people. It’s the reason why so many of us travel to warm, sunny and tropical places in the winter to experience that instantaneous mood elevation. (Of course, that’s also why I am marred by sun damage and saw so many patients in my office with skin cancers, but that’s a downer, so let’s focus on mood elevation!) The good news, is that I have recently found the sunny side of rainy days. Who knew there was one right? But there is….just look in the mirror, it’s you.

Spending more time indoors, I have spent more time getting to know me. It sounds strange, that after all these years of being me, I never spent much time really listening to my inner voice: what she likes, dislikes and is curious about learning. She talks a lot by the way, so for the longest time I just shut her up because I had work to do, or kids to chase around, or frankly (and most truly) I was afraid of what she might be saying. But this recent move has provided me with an opportunity to spend more time indoors and by default more time with me, so I have indulged her (speaking about myself in the third person is odd, I know, but bear with me).

She wanted to cook. Now for those of you who know me, know that this is outrageous because the stove and I had never really bonded. There was always the occasional flirting with brownies and chocolate chip cookie baking, but real cooking… not a chance. My sweet husband had indulged my culinary incompetence for the last 18 years (I know, he is a saint) and whipped up delicious meals for the kids and I.  Until now.  At the beginning of the new year I started critically reading food labels and realizing that despite my umpteen years of schooling and learning the crazy terms and acronyms that lend themselves to dermatology, I couldn’t pronounce or understand 90% of what was on the ingredient lists of most packaged food. I knew I didn’t need to have gone to medical school to know that this was not a good thing.

So what next? I got schooled. I recruited the help of a nutrition counselor (love her!) and delved into the realm of whole foods. Now I know this is not a new concept. But while the rest of the gang was getting wise to the ways of nutrition, I had my nose in the derm books and remaining blissfully ignorant to all the additives and preservatives that filled the boxes in my pantry.  Long story short (sort of…I told you “she” had a lot to say), empowered with my new knowledge and abundance of rainy days, I put on my figurative big girl pants and dove into cooking. I have  roasted vegetables. That’s right rutabaga, you don’t scare me anymore. I have made soups, stews, gluten-free and dairy-free entrees, desserts, sides and salads… it has been life altering. For me. For the kids. For my my husband.

Yes, the warmth and vision of the sun is uplifting emotionally, there is no doubt. But you may find that if you step into the shade, whether literally or figuratively, and listen to your inner voice, she/he may have something interesting to say and lead you to a new type of “shaded bliss.”