October 25, 2015

Dear Patients,

First, some administrative issues:

Please get your influenza vaccination! Just drop by my office, any day, Monday through Friday, between 8:30 and Noon, and we will be happy to give you the vaccination. We will use our very best efforts to get you in and out quickly!

~	Please get your influenza vaccination! Just drop by my office, any day, Monday through Friday, between 8:30 and Noon, and we will be
	happy to give you the vaccination. We will use our very best efforts to get you in and out quickly!

~	Re-enrollment packages went out this week, either by US mail or, if you requested, by email. Please return your form and payment by
	December 18; remember, checks will not be cashed or credit cards processed until 2016. Nevertheless, the December 18 date is
	important as I need to promptly address my waiting list. If you are not re-enrolling, please respond to this email now.

And now the Newsletter for late fall - awkward actions that can be meaningful and information on skin cancer:

Have you ever been in a position that you see something of potential importance that should be addressed and yet it may be with a total stranger? It feels awkward or maybe politically incorrect to act and yet, a little voice in your head says to you that you must. You may be right or wrong about the issue but you decide you will leave it to that person to decide. Yes, be a Good Samaritan and do not buy into "no good deed goes unpunished". The scenarios are heterogeneous; perhaps it is a low tire, or an open zipper, or a parent who is abusive to a child. For me, it is often medical.

Recently, while in the locker room at my fitness club, I spotted a man with an obvious (at least to me) atypical pigmented skin lesion on his back. I did not know him but when I saw the lesion, I felt compelled to alert the stranger. The response, as in the past, was surprise, followed by appreciation. After my discussion with the stranger, another fitness patron who overheard my conversation asked me if he had any skin lesions that needed attention! As my patient, you all know that every year I want to look at your skin entirely, it is part of every physical I perform. If I have to wonder about a lesion for more than a moment, I want it off. Either I will do it if it is small and not in a cosmetically sensitive location, or I will send you to either the dermatologist or plastic surgeon, depending on the location and size of the lesion.

Skin cancer is the most common cancer in the United States. The two most common types are basal cell and squamous cell. Pre-cancerous growths are called actinic keratoses, many people mistake these for "age spots". Another type, melanoma, is more dangerous, but less common.

Anyone can get skin cancer. It is more common in those who spend a lot of time in the sun or may have been sunburned, particularly at a young age. The older you are, the greater your risk. And if you have a light complexion and always burn and never tan, you are at a higher risk. The earlier it is diagnosed, the better the prognosis. Most skin cancer is cured easily.

Here is some helpful information for doing your own skin exam:

Actinic Keratoses are red and scaly growths, often on your face and scalp and backs of the hands. These are pre-cancerous.

Basal Cell Carcinomas, followed by Squamous Cell Carcinomas, are the most common types of skin cancers. They are very curable; they may look like a red bump, they can be shiny and pink, some scale, some look like an ulcer or crater and bleed and ooze, some look like a pearly nodule. The sooner treated, the better off you are.

Melanoma, when detected early, can be cured. We all should learn to look out for Funny Looking Moles (FMLs). I am always on MOLE PATROL and you should be too. Here is what to look for.

Use the ABCDE method for detecting FLMs:

A -	asymmetry. Normal moles are symmetric, you can fold them in half in your mind and the edges lineup.
B -	border. Normal moles have smooth borders, abnormal moles have notching.
C -	color. Normal moles have homogeneous tan and brown colors, abnormal moles have a mix of colors - red, dark brown, bluish, black,
	they may be stippled in multiple colors.
D -	diameter. Normal moles are typically less than 6 mm, but any mole that meets any of the above criteria but is smaller, should also be
	examined and evaluated.
E -	evolving. Normal moles stay the same, abnormal moles may change. E can also stand for erythema, which means redness around the mole.

Finally, there is the concept of the 'ugly duckling mole'; this is a mole that is different from the group around it.

Any mole that has one or more of these characteristics should be brought to my attention or the attention of your dermatologist or plastic surgeon.

You can go to this website to see skin cancer images.

Or check out the skin cancer video I did several years ago for the Columbia Association with my colleagues Drs. Cheryl Bansal (dermatologist) and Dr. Tom Grace (plastic surgeon):

And so it goes, we went from a chance glance at the skin of a man unknown to me, to skin cancer and awkward encounters that may lead to helping someone. As I have told my kids, you never get in trouble for doing the right thing! I will leave you with a YouTube from Broadway's Wicked, "No Good Deed Goes Unpunished". I love it, but think not! Good deeds are exactly that!

Here is a quote from Voltaire you might like, "Every man is guilty of all the good he did not do".

Happy holidays and wishing you well.

HAO

Harry A. Oken, M.D.

Clinical Professor of Medicine
University of Maryland School of Medicine
Office: 410-910-7500 Fax: 410-910-231