0:00

So what is melanin ? That word , we

0:02

hear it all the time . I'm melanated the melanin

0:04

in my skin . We're going to talk

0:06

all about what melanin is today and

0:08

much , much more on this episode

0:10

of the BlackMed Connect podcast with

0:13

our phenomenal guest , dr Jeffrey Scales

0:15

. He's a dermatologist and he's the

0:17

founder of the North Carolina Center for

0:19

Dermatology . On this episode

0:21

we talk a little bit about what melanin

0:24

is , skin cancer , about

0:26

the practice of dermatology and the amazing

0:28

things you can do as a dermatologist

0:30

to care for your patients . We

0:33

also can't forget our bolus round where

0:35

we asked Dr Scales some rapid fire questions

0:37

, but you got to stick around to the end to

0:40

hear what his answers are to those amazing

0:42

questions . Let's jump right into the episode

0:44

. Roll the music . You

0:57

mentioned a little bit about the work-life balance

0:59

that you've been able to create with dermatology

1:01

. Can you share a little bit about what

1:04

were the circumstances or what made you found your own practice

1:06

and how did you go about doing

1:08

that ? Because here on the BMIC podcast we're

1:11

also really excited about innovation

1:13

and ownership and entrepreneurship and

1:15

everything in between . Can you share a little bit about

1:17

what it was like to start your practice ?

1:20

Sure , at the time I started my practice it was

1:22

a lot more common than it is now

1:24

. Medicine has become increasingly

1:26

corporating . Increasingly , you find

1:29

that hospitals and hospital systems

1:31

monopolize a lot of the area around

1:33

where they are . It

1:35

is much more challenging for people

1:37

to consider something like that now . Dermatology

1:40

still is one of those specialties that avails

1:42

itself of the opportunity to do that , although

1:45

diminishingly so . It's

1:47

nice to own my own practice

1:49

. There are some great responsibilities

1:51

that come with it , as well as some headaches that come with

1:53

it , but that's going to be in any setting that you

1:55

work . My wife works at the hospital

1:57

and she is a division chief and she's responsible

2:00

for 12 , 14 doctors and

2:02

she has certain kinds of problems that she experiences . I

2:05

have different problems that

2:07

I experience things like making payroll

2:10

, checking what sort of benefits we

2:12

offer , things like that that really respond

2:14

more to being a business owner

2:17

. There's working in a particular

2:19

job and there's working on a particular

2:22

job , so I'm often balancing both those things

2:24

. Today I'm rushing around seeing patients

2:26

and then someone will stop me and ask do

2:28

we need to do this transfer ? Is it time

2:30

let's check on medical benefit ? These things

2:33

I get pulled in another direction have

2:35

to be a different person , have to be a business

2:37

person , and so I've done

2:39

so long now I've gotten used to it In many

2:41

regards . If you ask most doctors , all they want

2:43

is to practice medicine . That's what they're trained to do

2:45

. They want to take

2:48

care of patients and make people better

2:50

, and that's very much my desire as well . But

2:52

I also have to balance that other part

2:54

. Now you could work for a

2:56

large hospital system much as you do and my

2:59

wife does . But you also realize

3:01

it's not just invasions . There's all sorts of

3:03

responsibilities for your division

3:05

. You have committees , you

3:07

need to be on leadership roles

3:09

that you will play , particularly as you're there

3:11

longer , and so that takes on a different type

3:14

of demand . So I think it's

3:16

just deciding which you want . But

3:18

with that in mind , I'm fortunate

3:20

I have my own small private practice medicine . Now

3:23

I'm expanding into opening a small

3:25

aesthetic center right next door in

3:27

some space on that island , and

3:29

the open house will be in

3:31

early December I think December the 3rd be

3:33

agreed upon and that's

3:35

fun and exciting . That's choosing

3:38

to do something . That's very different . It's very different type of

3:40

medicine . Well , consumer medicine is

3:42

medicine where people hey , can't I

3:44

just to have some services that

3:46

are not covered by insurance

3:48

, so the entire insurance issue is

3:51

different . So it has given me the opportunity

3:53

to develop some new skills

3:55

. It's given me the opportunity to acquire

3:57

certain assets and things . I give a perfect example of

4:00

my condo space , where I have

4:02

my practice and also where I have my aesthetics

4:04

, and it's appreciated significantly

4:06

since I've owned it . So it's something that's really up game

4:08

well with and learn

4:11

to be a landlord , as well as other

4:13

skills that come with that learning how to get

4:15

contractors and get things repaired . That's

4:18

again another set of skills that you don't necessarily

4:20

have to have if you work in a big hospital

4:22

system or a big practice . So

4:24

, yes , it's had great benefits . I

4:27

really like the idea of ownership . I've taught

4:29

my children all three of them that

4:31

it's important to own something . It's

4:33

not just to own a car or to own consumer

4:35

items . Those are things that we're really good

4:37

at as a people . We are great consumers . We're

4:40

some of the best consumers in the world . We

4:42

spend a disproportionate amount of money

4:44

on certain fields , certain types

4:46

of businesses that really depend

4:49

on us , but I think the ownership

4:51

of business , the benefits

4:53

that come with that including

4:55

the tax benefits that come with that are

4:58

important to consider . Being an employee

5:00

is good . You can make a money as an employee , but

5:02

always you need to have something on the side . So

5:04

my daughter is going to Madison and I've talked to her about that

5:06

. I said , yeah , honey , and I've told all three of them

5:08

but this was one of the only

5:10

ones that listens I told all three of

5:12

them you need to have some kind of business on the side . You

5:14

need to have something that is working for you

5:16

, that other people are working for to

5:19

help benefit you . So a perfect example

5:21

is this my wife and I purchased

5:23

a small condominium from her mother

5:25

in Miami and

5:27

we got it for a reasonable price and we rented out

5:29

and it provides a certain amount of money per month

5:31

and , as I told my daughter , you have people

5:33

who go to work every day , who pay the rent , who

5:36

put money towards your education

5:38

, towards your long-term benefit . It

5:40

will always be something that you want . It will appreciate

5:43

. That's the type of business

5:45

that you need to have indefinitely

5:47

. So there are tax benefits and things , and

5:49

you don't have to be planned to be a

5:51

big landlord forever , but

5:54

you certainly can do things like that

5:56

that help you from a tax standpoint and

5:58

long-term asset benefit

6:01

, and I think we all need to

6:03

think about that . If it's not that business , it can be

6:05

something else . I started a little line

6:07

of products here which called Dr Clear Skin

6:09

, and I like it very much and

6:11

it's slowly growing . It's

6:14

never going to be L'Oreal or

6:16

Revlon or something like that , but it's something I do

6:18

and it's something that , again , I get some

6:21

benefit from in terms of learning to be an

6:23

owner , and so I am trying

6:25

to teach all of my children

6:27

and everyone I can talk to about the importance of owning

6:29

assets , things that appreciate . We

6:32

spend a lot of money on things that depreciate cars

6:34

, vacations , food , all

6:36

these experiences . There's nothing wrong with any of

6:38

those things , but those have to

6:40

be things that you do along with the

6:43

other things . You should always be looking

6:45

for something to be involved with , be it some kind of

6:47

small business it could be

6:49

a lawn mowing business or something or something Just

6:51

something that you can have , that

6:53

you can start on your own and you can build into . It doesn't have

6:55

to be something you start off really big

6:57

, as I tell them , you have to be something big . But it has

6:59

to be something big , because the ownership

7:02

classes in this country , as we've seen , are

7:04

the ones that reap the spoils of

7:06

the economy that we have , and be it

7:08

Jeff Bezos or Berkshire

7:11

Hathaway or any of those things , those are

7:13

ownership issues and I know I'll never be any

7:15

of those people when I'm seeing that aint . But

7:17

there's a reason that people own

7:19

things . There's a reason that they

7:22

own companies , swords

7:24

, teams and things like that . We need to own those things

7:26

as well , because that's how you develop

7:29

economic clout in the society . Now

7:31

, how much you spend , but what assets

7:34

you have . What can you control

7:36

? What benefits your brain ? In

7:38

that regard , for instance , I hire . I have a

7:40

very diverse staff . I have a number of people

7:42

who are Hispanic , a number of people who are African

7:44

American , someone from India , people

7:46

, a lady from Cuba . These are people

7:48

who , in many regards , may not

7:50

have had some of the same opportunities to

7:53

be in some of the positions that they are

7:55

, because sometimes they don't necessarily

7:57

get the benefit of being hired in the same

7:59

way that other people are . So I feel very good

8:01

about that , about the opportunity to put people in positions

8:04

to do things that perhaps they would not

8:06

get the same opportunity in other places .

8:08

I love that . I love that . I

8:10

think to your point of ownership . It's

8:13

critical . We are such

8:15

a large consumer group , we are constantly

8:17

consuming from others , so

8:20

any opportunities to talk about the importance

8:22

of ownership and even

8:24

you know for I know a lot

8:26

of people in training now who even have small

8:28

side hustles as they're coming through training

8:31

, and I think that's something

8:33

that's unique and interesting

8:35

. Or even for me , I wrote my children's

8:37

book as a trainee . So

8:39

it doesn't have to , you don't have to wait to

8:41

start . You may not be able to finish everything

8:43

at the same time , you may have to kind

8:46

of obviously put your emphasis

8:48

on getting through training or getting through med

8:50

school , but you can start small , like you said

8:52

, and it can hopefully grow . So

8:54

you know , thank you for that advice . I'm

8:57

listening , just as much as I hope my audience

8:59

is , to the wisdom

9:01

you're sharing , because ownership is so critical

9:03

, especially in a time where corporate , like you're

9:05

saying , corporate medicine is taking

9:08

over and changing the landscape

9:10

of medicine , and so

9:12

I've always admired individuals who have

9:15

their own practices and people who are starting

9:17

maybe their own direct primary care or direct

9:19

practices as well . So thank you for

9:21

sharing that importance and value of ownership

9:24

, and you know that's what we're all about here

9:26

thinking about innovative and creative

9:28

ways to have

9:30

our careers , because it doesn't have to look

9:32

one particular way . And

9:34

so you mentioned your aesthetic clinic

9:37

. You mentioned your product line . Can

9:39

you share more about what is your product line all about

9:41

and what will you be doing in your new clinic when

9:43

you want to be separate ?

9:45

Sure . So I started a little really curate

9:48

a little product line that I put together that

9:50

focuses on assisting with

9:52

shaving difficulties . So I have

9:54

a number of steps in a little

9:56

package that I put together that

9:59

should help enhance people

10:01

having successful shaving . There

10:03

are quite a number of people

10:06

who have difficulty shaving

10:08

and I think that it's

10:10

often overlooked , particularly among us

10:13

, and I think there are some things that we need to consider

10:15

, and so I have put

10:17

together a few little products which I think will make shaving a bit

10:19

easier for both men and women in the areas

10:21

where they shave . So it's called Dr Clear

10:23

Skin . You mentioned the aesthetic center

10:25

, and the aesthetic center is a place where some

10:27

of that same interest will apply . I

10:29

have a particular laser that's good

10:32

for people of all skin types to

10:34

help with decreasing the amount

10:36

of hair people grow in some areas . There's a number of men

10:39

and women that can benefit from decreasing

10:41

how much hair grows and complexity

10:43

of some of the shaving issues that come with it , and

10:46

so that will take place there , as well as a few

10:48

other cosmetic items that we

10:51

are going to be offering chemical peels

10:53

, microdermabrasion , laser treatment , morpheus

10:56

8 treatments things that

10:58

have benefit for many

11:00

people and it's a very

11:02

new avenue for us . We've been doing some of it

11:04

slowly , but it's

11:06

something . Now that we're taking a more aggressive

11:08

approach and a lot

11:11

of regards is funny . I'm 62 years old and

11:13

what a lot of people talk to me about is when am I going

11:15

to retire ? And frankly

11:17

, I have no interest in retirement right now . I

11:19

read two good books that

11:21

talked about retirement and in it they

11:23

say never retire . You don't have to continue

11:26

to work as you are . But if you're able to do something

11:28

and you're capable still , which I feel like I'm still

11:31

able to do both of what I do then

11:33

why stop ? For many people

11:35

, what is retirement ? Retirement is sitting at

11:37

home , watching TV , playing golf four times a week

11:39

, pinching your pennies and

11:41

hoping that your Medicare is going to last

11:44

. Those are things that perhaps I'll get to at

11:46

some point , but at the moment I'm starting

11:48

this new endeavor and I'm looking

11:50

forward to it . I'm looking for the challenge . My children

11:52

are all grown . I think my risk

11:54

is less Some risk , but it's less

11:57

risk because my wife and I are only two

11:59

we really have to take care of right now . So

12:01

if it goes great which I'm confident

12:03

it will then I'm going to be excited

12:06

and there will be a new phase in my life when I learn

12:08

something . If it is slow to start or

12:10

perhaps doesn't go as I would like it to , I

12:12

can take some time to redouble my efforts

12:14

, learn from it and keep moving . So it's

12:16

very interesting to have a life . I wouldn't have said that

12:18

when my children were 17 and 18

12:21

. But now that they're well into their

12:23

adult lives , I have a bit more freedom to

12:25

try something .

12:26

Yeah , that's exciting . I love that . I

12:28

love how you're taking us on this journey

12:30

of your career and it ultimately doesn't stop right

12:33

. What you make it is

12:35

how you make it intriguing and interesting

12:37

, and what terms and twists you're going to have to

12:39

not only keep it exciting

12:41

for you , but really benefit and impact a lot of

12:43

people as well . You've spoken about

12:45

the impact on patients . You've spoken about

12:47

how you've been able to hire a diverse

12:49

staff , and now you're talking about ways

12:52

in which you'll help a different population of patients

12:54

. So I'm really appreciative

12:56

and I'm learning a lot on this podcast episode

12:59

, as I hope my audience is as well . And

13:01

you mentioned before or we may not

13:03

have talked about it just yet , but you

13:05

have your practice and

13:08

we know that only about 3% of

13:10

all dermatologists are black or

13:12

African-American . So what

13:14

has it been like being in this space

13:16

as a person of color , as

13:18

a black individual , and what advice

13:20

would you have for someone who's

13:23

trying to potentially go into

13:25

a field where diversity

13:27

really isn't what we would like

13:29

it to be ? What would be your thoughts on that

13:31

?

13:32

So that's a good question . Dermatologists are a wonderful

13:35

field of medicine . It's probably

13:37

one of the most challenging

13:39

to get into at this particular point . It wasn't

13:41

always that way , but it is now , partly

13:44

because it can be quite

13:46

easily practiced

13:48

without worrying about a family

13:51

. You certainly can have a family , you can have it

13:53

, you can work part-time , you can work full-time . So in a

13:55

lot of ways it's an ideal bit of medicine

13:57

, or a field of medicine where you can achieve a lot

13:59

of things . It's very challenging to get into , made

14:02

very good efforts to try to

14:04

diversify , but it's one of the least diverse fields

14:06

of medicine . I think if you were to look

14:08

at income based upon the

14:10

types of specialties and you would correlate

14:13

a line , a bunch of graphs looking at

14:15

the percentage of diversity

14:17

both by sex and by

14:19

ethnicity , I think you

14:21

would find that the more expensive

14:24

or the greater the income is , especially

14:26

the fewer people of color , the

14:29

fewer women that they have , be it neurosurgery

14:31

, orthopedics , dermatology

14:34

, dermatology is making strides

14:36

to diversify itself

14:39

, which is good . One of the reasons is

14:41

necessary because people of color

14:43

need to have people in various

14:45

specialties that are prepared to welcome

14:48

them into their practices

14:50

. There are some practices that

14:52

probably are not as inviting for

14:54

people of need with a

14:56

color . A perfect example is Medicaid

14:59

use . So in our state a disproportionate

15:01

number of people on Medicaid are

15:03

both black and white , but it's

15:06

very hard to find dermatologists willing to even

15:08

accept that . So it affects people

15:10

of color , it affects children and

15:12

we're one of the few private

15:14

practices willing to accept that in our area

15:17

. Certainly you have the universities like Duke

15:19

and UNC which do a great job

15:21

of helping . But I never wanted

15:23

to limit access to what

15:26

can be important care to people

15:28

on the basis of whether they are

15:30

Medicaid or Medicare . Those

15:33

people are people very much like my family

15:35

. Those are people , those

15:37

are my relatives , those are best

15:39

. From where I come . I'm two generations

15:42

from sharecropping , literally two generations

15:44

from sharecropping . So when

15:46

I see these patients I see my people

15:49

, I see my family

15:51

, I see my cousins and my grandmother

15:53

. So the idea of

15:55

providing something for them that

15:57

might be necessary . I don't in

15:59

any way want to overestimate

16:02

my value as a physician or the

16:04

need that people might have for me , but I

16:06

will say that there are a number of us who

16:08

just have great needs and cannot access

16:11

things because of limitations

16:13

, be it economic limitations

16:16

and sometimes societal and social

16:18

limitations . To watch what's

16:20

happened in this country after President

16:22

Obama became president and his

16:24

leaving and watching the pendulum swing back

16:26

in a lot of ways that I just thought were inconceivable

16:29

at this particular time in American

16:31

history has really been eye-opening . So

16:34

, as I told my daughter who is going to spend it , says , a

16:36

part of what happens with people that are doctors

16:38

of color is that you are the great equalizer . You're

16:40

the one that makes sure that when

16:43

a person steps into

16:45

a room , regardless of their economics

16:47

or regardless of their ethnicity be they white

16:50

, black or otherwise that

16:52

those things aren't taken into consideration when medical

16:54

decisions are made . It will provide for them

16:56

the care that you would provide the same for your family

16:58

and your friends , regardless

17:00

of their backgrounds , and I consider that

17:03

part of my role . My role is to make sure that people

17:05

who sometimes don't get a voice , don't

17:07

get access to things that are important to them , have

17:09

an opportunity to have that in our setting

17:11

. And so you ask about diversity

17:13

and dermatology . What do you want to do to get dermatology ? So I did

17:15

go off on a tangent there a bit .

17:17

No , that's a great tangent . Before

17:20

you go on , I want to say something to the audience

17:22

about what you mentioned . You mentioned

17:24

that Medicaid patients are

17:27

oftentimes not accepted by certain

17:29

practices in the area and I think for

17:31

our audience , who may or may not understand

17:33

that Medicaid doesn't always

17:35

pay the same amount for the same

17:37

procedures or the same amount for

17:39

the same things you're doing in the clinic , as

17:41

a private insurance provider

17:43

may provide or may pay . So

17:46

when a practice owner is making

17:48

a decision or the clinic is making a

17:50

decision about how many of a

17:52

certain group of patients they can take , a

17:54

lot of times they're thinking about the money aspect

17:57

of it and not taking into consideration

17:59

that black and brown individuals and those

18:02

of lower socioeconomic status may

18:04

be lumped in just because of that type

18:06

of insurance that they have or the Medicaid that

18:08

they have . You've mentioned it a few times , one

18:11

with the practice example

18:13

, and even previously when you mentioned

18:15

you're going to be in a setting where

18:17

you train with a lot of

18:19

Medicaid patients or Medicare patients

18:22

. That's important to take into

18:24

consideration too Because , again

18:26

, like you mentioned , dr Scales , if your

18:29

individuals who are doing the training

18:31

aren't really considerate of the patients they're taking

18:34

care of ? What example are they going to

18:36

set ? What type of culture will it be at the institution

18:38

that you train ? So it's

18:40

all integrated . And I don't think we talk

18:42

about enough in our training

18:44

and even in our early careers about how

18:47

the payment models we

18:49

are kind of dealing with

18:51

, whether these are not by choice . Right , we come

18:53

into medicine to help people . We don't think about

18:55

what it costs and , as you

18:57

said , I think about my grandmother or my mother

18:59

or my auntie when I'm just having

19:02

a conversation with a patient . But a lot

19:04

of the decisions that are made involve

19:06

the money side and the money exchange

19:08

to keep the lights on for some practices

19:10

and to make revenue as well . So I

19:13

just wanted to bring that part back into

19:15

the conversation because it

19:17

intertwines a lot with the patient

19:19

care we provide and the types of challenges

19:22

that we have as health care professionals trying

19:25

to give the best care to our patients . So

19:27

I'll let you proceed , but I wanted to reiterate

19:29

that point too .

19:31

Yeah , I think it's all appropriate to think

19:33

about this . I think in many regards , like

19:35

I was telling my daughter again when she's going to the clinic

19:37

, I said you're there training to

19:39

be a doctor , but you , being a doctor

19:42

represents in your community

19:44

something different than many other

19:47

communities , one so

19:49

a perfect example . She did really well at

19:51

Spelman College . She was extremely good student and

19:54

she's very smart and she's very motivated

19:56

. There were other college students

19:58

that would come to her because she got admitted

20:00

to the University of Pennsylvania through

20:03

a particular program called the PATH program

20:05

, where they will identify you early

20:07

as a person that's qualified

20:09

to go to their institution and they

20:11

will offer you early admission . And

20:13

she got that . She didn't have to take DMCAD or interviews

20:16

or anything . She had an interview for the program but anyway she

20:18

got admitted . Very smart young lady . But

20:20

there were young other students who were trying to

20:22

do the same thing . They would come up to her and ask her questions

20:24

. They would see her and hold her in a certain esteem

20:26

and she said to me you know , dad , get tired

20:28

of people asking me about these things . I

20:30

get tired of people saying , oh , you're

20:32

that smart when they did that and I say I understand

20:34

your point , honey , I understand what you're trying to say , that

20:37

you want to be seen like everyone else . You are like it . But

20:39

she was just because you got this program , because you're smart . I mean

20:41

, yeah , you're smart , that's fine . You're

20:43

very social , you get out and do things . But realize

20:45

that sometimes what do you represent ? You

20:48

represent an opportunity in

20:50

ways that other people have

20:52

not seen before . I've

20:54

had patients come to my office and come great

20:56

distances and they'll bring their children

20:59

and they'll say I want you to see what a black doctor

21:01

looks like . And it seems like a very small issue

21:03

. It is a very small issue from my

21:05

point of view . But what

21:08

does that represent ? It represents

21:10

seeing opportunity

21:13

in a place where they may never have seen opportunity

21:15

before . Hey , I had someone

21:18

said hey , you look like my cousin . So

21:20

when they see me and I look like their cousin

21:22

, they realize so my cousin could be a doctor

21:24

, my family members can be a doctor . And

21:27

you know I'm not going to say

21:29

that being a doctor is the greatest thing . It's not . It's

21:31

a nice profession , it's wonderful , I enjoy it . But

21:34

what you represent is

21:36

someone who's able to go

21:38

out into the greater society and

21:41

to achieve things that are challenging

21:43

and to be like the rest of us

21:45

. Opportunity , seeing

21:47

yourself in positions that you can't get . Other people

21:49

don't see you . So a reminder

21:52

, her , that speak to these people , talk

21:54

to these other kids because they

21:56

see you as something that they would aspire

21:58

to be like . So that's where those

22:00

sorts of things come up . So , yes

22:03

, it is different . My

22:05

daughter's been with me when we're here in

22:07

Durham and she's seen people stop me and

22:10

thank me and talk to me and it just really made

22:12

a really big impact on her and ever

22:14

think of it . It's like , hey , you're a great

22:16

doctor , a doctor's skill is kind of

22:19

thing , because that's definitely isn't the case

22:21

in that regard . But what it then

22:23

represents again is communities

22:25

that are striving to do

22:27

better things . So it's much more

22:29

than just the practice of medicine in

22:32

the role that you play .

22:34

Absolutely , absolutely . I love

22:36

that . I love that the community really

22:38

does admire . And it starts early

22:41

. It starts when you're in med school

22:43

, starts even when you're in college and individuals

22:45

are trying to get to that stage . So you

22:47

kind of carry this badge

22:49

of honor almost for your community

22:51

, and even when we're not thinking about it because I

22:53

know I oftentimes I'm not thinking

22:56

about the fact that I'm carrying this but

22:58

other people are watching and looking up to

23:00

you and it's something that they

23:02

admire . So you bring up a great

23:04

point there . Hello everyone

23:07

, are you enjoying the episode so far this week

23:09

? Well , I'm excited to

23:11

announce that this week's episode is sponsored

23:13

by the BMed app . That's

23:15

right , you heard it the BlackMed Connect

23:18

app . This app will be for

23:20

any black or brown , pre medical students

23:22

, medical students , residents , fellows

23:24

and attendings , even for institutions

23:27

. We're in the process of developing

23:29

our app and we wanted to share it with

23:31

you now . So if you're interested

23:33

in receiving updates on when

23:35

the BMed app will be available

23:38

to the world , then head on over

23:40

to bmedconnectcom

23:42

slash app app

23:44

and join the wait list . Let's

23:47

jump right back into the episode . I

23:50

want to switch gears a little bit , because I would

23:52

like to ask you for a little bit of your dermatologic

23:55

expertise here . I'm going to

23:57

actually start with a very basic question , because

23:59

in the common vernacular right

24:01

now we use the term melanin a lot

24:03

Melanin , melanated skin

24:05

. Loving our skin , which we do Can

24:08

you share with the audience what is melanin

24:10

and why do different individuals

24:12

or different ethnicities have different types or

24:15

different amounts of melanin ?

24:16

Sure . So melanin is the color

24:19

aspect of your skin . With

24:21

rare exception , everyone has melanin

24:23

in their skin . Exceptions are people who are

24:25

a bit of LIGO , like Michael Jackson and

24:28

many others . But it is a

24:30

particular compound that's made in the skin

24:33

to protect the skin

24:35

and some of the things

24:37

below the skin from getting damaged

24:40

as a result of the sun . So the sun

24:42

is wonderful , we need it for vitamin D , we

24:45

need it for all sorts of things

24:47

, but as it enters

24:49

the skin it damages the

24:52

skin and the skin has to repair itself . There's

24:54

all these little chemicals that are in the body

24:56

that are there that correct the

24:58

damage that takes place when you're out in the sun . So this happens

25:00

every time you're out . But your body corrects

25:02

. It also shields some

25:04

other things below the skin by

25:06

putting up . I like to think of it like an umbrella . Melanin

25:09

is like an umbrella in the skin . It keeps

25:11

things from going deeper than it needs to

25:13

. Now , the more melanin you have , the less

25:15

penetration of the sun rays

25:17

deeper into your skin , the less you

25:20

have , the greater chance you have of penetrating

25:22

and leading to types of skin cancer . People

25:24

of color and that's a broad word

25:27

that I've been using , a broad term I've been using . But

25:29

people of color generally have a

25:31

baseline SPF of about three . Spf

25:34

represents sun protection

25:36

factor

25:38

. So if I put my skin out in the sun , how

25:40

long does it take it to turn red ? Then I apply

25:43

the SPF and then I measure

25:45

how long that same skin takes to turn red

25:47

again . When you say three , that means that it

25:49

took three times the length of time

25:51

to turn red than it did before . And that's true

25:53

up to about SPF , about 15

25:55

. And then there are some other factors

25:58

that come into play , but anyway . So melanin

26:01

is there to protect

26:03

the inner parts of the body . People

26:05

ask well , if I get some sun , I get

26:07

more melanin , don't I ? I mean we all get a bright , brown

26:09

or winter in the sun . That's a great thing . That's one of the

26:11

adaptive responses that the

26:14

body has developed . But along the way

26:16

some damage is taking

26:18

place that is generally reversible

26:20

but can be cumulative , meaning

26:22

at the more sun I get over my lifetime , the better

26:24

chance I have of skin cancer

26:27

, premature wrinkling from

26:29

sun . So melanin is a

26:31

great important thing . It is not

26:33

the same thing as shade . So I mean melanin doesn't

26:35

mean you won't get burned or that

26:37

you won't get skin cancer or that you can't

26:39

have some of the changes that come . It just gives you

26:41

a better chance of avoiding

26:44

those things longer .

26:45

Awesome , excellent , excellent . And so if

26:47

you could share a little bit

26:49

about skin cancer , because you've

26:51

mentioned it a few times here in this portion , why

26:54

is it that , as

26:56

black individuals and black and brown individuals

26:58

, are they more or less likely

27:00

to get skin cancer ? You mentioned the melanin

27:03

protection that we get . Is the severity

27:05

any different ? Can you speak a little bit about the

27:07

differences in skin cancer by race and

27:09

ethnicity ?

27:10

Sure . So ethnicity , yes , every

27:13

person is capable of having skin cancer . Having

27:16

darker skin decreases your risk

27:18

. The last study I looked at , which is really quite

27:20

old , says that we have about

27:22

one-tenth the risk of skin cancer

27:24

that the average

27:27

person has . The location person has . Now that's

27:29

very broad numbers that you

27:31

can't hold it to . But basically what it says

27:33

is that our risk is lower if you have brown skin

27:35

. Skin cancer is the most

27:37

common cancer in the United States . What it means

27:39

is the sun goes through the skin

27:42

and it damages particular

27:44

cells in the skin . So we talked about melanin

27:46

before . Melanin is created

27:49

by these particular

27:51

cells called melanocytes . Melanocytes

27:54

job is to produce these

27:56

little color packets

27:59

and to distribute them

28:01

to the skin around them . But when damaged

28:03

melanocytes become melanoma

28:05

, melanoma is a highly deadly type

28:08

of cancer that can affect

28:10

all people . Melanoma

28:13

generally happens in some distributed areas , but

28:15

you can get melanoma in places like the lining of the brain

28:17

, the back of the eye , all sorts of things . So partly

28:19

sun related , but not completely

28:21

sun related . So that's one

28:23

type of skin cancer that's probably the most deadly one that

28:26

we talk about commonly . Secondly , there

28:28

is basal cell carcinoma . There are these cells

28:30

called basal cells which help divide

28:32

and create new skin . And then there's swamous

28:34

cells . Those are the cells in between the basal

28:37

cells in the top layers of skin , and

28:39

those two can become skin cancer . So

28:41

those are the three most common types that

28:44

we talk about and , as I said there , it is the

28:46

most common type of cancer . In the United States

28:48

it's probably at least in excess of a million cases

28:50

a year . The majority of them are treated easily

28:53

and repaired and you

28:55

go by your business . But some of them can be challenging

28:57

. Melanoma is very serious . Squamous

28:59

cell carcinoma can be very serious . Basal

29:02

cell to a lesser degree , but

29:04

still possible to be deadly .

29:06

So what can people do ? What should

29:08

our listeners and those

29:10

who may be watching ? What should they look out for

29:12

? What should they tell their family members to look

29:14

out for when they think about the

29:16

potential for skin cancer ?

29:18

Sure . So it's hard to have easy

29:20

, simple statements that make it possible

29:23

to determine all kinds of cancer in

29:25

the skin , but there are the five

29:27

ABCDE criteria

29:29

. So A represents asymmetry

29:32

, something that used to be round but now it's not round

29:34

anymore . B border irregularity

29:36

it is jacket around the

29:38

edge . C color variability Two

29:40

colors , three colors in a particular

29:42

mole instead of just one . D is diameter

29:45

six millimeters or greater are

29:47

the higher risk lesions . And

29:49

E is evolution rate

29:51

of change Is it changing slowly or is it changing fast

29:53

? Those are common recommendations

29:56

for people to look at , and if

29:58

they see anything that looks remotely suspicious

30:01

, you should follow up with a dermatologist Preferably

30:04

a dermatologist , someone who can help interpret

30:06

what they see , and to get

30:08

the specimen in the hands of a

30:10

dermatopathologist , a person that does

30:12

nothing but study skin under the microscope .

30:15

Absolutely so . When people go to get

30:17

their physicals , should they ask for their

30:19

doctors to kind of take a look at their moles , or

30:21

what do you think about that ?

30:23

I think ideally , that would take place . No , I've had

30:25

physicals in the last few years . People

30:27

don't even take your clothes off anymore . It used to be you took your

30:29

clothes off . Obviously we went for physicals . That's changed

30:32

quite a bit , so I think it's hard

30:34

to get it without specifically

30:36

asking for it and with that in mind , particularly

30:39

if you are in a higher risk category , meaning

30:41

you have fairer skin , it's worthwhile

30:44

then following up with a dermatologist who can

30:46

check your moles .

30:48

Excellent , and so any parting

30:51

words from a perspective of

30:53

this aspect , the dermatology aspect

30:55

, before we move to our bolus round , do

30:57

you have any parting words that you wanna share with

30:59

the listeners or those who are maybe watching ?

31:02

Sure . So not only recommendations I'd say

31:04

is that pay attention to your skin . You can have

31:06

your partner look at the back and the areas that

31:08

you can't see . If there's

31:10

anything that looks unusual , maybe

31:13

concerning maybe something changing quickly , it's worthwhile

31:15

going to a doctor , be it your primary

31:17

care doctor or a dermatologist

31:20

, and letting someone look at it and let them check it . I

31:23

mentioned that earlier that browner

31:25

skin people have less skin cancer , but one

31:27

of the statistics that comes up , or one of the things that comes

31:29

up , is that when found , it tends to

31:31

be more advanced . So part of it is

31:33

that perhaps there's some biology about that

31:35

, where browner skin people tend to have

31:37

more aggressive skin hazards . Perhaps there's

31:40

some socioeconomics about that , that

31:42

people have less

31:44

access to doctors who can

31:46

catch these cancers earlier . And

31:48

third , sometimes people are not as comfortable

31:50

looking at certain skin diseases in

31:52

browner skin people . So I think it's important

31:55

that If you have anything that remotely

31:57

looks suspicious , let someone check it . I've found all

31:59

types of skin cancers and all sorts of people over

32:02

in my life .

32:02

Great advice and great wisdom there and

32:05

even mentioning we don't always even learn

32:07

about different skin conditions on

32:10

different shades of skin or

32:12

different complexions . So I think there's

32:14

a big push now , even in medical

32:16

education and even in

32:18

books and in textbooks , to include

32:21

individuals of all different skin tones

32:23

. So even bringing that up is really important

32:25

. So I do want to thank you for sharing

32:27

with us , but we definitely have to still do our

32:29

bolus round here . So the

32:31

bolus round for those who may not have heard of this

32:33

before is our fun rapid

32:36

fire round that we do with our guests , similar

32:38

to when we give a bolus in medicine , which

32:41

is when we give a large amount of

32:43

fluids rather quickly . If a patient

32:45

may be in a traumatic situation

32:48

or maybe has an infection or dehydrated

32:50

, we give that bag of fluid and we call that

32:52

a bolus . So if you don't mind , dr

32:54

Scales , we're going to jump into our bolus

32:56

round . Are you ready ?

32:58

Let's do it .

33:04

All right . So my first question for

33:06

you is are you a Duke

33:09

fan or a Tarhill fan ? Or I'll

33:11

even give you the opportunity to say if you're

33:13

an other fan .

33:14

Sure . So when I first moved here , people asked

33:16

me which did I like best , duke or

33:18

UNC ? Now I had come from

33:20

Maryland , suburban Washington , so we had the University

33:23

of Maryland and all of them were in the ACC at

33:25

that time . So I would say Maryland . People like no seriously

33:27

which was Duke or UNC . So I

33:30

appreciate good sports , I like Duke and

33:32

UNC . My wife happens to work at UNC so right

33:34

now I cheer as a Tarhill but I'm

33:36

always happy to see teams in the area do

33:38

well . I've lived places where college sports were

33:40

not very big , like in Cincinnati

33:43

, and even in the Washington DC area was

33:45

to a lesser degree . I was there when Georgetown

33:47

was really big in college

33:50

basketball but college football was not quite as

33:52

big a sport there as pro football .

33:54

Awesome , awesome . I often run into the problem

33:57

of not knowing who I want to root for either . So

33:59

, being a Duke med grad and

34:01

a UNC Chapel Hill pediatrician

34:03

, it's a hard choice

34:06

of what color blue I'm going to go for on a given

34:08

day .

34:09

Yes , I can understand that .

34:12

All right . So if you had to choose

34:14

one vacation , would you choose a warm

34:16

weather destination or a cold weather destination

34:18

, and where would you go ?

34:19

Warm- weather , without a doubt . The bulk of my vacations

34:22

are warm weather . I do like to ski in

34:24

cold temperatures . I don't get to

34:26

do it very often . I probably ski once every

34:28

couple years , and that might be five

34:31

to seven days . But I'll go through the a

34:33

couple warm weather vacations two

34:35

, three , four times a year . Yes , I love warm weather

34:37

.

34:38

Fantastic , fantastic . Well

34:40

, if you had to choose one sport to watch

34:42

, which sport would you watch for

34:44

the rest of your life ?

34:46

That's a great question . I'd probably watch

34:48

basketball . I like pro

34:50

basketball and college basketball . I like pro

34:52

football and college football as well , so I couldn't

34:54

go wrong with any of those things . So

34:56

if I had to just choose one pro

34:59

and college I'd probably watch the NBA .

35:00

Fantastic . What's your favorite team ?

35:02

So in the NBA , I am from the Washington

35:05

DC area , and so we have the

35:08

Washington Wizards , which used to

35:10

be the Washington Bullets . Most of you are too young to

35:12

ever have known that , but it

35:14

is . I'd probably say it's my favorite team

35:16

. They're not competitive . They haven't been competitive in a long

35:19

time . So I enjoy good basketball

35:21

, no matter who plays it . I'd love to see

35:23

Washington do well , but that's going to be some

35:25

time . I think , yeah , that's going to be some time .

35:28

Absolutely Well . Okay , a few

35:30

more questions here . If you had to choose

35:32

what type of music you want to listen to

35:34

whether that be gospel or R&B

35:36

or rap or hip hop or reggae

35:38

or jazz what genre would you pick

35:41

in ? Who's your favorite artist ?

35:42

Wow , I like many different types of . I had to just

35:44

choose one . So I like reggae , I like

35:46

classic jazz , I like smooth jazz

35:49

, I like . I do like some classical . I've

35:51

been listening to Afro beats lately . I really

35:53

have enjoyed that and

35:56

so it's hard to narrow it down

35:58

. I'd like hip hop . I'd listen to old school . I really would

36:00

rap just first game out . So I've been listening to that since

36:02

the beginning , back to the Sugar Hill game

36:04

. So I like everything I did . Some of

36:06

it now has gotten a bit out of hand . It's a bit too

36:08

violent , big two corporate

36:11

. So I've had to choose one . It really

36:13

depends on the day . Some days I'm feeling a little

36:15

bit down . I put on some really hardcore rap

36:17

and I like . And there's some days I just feel like listening

36:19

to jazz . I listen to a fair amount of

36:21

jazz , so probably tend to

36:23

go to concerts . Someone says , choose a concert to go to

36:25

. I would go to a jazz concert .

36:27

Fantastic , fantastic , and I love that Jazz

36:29

Afro beats all of the above . You

36:32

need all of them . I feel like for them , whatever mood

36:34

you're in .

36:35

Yes , and reggae I like a lot too . I really like reggae

36:37

.

36:38

Wonderful and okay . Last

36:40

question would you share a little bit more

36:42

, just one more time , for our listeners about your

36:45

organization and how they can

36:47

find you and if they would like to come

36:49

and see what you're doing , even as a patient

36:51

, come to see you . If you could share

36:53

some information there .

36:54

Sure , I'm at the North Carolina Center for Dermatology

36:56

in Durham , north Carolina . Our number

36:59

here is 919-484-9551

37:02

. You can find us on the web , nccdermatologycom

37:07

. We have a Facebook page , instagram

37:09

as well , so you can find

37:11

us there . You can find

37:13

me also under Dr Clear

37:15

Skin , dr Jeffree Scales

37:17

. I am available to be reached here . We have a website

37:20

as well , where we take

37:22

new patients , of course , and

37:24

that website also includes a place

37:26

for you to send email if you're interested

37:28

, so I can be found many different places

37:30

.

37:31

Excellent . Well , thank you for sharing that , and

37:33

if you're in this area , I can't

37:35

leave without asking you your favorite restaurant in this

37:37

area . So if someone's coming to see you and also

37:39

wants to get something to eat , where would you send them ?

37:42

Yeah , I'm a real foodie . I love eating in restaurants

37:44

around here , be it Raleigh , durham

37:46

, chapel Hill . I'm biased towards the Durham restaurants

37:48

. I think they happen to be the best

37:50

. If I had to choose a restaurant

37:53

, and with that in said , I'll choose probably my favorite

37:56

restaurant in the areas of restaurant , called Lanterry

37:58

, which is in Chapel Hill . Believe it

38:00

or not , it's a mix of southern and

38:03

Asian food . I also

38:05

like a restaurant in Raleigh which I was eating

38:07

it last weekend called Brewery Brevana

38:09

. It's both a brewery and

38:12

the Asian restaurant and a bookstore , all wrapped

38:14

up in one Really elegant looking place

38:16

. I like that place , and then there's a long

38:18

list of others that I like . So in

38:21

an effort not to bore anyone , but yes , I definitely

38:23

like there's one in Raleigh too , called Death in Taxes

38:25

, which I really like .

38:26

What a name .

38:28

I go to everything around here barbecue

38:31

restaurants , asian restaurants and

38:33

I like good Mexican food too .

38:35

Fantastic . Well , I just want

38:37

to say thank you so much for your time

38:39

. I know I've gained a lot of wisdom from

38:41

this episode . I hope the listeners have

38:43

as well in those who are watching

38:46

. And so , if you don't mind liking

38:48

this episode , if you're on YouTube and

38:50

subscribing to the channel and if

38:52

you are listening , be sure to follow

38:54

the Black Med Connect podcast for

38:56

more fantastic episodes . And I

38:58

just want to say again thank you , dr Skills

39:01

, and until next time , always remember

39:03

for my audience to dream without limits

39:05

. All right , bye bye

39:07

, bye everyone . We hope you enjoyed

39:09

this episode with Dr Jeffrey's

39:11

skills . We had an amazing conversation

39:14

where we talked about certain skin conditions

39:17

and skin cancers , as well as

39:19

the importance of diversity within the

39:21

field of dermatology , and so

39:23

much more . We appreciate

39:25

our guests for taking time out to have this

39:27

amazing conversation . We also

39:29

had a lot of fun during our bowlers

39:31

round learning more about Dr Skills

39:34

and his interests . If you're

39:36

interested in learning more about how to connect with

39:38

Dr Skills , visit nccdermatologycom

39:42

to learn more and be sure to check

39:44

out the Dr Clear Skin product line as

39:46

well . If you enjoyed this conversation

39:49

, comment below and tell us what

39:51

you learned or what you took away

39:53

from the episode . Don't forget

39:56

to smash that like button . Go

39:58

ahead , do it right now . Go ahead , smash that

40:00

like button . If you're on YouTube and if you

40:02

haven't subscribed to the channel yet , what

40:04

are you doing ? Go ahead and hit that subscribe

40:06

button as well . If you're listening

40:09

on all podcast platforms , go ahead

40:11

and hit that follow button . Thank

40:13

you again , dr Skills , and to all our listeners

40:15

out there or those who are watching . Always

40:18

remember to dream without limits

40:20

. Bye .