Perspectives of a Polka Dot Mama Dermatologist

For many of us, heroes do not exist in fairy tales or behind TV screens. These patrons live among us, wearing white medical capes and carrying stethoscopic “weapons of cure destruction.” While doctors, for the most part, go unthanked in their day to day lives, the impact on patients’ lives are immense.

Dermatologists, strictly dealing with skin, nail, hair and its diseases, are vessels of lifesaving expertise. At Polka Dot Mama, we gotta say, we love derms. They are the ultimate cheerleaders for sun safety, creating a realistic viewpoint of the major causes of skin cancers, and the effects of unhealthy sun habits. Our great friend, Dr. Kelly Nelson, first diagnosed Tracy with melanoma at age 39. Since then, she has been been a true mentor to our staff at PDMMF on the board of directors. Without her professional guidance, we wouldn’t have been able to create our  foundation for melanoma education and awareness. Although she moved to Houston (Tracy still wishes that never happened!) she is overjoyed to share the stage with her at “Taste For a Cure: Chef’s Gala Benefiting Melanoma Research” occurring on May 1st. As Tracy stated, “Dr. Nelson is one of the kindest most compassionate physicians I have ever met.” It is fitting, therefore, that her perspective be shown in our blog series.

Can you explain why you decided on dermatology? What drew you to the specific profession?

Dermatology is an amazing specialty: we take care of patients over the course of their life, we are truly dependent upon our physical examination skills (we can’t order a scan to diagnose early melanoma – we have to use our eyes and our brain!) and we work with our hands performing skin surgery.  What I most love as a dermatologist who specializes in melanoma in the academic setting is being integrated with a multidisciplinary team.  I work closely with the medical and surgical oncologists taking care of our complex melanoma patients at MD Anderson.

Is there a common trend of those diagnosed with melanoma? What would their traits be?

Melanoma is so tricky because it truly affects all ages, all genders, all ethnicities. No one is immune from melanoma.

Over half the battle is won when patients are aware of their skin – I teach patients to look for their “signature nevi” (or the typical pattern to how they make their moles) and their “ugly duckling” (one thing that isn’t like the others).  Patients are with their skin every day; I just get to see it every few months!

Is there certain lifestyle trends with those who are diagnosed with melanoma?

Our best understanding of lifestyle impact on melanoma risk is that tanning bed exposure, even minimal exposure early in life, imparts an increased risk of melanoma, as does episodic intense sun exposure.

What is the number one mistake people do concerning sun safety?

The concept of obtaining a “healthy base tan” before traveling to the beach is completely spurious.  Any tan is a marker of photodamage to your skin: upon exposure to UV light your skin cells sense the damage and make melanin (the substance in our skin that contains pigment). The cells actually put that melanin over the cell nuclei (where your DNA is stored) like a miniature hat to protect the DNA from further damage! Your skin cells know when they need a sun hat and so should you!

What lifestyle choices have you personally made in order to stay sun safe?

Well, the biggest impact in keeping my skin sun safe wasn’t really a choice: I was an unathletic nerd in middle school and early high school with glasses, braces, headgear, and I loved to read.  So, my spare time was spent curled up with a book instead of tanning.  And there wasn’t a big tanning culture at my school or with my friends.  Once I was in college I was aware of the concept of sun safety and starting using a facial sunscreen daily and was more cognizant of using sunscreen at the beach or lake.

Do you have any family members or friends who have been affected in any way by skin cancer and melanoma? How has that affected you in turn and motivated your work?

My patients have been the most influential on my career choice and motivation, although my husband’s family has strong skin cancer history.

Although your skin is probably perfect, how do you believe your spots tell a story? In other words, how do your freckles, moles, or sun spots indicate who you are or your individuality?

I’m very proud that I live in my authentic skin – I consider the furrow between my brows a reflection of the compassion and concern that I share with my patients, and the crows feet that are appearing by my eyes a reflection of the joy that I find in every day.

After moving to Houston, both my husband I are much more aware of the sun than when we were living in Durham.  We both use high spf sunscreen to our face (and to his bald head) daily; Keith is (or was, before our baby was born) an avid athlete, and we work together to help him exercise outside early in the morning with sun protective clothing and sunscreen; at triathlons he’s pretty easy to pick out of the leathered skin crowd with his translucent cave creature complexion!

What is the most rewarding aspect of your job? The most challenging? 

I love caring for patients at all points along the melanoma spectrum. A lot of my younger early stage melanoma patients carry a lot of anxiety – especially young mothers who had to press to have their melanoma biopsied or excised.  They feel enormous pressure that each of their moles is a “ticking time bomb” and that, because they found their first melanoma, and had to convince their doctor to remove it, only they can find their second.  For these patients I commit to recognize their anxiety, name it, validate it, then lay out our plan for taking very good care of them moving forward.

And I also care for patients and their families with advanced melanoma that is no longer responding to chemotherapy or immunotherapy. I have visited their homes when hospice care has started and held their loved ones while they cry.  The hardest part of my job is that melanoma takes people when they have so many rewarding years left to give.

What is one adjective to describe yourself ?

“I am gritty”

I have backbone and I have grit. My family comes from the coal mining country of Virginia and they didn’t shy away from challenges. Not infrequently I need to have tough conversations with my patients: I find an area on their skin that is concerning for a new melanoma or a metastatic melanoma deposit.  We always discuss those concerns up front so my patients know exactly what I’m thinking and the next steps in our plan to take good care of them.  As soon as their results return I touch base with the rest of their melanoma team, refine their treatment plan, and call them personally to relay the next steps.  Are those conversations tough? Absolutely.  Are they at the core of my personal mission to connect personally with my patients? Without a doubt.

If you would like to see the Polka Dot Mama’s original blog post concerning her melanoma diagnosis, click here.