I have spent the last four weeks staring at people’s skin — with their permission, of course. I have been working with the Dermatology team at UF, and it has been an eye-opening experience. The skin is such an interesting organ; everyone has it and there are so many different shades, quirks and curiosities you can find with it. You can tell if someone’s spent a lot of time in the sun, if they work a lot with their hands and what kind of accidents and surgeries they might have been through. It can be an indicator, not just of how well you appear on the outside, but also if there might be something going on inside your body. Because of how versatile and interesting skin is, I decided that rotating with the Dermatology team would be worthwhile. At the very least, I could develop the skill of identifying and naming lesions on the people I meet, which will hopefully make me popular at parties.
The dermatologists at UF are all very nice and friendly people. They are very intelligent, and all of them seem to have perfect skin themselves. I don’t think it’s one of the requirements to be a dermatologist, but it certainly can’t hurt. Each of them would also make for excellent detectives. The interesting thing about dermatology is that a lot of lesions and rashes can look similar, and it takes a lot of thinking to figure out what’s really going on. Bumps and rashes can change appearance over time, go to different places on the body, and do different things. It also depends on how old they are and if a patient has put something on them or scratched at them, so there can be two or even three different things going on in just one skin finding, and it’s up to the dermatologists to sort all of that out.
It’s amazing to see them at work and watch how they come to their conclusions. I remember one patient who had a rash on her abdomen and the right side of her face, which was a very strange distribution for a rash. After asking some questions, the doctor was fairly certain that the patient had a contact allergy, likely to nickel from a metal belt buckle that she usually wore. As for her face, the doctor asked if she played any sports that required her to wear a helmet, recently changed her pillowcase or face wash, and other questions he could think of. Eventually, he figured out that her cellphone had a metal case that she would rest against the right side of her face whenever she talked on the phone, and that was exactly where the rash was. It was very impressive to witness, and the kind of thing you would expect to hear in a Sherlock Holmes story. It’s funny how everything is revealed in the skin, right in plain sight, but it takes a lot of effort and experience to unravel what is going on.
As for myself, I started out learning all of the common things that appear on patients. There are a lot of ordinary things that you often see people walking around with, like: seborrheic keratoses, skin tags, eczema, warts, solar lentigos, acne and cherry angiomas, all of which are not worrisome. While other things like: drug rashes, actinic keratoses, squamous cell carcinomas, basal cell carcinomas and pigmented lesions suspicious for melanoma require caution and treatment. I’ve also seen conditions like: psoriasis, rosacea, vitiligo, lupus and mycosis fungoides, which many people have heard about but may or may not have seen. It amazes me to see the kinds of things that can happen with skin, and I’m grateful that I don’t have too much going on with my own.
Sometimes if we encounter a lesion that we can’t immediately figure out, we biopsy it to see what it looks like under the microscope. Sometimes we shave the lesion off, and sometimes we punch it out with a tool that acts like a cookie cutter. I’ve been fortunate enough to get experience doing lots of both. It’s a peculiar thing to do, cutting out a piece of someone’s skin, and perhaps even more peculiar to be on the receiving end of it. I had a shave biopsy performed on myself a few years ago, which was actually done by one of the attending physicians I ended up working with this month, and it was a very odd experience.
I had a rash on the back of my left hand for a few weeks that was very itchy and was taking a long time to go away, so I went to see the dermatologist to figure out what it was. The dermatologist looked at my hand, poked it and pushed on it, and wrestled my arm to bring my hand closer to her face to get a better look.
“Hmmm… I don’t know what this is,” she said. “Let’s biopsy it!”
And before I knew it, she was setting up the instrument tray and the nurse came in the room with a camera to take a picture of my hand for the records. I was a little surprised, as I wasn’t quite expecting a biopsy so suddenly. But I wanted to get to the bottom of what was going on, and it felt like the right thing to do. After numbing the area, the doctor took out a tiny saw with plastic edges that she held between her index finger and thumb, and shaved off a piece of the rash. The saw reminded me of the saws that you see pairs of cartoon lumberjacks using to cut down trees, only hers didn’t have any teeth. Afterward, they put a Band-Aid on it and sent me home. A week later, I got the results and it turned out to be spongiotic dermatitis, which is a characteristic of eczema. They gave me some steroid cream to use on it and it went away, and hasn’t bothered me since. Though, I do still have a pigmented scar on my hand as a reminder of the experience.
And now being the one to do the biopsies feels like completing some kind of circle. I feel more comfortable doing them, as I’ve gone through the experience myself. It’s very humbling too, as your skin is the most obvious part about you, and trusting someone enough to perform a procedure on it is very significant. I have learned so much from this rotation, and I believe that what I’ve learned this month will definitely help me in my future practice.
The only other significant event that occurred this month was that I finally finished the last of my residency interviews. I am very happy with how my interviews turned out and can see myself training at every place I visited. After going over all of my programs with my adviser, I ranked them all in a list and submitted it to the National Resident Matching Program. In March, a computer algorithm will take all of the applicant lists and residency program lists and try to make as many suitable matches as possible. Much like with a skin biopsy, the only thing left to do now is to wait for those results.