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An Exclusive Interview with Doctor Piasecki: Sun, Cancer and Success

I was delighted to be offered the chance to interview Dr. Justin Piasecki, founder of the world renowned Skin Cancer Center in the US. Dr. Piasecki is the only surgeon in the world certified to offer this combined treatment. With his one-of-a-kind training, Dr. Piasecki pioneered plastic micrographic surgery, the unique skin cancer treatment that combines Mohs surgery (the highest cure rate surgery for skin cancer) with cosmetic reconstruction for the most cost effective and convenient approach to skin cancer care. As the only doctor to offer this, Dr. Piasecki already is uncommon in the world of medicine, and that was before he was crowned and was featured on the television show “The Doctors” as one of America’s “Most Beautiful Doctors.”

What would you say is the most common type of cancer you deal with? Is there a prominence of cancers caused through over-exposure to UVA/B?

By far, the most common skin cancer types are basal cell carcinoma and squamous cell carcinoma – they are more common than all other cancers combined. And yes, we believe the most common cause is cumulative exposure to UVA and UVB radiation present in sunlight. Both UVA and UVB cause skin cancer.

Which type sunscreen do you prefer to wear on a daily basis? Do you prefer a dedicated product or a product such as a moisturizer that contains an SPF? What are your favorite brands?

Not to sound sarcastic, but the best sunscreen out there is the one you will wear. If it is too expensive that you won’t wear it, or if it’s too greasy or fragrant that you won’t wear it – it will sit in your bathroom cabinet and do nothing to help you. There is no evidence that one brand or particular product is better at preventing skin cancer than another. Broad stroke recommendations: SPF of 30 or greater applied every day, and if you are spending an extended period of time outside, the sunscreen needs to be reapplied every 2-3 hours (because the UV radiation will destroy the sunscreen on your skin over time); if you get in the water, assume the sunscreen is gone from your skin and reapply; if you can’t reapply to your whole body (keep in mind the SPF of regular clothing is only 5-6), atleast reapply to your face and hands (the sites most commonly affected with skin cancer, and the locations most cosmetically sensitive); beyond that, try several brands that are affordable and choose one that you like, that is comfortable and that you will use.

For those reading who have had treatment for cancers and are suffering with the after effects such as scarring and hyper pigmentation, what are your favorite non-pharmaceutical recommendations to help with this?

First off – prevention and proactivity. Be sunsensical (as described above with sunscreen), and if diagnosed with skin cancer on your face, be proactive about your healthcare – be your own advocate, ask questions, and make sure you are treated by an expert in removal of the skin cancer (certified by the American College of Mohs Surgery) and an expert in reconstructive surgery (gold standard is board certification by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery). If we are talking about current poor cosmetic results, there are almost always things we can do to improve the results after the fact, so don’t rule out that possibility. If within a year of surgery, nightly massage of scars for 15 minutes, with a high concentration vitamin C scar cream (I prefer InviCible (available at www.inviciblescars.com) has been shown to improve the appearance of scars. After a year, surgical dermabrasion, or scar revision/reconstruction can make a world of difference.

Do you have any horror stories that really outline the need for people to wear daily sun protection? What were you able to do in this situation? I see it every day.

It’s often made worse by denial both by patients and physicians assuming a small lesion is not cancer, or that a basal cell carcinoma is not life threatening, so let’s try to get away with freezing it or treating it with a topical cream. Sometimes that works, but many times it doesn’t. Like anything in life, if we cut corners, we often get burned.

I once had a beautiful young woman as a patient who had a lesion on her central upper lip which she dismissed as nothing important. When it wouldn’t heal she saw her doctor who froze it with liquid nitrogen. When it came back again a month later, it was frozen again. This process was repeated over 2 years for a total of 7 treatments. Ultimately a biopsy was performed and revealed basal cell carcinoma. This was then treated with a topical cream. That failed. When she got to me and we resected the cancer properly with the Mohs technique, the full extent of the cancer was the entire central portion of her upper lip to her teeth, and the lower part of her nose; I reconstructed her in combination with cosmetic rhinoplasty (nose job) techniques and she’s happier with her appearance now than she was before her cancer was ever detected. But clearly, preventing the cancer in the first place would’ve been ideal, and earlier detection would’ve presumably permitted cure with less tissue loss.

Other than a good diet and seemingly plenty of exercise (I know, I’m terrible), what do you do to keep your skin looking so immaculate?

Logic, common sense, and a keen understanding of what we know in medicine and in science. I try to be smart not just about a balanced and healthy diet, but one that addresses the skin in a positive way. Foods containing vitamin A, E, C, folates, Omega-3 fatty acids, lycopene and selenium have all been shown to be important, helpful and very valuable for the skin. Vitamin A helps decrease clogged pores and thus skin breakouts and is well represented by low sugar yoghurts and carrots; vitamin E is thought to assist the skin in UV protection and is concentrated in almonds; vitamin C is an important cofactor in collagen synthesis and is a powerful antioxidant – so eat sweet potatoes to help decrease the appearance of wrinkles; spinach is high in folates and may play a role in protecting the skin through augmentation of DNA repair mechanisms; Omega-3 fatty acids (salmon, flaxseed oil) can help decrease the appearance of wrinkles and improve dry skin; lycopenes (tomatoes – particularly cooked ones) are important antioxidants and may have anti-aging effects by reducing free radicals; selenium (tuna) may help preserve elastin and thus decrease the rate of photoaging; foods to avoid include simple sugars and simple carbohydrates as these can increase clogging of pores and increase breakouts (white bread, lots of milk).

Beyond that, I use skin care products which I’ve developed myself based on my background in chemistry, biology, skin cancer and cosmetic surgery – an atraumatic cleanser with anti-acne properties, a patent pending moisturizer with zinc oxide (SPF 30), and a nighttime cream with retinols (vitamin A), vitamin C, D and E. We are actually working to bring these to the market in the next year to raise money for charity.

If you could pick just one, what would be your biggest resounding success story to come from your surgery?

I can’t pick just one. I get to cure cancer every day, and put people’s lives back together afterwards in a way that often makes them look better than they did before. I get to do this in a center devised, built and trained to focus on skin cancer – to offer the best outcomes, the highest safety margin and the finest results for less cost. It’s quite cool. I suppose one particularly neat story was a prominent public figure who was frequently in the spotlight on in the media who I treated for a facial skin cancer who was so thrilled with his results, he sent me a postop photo of himself with the president at the White House Christmas party 2 months after treatment, remarking that no one there knew he had anything done.

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