The Dylan Gemelli Podcast - Episode #159: Your Mole Could Be Cancer And You Wouldn’t Know… Featuring EXPERT Board Certified Dermatologist and DERMOSCOPIST Dr. Michael Christopher!!

Episode Date: September 3, 2026

Episode #159:  Your Mole Could Be Cancer And You Wouldn’t Know… Featuring EXPERT Board Certified Dermatologist and DERMOSCOPIST Dr. Michael Christopher!!   Could your dermatologist be missing melanoma that looks completely normal? Board-certified dermatologist and expert dermoscopist Dr. Michael Christopher reveals why visual skin exams aren’t enough, the truth about sun exposure and sunscreen, and how to catch melanoma before it becomes deadly. Dr. Michael Christopher identifies roughly 150–215 melanomas per year and advocates for making dermoscopy a standard part of skin cancer screening and dermatology training. He explains: ◼Why melanoma can look completely normal to the naked eye ◼Why dermoscopy could dramatically improve skin cancer detection ◼The truth about tanning beds, UV exposure and sunscreen ◼How genetics can cause melanoma even without sun exposure ◼What most people misunderstand about psoriasis, acne and Accutane Chapters: (00:00) Intro (00:35) Timeline (01:41) Meet Dr. Michael Christopher (03:45) What Is Dermoscopy? (04:55) Why Are So Many Melanomas Being Missed? (07:12) What a Dermatoscope Can See That Your Eyes Can’t (09:07) Moles and Melanoma Risk (11:04) How Dangerous Are Tanning Beds? (12:45) Red Light Therapy and Skin Cancer (13:51) UVA vs. UVB (15:48) How to Use the UV Index (17:05) Is Daily Sun Exposure Healthy? (22:30) The Fitzpatrick Skin Scale (23:25) Can Melanoma Develop Without Sun Exposure? (26:27) The Stages of Melanoma (28:31) Can Advanced Melanoma Have No Symptoms? (31:25) Melanomas That Look Completely Normal (33:01) What a Proper Skin Check Should Look Like (35:05) The Problem With Dermoscopy Training (38:51) Should Dermoscopy Become Standard? (44:36) What Causes Psoriasis and Eczema? (49:09) Metabolic Health and Psoriasis (50:47) What Causes Acne? (53:13) Is Accutane Dangerous? (56:02) Is Sunscreen Actually Toxic? (01:01:01) How Much Sunscreen Should You Use? (01:01:45) Final Thoughts   Follow Dr. Michael Christopher: Instagram - https://www.instagram.com/michael_christopher_md/?hl=en   ____________________________________________________________________________________________   TODAYS EPISODE IS SPONSORED BY TIMELINE!    To PURCHASE MITOPURE visit Dylan's landing page and use code DYLAN to save 20% OFF!!   https://shop.timeline.com/DYLAN    _______________________________________________________________________________________ JUST THRIVE Probiotics   Use my link below and receive 90 DAYS OF FREE Digestive Bitters when you sign up for 90 days of the Probiotic!!!     https://justthrivehealth.com/DYLAN       ALSO Take 20% off at Just Thrive SITE WIDE with my link below https://justthrivehealth.com/DYLANGEMELLI   ______________________________________________________________________________   Get the Apollo Neuro for $99 OFF!! USE CODE GEMELLI to save https://apolloneuro.com/gemelli   ___________________________________________________________________________________________ TRULY Increase Your NAD LEVELS with WONDERFEEL NMN: https://getwonderfeel.com/?utm_source=DylanGemelli&utm_medium=podcast   ___________________________________________________________________________________________ The Dylan Gemelli Podcast: ◼ Follow Dylan on Instagram - https://www.instagram.com/dylangemelli/ ◼ Visit Dylan’s website - https://dylangemelli.com/ ◼ Dylan Gemelli Health and Wellness - https://www.youtube.com/channel/UCdFBUS_MMN25QRkJsUz8QvQ ◼ Spotify - https://open.spotify.com/show/3In4QlJj4IvHqq0eduKj7m ◼Apple Podcast - https://podcasts.apple.com/hr/podcast/the-dylan-gemelli- podcast/id1780873400

I find between 150 and 250 melanomas a year. The average dermatologist in Arizona finds around 20 a year. Of the roughly 8 to 10,000 people that die a year, they are actually diagnosed with what we consider early stage melanoma. How often do you find something that looks normal that is an actual melanoma? Almost every week. Oh, shit. I find so many skin cancers every day that you would not be able to see without using a dermatoscope.

So are there other ways to develop skin cancer melanoma? was without it being sun related? Oh, 100%. And what are some of those? Your biology may not be the same in your 40s as it was in your 20s, but your standards and goals can be even bigger. We're at a time where we have more tools and methods to not just live longer, but also healthier with better results as we age. Aging is no longer viewed as a decline. It's about optimization and time efficiency. Training smarter and more efficient is a new standard, and we now know how to get more from the workouts we are already doing. Now, chances are your supplement stack is missing a much healthier foundation. So enhance it with Midapear, a targeted supplement that revitalizes your

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Welcome back to the Dylan Jameli podcast. So I am pumped today because I have a very well-educated, well-rounded guest that I hit it off with right away. But we're going to talk about something that I have not talked about yet. And I'm really happy to get into it because there are so many people that, you know, that put content out on the sun and people that have put the fear of God into some people and then told others that everything out there's nonsense. And we don't get into the nitty gritty about that and talk to somebody that's just straight science.

But then the other aspects of what my guest does, especially when it comes to identifying melanomas and his way of going about it that I've never heard of and never seen. And so this is going to be a learning experience for everybody today, which I am just, I'm ecstatic to bring this to light because the goal on the podcast is to always to bring new concepts and a good down the middle approach to giving everybody the best knowledge possible. So my guest today is a board certified dermatologist and expert dermoscopist recognized for his work in early melanoma detection. And he has been using evidence-based use of dermoscopy. and he identifies between 150 and 250 melanomas annually. And that is just with the discussion we had back and forth,

far more than you see on national state averages. So he's doing incredible work. He's doing something special. And I am super excited to introduce you guys, Dr. Michael Christopher. It's a pleasure. Thank you for having me on. I appreciate it. I am stoked, like I said, to have you here.

And we had a good discussion prior and the things that you were telling me were startling, troubling, but also I'm grateful that I met you so that we can get this out there and get people aware and start talking about things that I think they're not aware about that you do. So let's get into the dermoscopy because I'm still having trouble saying that because I've never heard of it. Could you kind of get into what that is? Yeah, absolutely. So I brought a tool with me. I'm not sponsored. I don't work for any company.

I just want people to be aware of that. Not that other people do. Okay, but me personally, I don't work with anybody. This is what we call a dermatoscope. And so if you see a board certified dermatologist or say an MP or PA and you get a skin exam, when they're looking over your skin, they shouldn't be just doing a visual exam. They should look at every single mole with every pink spot and every sun spot that you have on your body with a dermatoscope. Because things that can look normal, like that little mole on your hand,

And I'm not saying that is harmful. It looks round, regular, looks like it has even borders. But if I were just to look at that with my eye, I cannot tell you, and this is as an expert in dermoscopy and a board certified dermatologist, that that is normal. The only way that we can tell that is normal is if I put a dermatoscope on it. And if people are not using a dermatoscope, what does that create? It creates melanomas that are identified much later in their course and there is a mortality association with it. In Arizona, you kind of stated some statistics. I find between 150 and

215 melanomas a year, the average dermatologist in Arizona finds around 20 a year. And that's kind of on the national average. So if there's that large of a gap, you can imagine how many people go in to get a skin check. And it's not that people are not trying. They are looking at your skin thoroughly. They are just missing stuff that is not obvious to your naked eye. And that's due to training and lack of utilization of this tool. Why do so many people eyeball it and do that approach? I've never even heard of the scope and the tool that you have until I met you. Yeah, great question.

And I can't answer that, to be honest with you. Dermoscopy, the discipline, which is the study of the structures that you see within when you're using that tool, was invented in 1989. I was born in 1984, right? So my whole medical career, actually, what got, me very interested in dermatology was the potential intervention at the earliest stage of cancer within dermatologic disease, and that is through dermoscopy. So it was foundational for my interest in the field, and I can't tell you why other people don't use it, because I think it is

the most important thing. When we give a skin check and we're doing a cancer screening, it's like women getting their annual mammogram. Yeah. After 40, that's what's recommended. And if you didn't do a mammogram, you just had a woman do a self-breast exam, how are we going to know that there is disease that is potentially there? There are many breast cancers that don't present as a lump, right? So a woman would not be able to find it. Well, same as melanoma. They're not all irregular.

They don't have symptoms, meaning they're not itchy, painful. They don't bleed. And we may not be able to see it. And we can see it when we utilize that tool. Yeah, because everything I've ever. learned and when I go in it's a eyeball approach and if it doesn't look irregular or doesn't show any of the things that you've talked about or or that we kind of know in general it's like okay move on now when you use that tool what does it show like in particular that you can't see with the

naked eye what we see within a Dramatoscope you can see structures that you cannot see with your eye and one of them is the pigment architecture so that mole right there, which I'm just gonna lay my dermatoscope on just to, I've looked at it enough times just to make sure it's fine. But it can show me the network that is present within it, and if that is regular or irregular, it can show me angiogenic structures, so structures of blood vessels and signs that there is, say, increased vascular density within a mole, which is a sign of a melanoma. It shows me structures that we see within the skin. So you can actually, you're not just looking at the surface, you're actually looking within the dermis, which is a middle

portion of your skin and some of those structures like shiny white lines uh orthogonal lines those are uh features that you can see within an invasive melanoma even though even though from the outside it looks like a completely normal mole okay so it's like it's almost like an x-ray vision tool so to speak correct right it's it's a secondary image uh imaging to where can think about it like this you get an x-ray say you come and hit your you have a knee injury your knees sore uh Maybe you feel like you tore your ACL. You go get an x-ray of it. The x-ray is actually not going to show you you tore your ACL.

No. Because it can't see it. And that is kind of what we want to do, a visual skin exam. If we're just doing it visually, you cannot see those structures I just outlined to you within the scope, the pigment architecture, the blood vessels that are present within it, the structures that are in the middle portion of the skin in the dermis. You need another tool. And the dermatoscope is that tool. as you're assessing, say, your knee for an ACL tear, well, the x-ray is not going to show you if the ACL is torn.

You need an MRI, right? And the MRI will be able to actually assess those structures and we'll be able to say, oh, yeah, clearly there's an ACL tier or the ACL is intact. You wouldn't try to assess an ACL tier with just an x-ray. Right. Here's a question for you. On a normal person, and obviously everybody's differentiating here,

how many moles does a person tend to carry? Oh, God. Great questions. Some people have very few. And I actually, maybe I need to look into the literature on that exactly because it is so varied. Most people have moles. It's just how many do they have? One of the risk factors actually for melanoma is the number of moles you have and not just a number of moles you have, but if you also harbor at atypical moles. And that is a component when we look at risks of melanoma that tie into familial or genetic risk factors. Not all melanoma is just created from the sun. Most of it is from the sun. But there are familial traits.

We call them germline mutations that increase your risk and odds of developing melanoma. Okay. So one of the things I've noticed on myself, after too much time in the sun, as I've gotten older, is a few more popping up. How like the one you see here, that was not always there. And I've had certain ones. they all kind of look the same. I know that doesn't mean anything. What causes that to happen? Is it something that you age from being in the sun too long? Moles are sun-induced, right? You can have genetic moles, but moles are absolutely can be sun-induced. And getting new moles does not

always mean that there is trouble associated with it. Right. Until you're about 40 years of age, once you hit 40, if you're getting a new mole, even if it looks normal, it should be evaluated. But there is an association with sun exposure and the number of moles that somebody does develop. So that is an important thing to pay attention to. I noticed after long vacations on the beach that they popped up. That's when it happened. Yeah. Two weeks straight have three and a half four hour layouts.

That's when I noticed. What about tanning, like in a tanning bed? Terrible. Yeah. So tanning beds are actually UVA, right? So when you're looking at getting sunlight, you're looking at obviously all spectrums, visible, infrared. UVC is actually, thankfully, filtered out. He's extremely toxic.

But UVA is what you're getting through the tanning bed. And it is highly concentrated. And we have a multitude of studies that show what the increased risks are of melanoma associated with sun, with using a tanning bed. So it's highly in hand. It is highly associated. And that is why places that have very good. data on melanoma and melanoma prevention have actually outlawed taining beds like Australia. It is not allowed there.

When I was in high school when they started to get popular, I spent a lot of time in them, a lot. You know, like teenage years. How much? Oh, I don't know, two or three times a week for a while. And then I owned a bed in Vegas. I didn't, and it's funny, I owned it. I used it less than when I had a membership somewhere. I just sat there.

But I haven't, you know, I stopped using tanning. beds well over 12 or 13 years ago probably but I definitely it was a prevalent thing back then and not a lot of data yeah absolutely and in particular tanning beds were you know you're large into fitness and health yeah it is heavily you know people tan like crazy because they want their to have tone and definition in particular for them on shows right but the big issue with tanning burning in general is acute intense UV right that acute intense UV is highly toxic, and you want to avoid that at all cost. What about like the craze of red light beds and therapies?

Does that have a negative effect? So no, it does not. That is not going to induce skin cancer. So for my scope of area of expertise, I have no concern with it. Okay. I do think that there is some benefits of using red light therapy in infrared, but you have to know the manufacturer. You need to look at the studies.

A lot of people will say, oh, it's good for your mood. It's going to help with your muscles. It's going to help with your skin. Well, what is a dose? What were the studies done that showed that dose was helpful? And are these companies and devices actually administering that dose? And so there is a dosometry that is associated with red light therapy. So if you're using it and I actually use it on my head to keep my hair nice and full.

So I do think that it is helpful, but you need to know the science behind the company that you are deciding to invest in. So, and I don't know the answer to this, and I don't know how many different options there are levels of this. But you hear UVA, UVB, how many different types of UV rays are there? And what are the negative ones and what are the good ones? And what should we avoid and what should we try to get? So UVA and UVB are the two forms of UV that you're going to be getting from the sun, right? UVC is filtered out by our ozone, which is extremely toxic. UVA and UVB, and I will say this with just understand that the dose matters, right, of everything.

UVB is definitely of the two much more carcinogenic, so meaning it is one that has, is heavily associated with melanoma tumor genesis, looking at basal or squamous cell carcinoma and the development of skin cancer. UVA is also associated with it. It's just that we get more, the amount of UVB that we get, the intensity of it is more, and it is more toxic. Now, as a dermatologist, you know,

getting any dose of UV, because UV, ultraviolet radiation is a class one carcinogen. And we know that it is a carcinogen across the board. So we know that it induces mutations in our body. But is there some dose to where it is, I don't want to say, not harmful, but the dose makes a poison, right? A little bit of UVA, so for me, if the UV is less than two, I don't wear sunscreen. I don't need to wear sunscreen.

I am not worried about getting a skin cancer based on a UV index of less than two. But as soon as UV index is above two, based on my Fitzpatrick skin type, it means a color of my skin, I'm a Fitzpatrick too. I absolutely make sure that I have sunscreen. Not only is that important of blocking UV radiation, but it also is helpful for photo aging, which photo aging is something that I also would like to prevent. How do you know the level of UV that's in the sun? Is it just something that's measured that you can look up online?

You can look up online or pretty much every weather app will have that. So if you go to your, I have an iPhone. If you open up your iPhone, go to the weather app, and it'll show you, say, you know, the heat for the day. If it's going to rain, you can click UV index. It's on there. And it'll show you the time of day when the UV is going to be higher than that, too. What determines the level of UV index? So time of year, where we are with latitude.

So from the equatorial line and time of year. So summer, winter, spring, fall. That's what I was going to ask. you closer to the, so closer to the equator, higher UV? Correct. Okay. And you're looking at that all year long, right? So it's all the closer to the equator, the more UV you're going to be getting throughout

the year. So does Iceland have a low level of skin cancer probably? You know, interestingly enough, I have looked at this. The data is not great. Really? Yeah. So I, but there are, there's a multitude of factors. So looking at like the, how they record, uh, skin cancer.

that is one issue, but it's not correlated the way that you would presume. Right. So I'm just curious because there's so many people on both sides of the fence that are either just most anti-sun people in the world or people that are like, man, you need to be in the sun all the time. And I'm one of those that's like, you need to get 10, 15 minutes of sun daily. Let's not go crazy. Let's get what we need, though, and not be frightened by it unless you have some sort of

condition. Right. Which, there are those. Yeah. And, but the time of day matters, right? Okay. So if you are getting 10 to 15 minutes of sun, we're in Phoenix right now. Yeah.

So in Phoenix, if you're getting 10 to 15 minutes of sun and the UV index is a 10 based on your Fitzpatrick skin type, you're a 3, that is harmful for you. Okay. You are causing UV radiation and you can measure, or you are causing UV radiation to cause DNA mutations in yourselves. And you can measure that. When we get excess UV, it causes cyclo-butane perimine dimers to form in our DNA. And that is something that is measurable. And we know that that is toxic. And that is a signature that we see within skin cancer in melanoma, basal carcinoma, squamous cell carcinoma.

My assumption here would be don't go out in the sun after like 10 o'clock because it's so strong. Am I right? So it depends. So that all that depends on the time of year. Okay. So in, for instance, in Tucson, which is where I live and practice, by 10 o'clock, even in the wintertime, the UV is going to be. around three. So that's probably pretty good. But I was in Austin in April and I was surprised it was 8.30 in the morning, the UV index is already three. And I said to myself, it's only, you know, it's spring,

right? That's early and it's already above that point. And the UV index was five until after 5 p.m. So people say 10 to 2. It actually is not, that is not a sensitive way to measure what the UV index is. But we have a way to measure it. Or you have a way to get the information. accurately and that's through your weather app. So does temperature play a role then in that? No, right? Not all. Think about going to San Diego right now.

What's the temperature probably? 90, I don't know. Lower. Usually 70 to 80. I mean, maybe even a little bit under that, right? So people, I see a lot of patients who they love to go to Coronado Island, you know, during the summertime and they all get burned. So like, oh, it was just so nice outside.

I didn't think I needed to wear a sunscreen. The temperature is not correlated. you could burn. So it is not, temperature does not equate to UV index. Okay. All right. Because I was in Miami and the other,

what, three weeks ago and I like to go for walks in the morning. In Phoenix now I do treadmill walks in the morning. It's too damn hot because I don't start until 10. Yeah. I do the sun like breathwork in the pool right after or something. You know, it's 10 minutes.

But I was out there and it was so, I mean, it was instant sweat. Oh, in Miami? Yeah, just instant. And so I'm wondering. since it's closer to the equator by the ocean, then the UV is probably a lot higher in the summer there, right?

It's probably, I would say it's probably higher for sure because it is closer to the equator. I would assume so. All right. But it would just be in everybody's best interest to check if you're going to spend any time outside. Correct. And most of the time, the issue where things come up

is that people, they don't plan on going outside. Yeah. Like where I see a lot of people where they get a sunburn, they have, they went outside to get. their mail and then they go and you know they look at a plant in their yard and then they move some rocks around and instead of it being a two-minute trip it's now 30 minutes outdoors and they burn so it's the the unintended sun exposure that people are not aware of and currently there as you said there's a lot of people who are on one side of the fence right now telling you to go out and

get your UV because it's healthy for you and so they're getting that information and not worrying about the downstream consequences yeah it's like partially right and partially not because it's not really engaging and looking at the actual rays right at the the moment they're not covering that correct and there's and they utilize people utilize data to say hey well you asked me a question earlier about uv radiation well is there what what is there some benefit well looking at uvaa it causes nitrous oxide to be released in your skin that is a dilator and that will reduce say blood pressure so systemic vascular resistance well we already know there's a ton of other things that do that excluding medications yeah if you exercise

you're going to release nitrous oxide yeah if you sit in somewhere that is warm you're going to release nitrous oxide so like sauna so you don't have to get a something that is toxic uh that is a grade one class one carcinogen uh to have a health benefit with that being said a small dose of UV, as I said, for me, if the UV index is less than two, I don't worry about it. So I'm not worried about that level of radiation getting into my body because the dose makes the poison. Well, when people want stuff to work out, they kind of pick and choose what they want, kind of like the red wine bullshit about, oh, it's got resperatrol and we'll just take resperatrol

and forget all the other stuff that goes with red wine. Exactly. I always tell people that it's like, come on, like, what are you talking about here? I mean, just because you want the wine. So you were bringing up something about a Fitzpatrick scale. You said it multiple times now. What is that? That's looking at from as light as you can be, which is a one to a six, so as dark as you can be.

Okay. And so when you look at that, there is a relationship, obviously, with that and your risk for potentially developing melanoma because you don't have as much natural. You can think about melanin as sun protection in your body to protect yourself from UV radiation and UV light. Okay. So it's just all determined on skin tone. That is a gross way to assess it. Okay. You can do skin biopsies and look at how much like feel melanin is present and how much pigment is present.

But yes, grossly you can look to see, you know, what color is that individual skin and compare it to that scale. And you can categorically fit where somebody falls. So are there other ways to like develop skin cancer melanomas without it being sunrelated? Oh, 100%. And we know that. What are some of those? They're genetically related, right? So there's germline mutations.

When you ask me about the moles, right? Like, you know, how many moles somebody has? Do you know? Well, we know, for instance, if you have a set number of dysplastic nebae or harbor dysplastic nevis syndrome, those individuals without UV exposure are just, they harbor an increased risk of developing a melanoma because they develop excess moles that are already irregular, right? So they don't have to get sunlight. per se that to develop a melanoma.

They have a familial history of it. And they have mutations are called germline mutations that are present that are inherited from their parents. It's like a balding gene. You say both your parents were bald. Women go bald as well. And you inherit the balding trait. Well, unfortunately, that means that you have a probability that you will be bald.

It's not 100%, but it's very similar for, say, melanoma risk. You may inherit a KDN2A mutation. that mutation increases your risk of getting melanoma without sun exposure. But the UV radiation in itself can propagate that as well. Okay. Wow. Is there any other ways or are those the two ways? Spontaneous and sporadic, right?

So unfortunately, things just occur. Okay. So when you look at melanoma that it occurs on the underside of your foot, so on the bottom of the foot, a lot of that is sporadic. spontaneous and unfortunately those are not we can tell you the the genetics in the melanoma itself and we can tell you do they harbor this you know a class seven signature which is a uv related signature within the DNA they don't so we know that they are not induced we know that there are certain cutaneous melanomas that are induced from the sun and that is majority of them and then there is a small fraction

that are not. That is why when you get a full skin check, it should be a full skin check. That means everything you're comfortable with. So for me, that's the whole body. Yeah. Oh, yeah.

I think same. You should definitely, I mean, why wouldn't you? It's all, I mean, well, because some people are modest

and they are, you know, but to me, just look. It's all, it's all, it's looking at genital skin is like looking at a toe

or a nose. Yeah, that's, it is the same thing. Yeah. That's, that's something I would recommend getting over quite quickly if you're going to

get something checked. I get lost there with people. I get it, I guess, to an extent, but not when you get older, man. I know. Modesty is gone. And it really, it should not be there when you're getting evaluated because how do you know what's not there? Last year, I found three melanomas on the butt. Three melanomas. You know, people not, they didn't use canning beds. It just spontaneously occurred. Yeah. And you wouldn't even know there's anything even there. Correct. Yes. You would not, I mean, that is not the easy area to look yourself. Oh, okay. So what are the stages of melanoma and how severe is each stage?

So if you find melanoma early, which is my objective, that is why I'm a dermoscopist, right? I said, so for me, what got me into dermatology, my interest in it in particular, I've always been interested in kind of longevity medicine and living a healthy life is one of the pillars of living long is preventing things that can take us out. early and cancer unfortunately is one of those things that can do that if you find melanoma at stage zero nobody dies from it all you have to do is remove it just right it off you cut it off and you're good to go if you find melanoma at stage one you actually have a a high rate of survival so if you look at the nccn or a jcc you know they'll give you you know what the five-year survivor rate is and it's like 98 to 99 percent but there's a lot of people that are diagnosed with the stage one melanoma of all the melanomas.

And so of the roughly 8 to 10,000 people that die a year, they are actually diagnosed with what we consider early stage melanoma. So objectively, if you can find it as early as possible, you shouldn't worry about it. So when I call a patient and tell them, hey, you have a melanoma in situ. It's not a big deal. We cut it out.

You're good to go. You truly are good to go. You just have to have continual skin surveillance, right? because you made a melanoma, that means that you have an increased risk. Compare that to somebody who has later stage disease, say it has traveled to the lymph node and it's stage even three eight, microteposites. That ratio of either you're good, nothing, right? Your 100% survivorship or even looking at stage one at like 98%.

Now you're at like 73, 74%. So that is substantially different. and the difference between how that may present on the body is not much, which is important. What kind of side effects would someone have if they were, if they had or would they even know? Nothing at that point. Nothing. Nothing. Correct.

Which is unfortunate. That is why it is kind of one of those more to me like scary cancers. It's not like, oh, I got a stomach ache or I have headaches. You can have something that's migrating through the stages, like stage 3A. that means you have a microdeposite in the lymph node. You would have no symptoms. But it's already moved from the skin into a lymph node. Would it show on blood work or anything at all?

Like any sort of blood things that you would look for? Not necessarily yet. But there are tools that are looking at that. So you're looking at circulating tumor DNA in your blood to assess to see, say somebody had a melanoma. It would have to be already past the top layer of epidermis. that's stage zero, okay? Meaning it would have to be stage one, stage two, stage three for a circulating tumor

DNA for it to be found in your blood. So how long can one sit there in stage zero? Could it sit there for a long time? We don't know. So we could, absolutely. And I'm sure that there are some that do that. But if I could tell you that, I would be a trillionaire. Right.

And look, I hope somebody does figure that out because then we can say, hey, we know definitively that this is okay. Yeah. Because there are some dermatologists who actually believe that. They think, oh, it's an early stage, you know, cancer. And same with patients. This is okay. You can watch it like a prostate cancer, right?

But we don't have the data to support that. Yeah. When we do, I will support it. One caveat. It is very easy. Now, this is a scar on my arm, not from a melanoma. it was a severely dysplastic mole. Having a small excision for a,

if it is, say, a melanoma in situ is not a big deal. It is very easy to do. You can knock it out. The morbidity from this is nothing. In six months, I'll send you a photo. You'll just see that there was a line. There will be no color pigment there. This is recent, yeah.

And so you'll look at it and be like, what's the morbidity and mortality of that of doing a small procedure on somebody's skin? Nothing. It is so little versus what is a risk of that going from a stage zero to something that kills you. Yeah. Right? To me, the balance is where we are. We don't know how to predict that.

Just remove it. I had that done once and they cut it right off and then it was nothing, but they still cut it off and said, you're okay. And I was like, well, shit, it healed in like a week. And I felt good. I didn't have to worry about it. Correct. Yeah. Super easy to do.

Get it removed. And if somebody has a different discussion and they say, hey, look, I don't want to do that. I would go through what are the risks and what is the data on it. But it is a very, to me, straightforward process. How many, I know you can't say exactly, but how often do you find something that looks normal that is an actual melanoma? Is it happening off? Oh, shit.

Yeah, so almost every week. Wow. Not even, so, you know, I preach on melanoma because melanoma has the mortality associated with it. Yeah. I find so many skin cancers every day. that you would not be able to see without using a dermatoscope. Really? Yeah, they're just, they look like normal little bumps on the skin,

and it's a basil cell. And something like that, say it's on the nose, it's a small, say a small basil cell, your nose, any area of tissue is space occupying. And so you want to identify stuff as small as possible visually to where you can't even see it so that the treatment, you can get a very tiny scar versus losing your whole, say, tip of your nose.

Yeah. How quick does that thing show? Does it show right away? Yeah, yeah. Instant. Now, there are certain things, dynamic rotation. So there's a lot of stuff that you'll do when you're analyzing the skin, but you always want to have it in polarized mode.

The polarized mode, that is what's showing you structures that are inside the skin. And it's your brain, right? It's what you're understanding within it. And so for me, I am an expert in this. And so when I have learners who I really just have board certified dermatologists who will fly in to see me to learn, if they ever do a exam or look at an arm quicker than I could look at an arm, they're doing it too fast. Okay. So people always ask, how long is the skin check should be?

I don't know. It depends on what's on your skin, but it should not be faster than I can do it because that means you have not assessed everything. Yeah, because, I mean, I'm thinking in my head, wow, if you're doing a full exam and someone's got, 30 moles or something like that's going to take a little bit of time right a little bit of time but 30 moles 30 moles should be pretty quick to go through okay you should be able to analyze I know it sounds you know rudimentary the length of time but a mole two to three seconds I've tried to count mine and I'm like in my head I'm thinking like what is average I've tried to count my wife's and yeah but but it's not just moles it's every sunspot so every lentigo somebody has I have to look at with a dermatoscope every pink spot uh that somebody has for you you have tattoos you have tattoos you have tattoos you have tattoos you have to you have tattoos you have I will march through the tattoos to see, because unfortunately that creates camouflage on the skin. But I will march through that area to see what is going on within it.

So for you, it's going to take longer. And that's okay. But look, that's what we signed up for. Yeah. It's to make sure that you were okay and healthy. Oh, yeah. I'd sit there all day for the, you know, but some people are in too big of a hurry, I guess, for their life.

They, you know. Unfortunately, and I think, you know, people, they have a different opinion on, Everybody can have a variable opinion on what they want to do with their health, but when you are getting your skin cancer screening, it should be the best screening. Yeah, I agree. I think with any screening you do of any kind, a heart, whatever, I think you should always try to do the most, you know, extensive to where it's not going to hurt you. Correct. The difference is with a lot of that stuff, though, so for instance, mammography for breast cancer screening, that's standardized, right? So for the most part, people, when you go get a mammogram, not you, men mostly don't get mammograms, right?

It does occur. I mean, men do get breast cancer. I actually diagnosed one last year. A person came in at a lump right underneath their areola, did a biopsy of the breast cancer in a male. So it does happen, but it is rare. So you wouldn't just standardize mammograms in men. But as a discipline, mammography is standardized. What is not standardized is dermoscopy, right?

I finished my residency in 2019. I had two lectures on dermoscopy that have utilized that tool. And even though we utilize it in clinic every day, that does not mean people understand what they are seeing. Yeah. And for me to create the level of expertise I have had, when people talk about how many hours of work you've put in on the back end, tens of thousands of hours of analyzing images with the histology,

meaning the pathology and correlating the structures of what we see on what we call the horizontal surface of the skin and the vertical surface that's within the skin and that's a pathology. And that stuff, unfortunately, even all the books that are out there, all the lectures that are provided, the content needs to be developed, curated,

and then instructed very well. See, and this is one of those things, so all related to chiropractor, because I've been in rehab for 20-some-odd years with my back, and I found a place that had what's called the Cox table, which is very hard to get certified for it. So most people opt to not get it. But it's like a dream as opposed to just getting thrown around and whipped around and popped and cracked.

This actually manipulate your back and it helps it. And that's kind of, I'm relating it to this to where it's like that's more of an unknown. It's like, oh, I've got to go get another certification or oh, I've got to take time to study this. How much does the tool itself cost? So this one costs a little under $2,000. Okay. Okay. as a cost in whole.

But some of the lower cost ones are around $500. So it really shouldn't be, the cost in itself shouldn't be a big deal for your dermatologist or dermatology provider to purchase. Yeah, that's what I ask because I'm like, okay, is there a hurdle here to doing it? So second question would be then, how difficult is it to read what that tells you? It is much more difficult than people would like to lead on. So that's probably the problem. That's the issue.

So a lot of stuff that people may presume is normal is abnormal. And then things that are say normal, they will biopsy because they think it is abnormal. Now, that occurs no matter what. I can go through the second part on at length because there are a lot of things that will create essentially interference or noise. in the skin and you need to actually take the tissue sample. Okay. If you get a, what I try to instruct is if you biopsy something, excuse me, that is normal, but you knew the exact reason why,

and you have the data to show it, you should always biopsy. Shiny white structures within a pigmented lesion that's popular, requires a biopsy. It comes back as a normal mole, fine. But because that, those shiny white structures could be dermal fibrosis in a melanoma that is invasive. So you have to take it off. But the understanding, the disconnect, there is a disconnect with the level of knowledge people have in that area.

So that's the big problem. That's the issue. And with this, that is what we need to change. Is there a certification or anything that you take to do that? Or is that just don't learn it? Yeah. So there are courses, right? So there are multiple courses.

You know, I was in Utah in May presenting at their state's meeting. I gave four lectures on it, right? I'll be in Colorado presenting at their annual conference discussing Dormoscopy. So there are ways to get the information, but I try to tell people you, there's a canvas every single day and that is the patient. And I want to look at, you know, a learning opportunity, but you have the ability to learn because you are you are actively doing it as you see skin. I don't want to put words in your mouth.

I'm going to ask you, would you say it's an active hope of yours to help get that into more dermatologist's hands? That is my goal. So my goal is for the public to be aware that dermoscopy is required for your skin cancer screening. It is required. As soon as a public, on a whole,

becomes aware of that, then it will push the institutions to start to change the instruction. Yeah. I'll give you kind of a little tidbit of like how we train. So in our, to become a board certified dermatologist, you go through med school and then you do four years of residency. At that time, when you sit for your board examination,

around 15, 20% of the questions are pathology, meaning what the structures look like underneath this skin, which is good, you need to know it. And we had lectures every single week on dermatopathology. However, in practice, most dermatologists do not actually read their own pathology. You have a fellowship, a dermatopathologist that is reading these slides. So clinically, the dermatopathology training that is required,

people don't utilize as much, right? But when we look at what is required for dermoscopy, on my exam in 2019, I don't think I had a single question that was dermoscopy related. When we look at that ratio of 15 to 20% being dermatopathology, I think we need to learn it. But if we're not going to be applying dermatopathology, We really need to be learning what we're doing every day on the skin in clinic.

And that is like learning something procedurally, right? Well, this is a procedural, you know, process, what you're analyzing. We should, that should be so foundational in dermoscopy education. And in my opinion, if you're a nurse practitioner or a physician's assistant and you're just starting right out and you go, you're now you're working in a dermatology clinic, there really should be certification before you can pick up a scope, you know, or be not pick up. of a scope of being a clinic and providing care for patients because the knowledge that it takes to get there is not low. It is a lot. One of my personal frustrations when I talk with people and I learn what they're learning in school and everything is it doesn't correlate to real world and real life situations and circumstances. It's kind of like taking fucking seven years of history in school

when you need to be taking courses on how to fix your credit and build your credit, balance your checkbook, things that are real life circumstances. And so my hope, and I'll relate this to the supplement industry, is when I'm around something and I see it's clean label project certified, you know, if you're into the seed oil, seed oil free certified, like they get these real certifications. They go the extra mile. And it's normally cost related by they don't. This isn't cost related. This is more time related or desire to learn more. My hope would be that we could encourage more people to learn more to be the best at what they do to, they, they, they, they, do what you do to make a difference.

Right. You know, you did this to make a difference, not to make a paycheck. You did it to make a significant difference. Correct. You know, of course, I want everybody to make a lot of money and what they do, but I want you to have a purpose. So, I mean, that would be the, my, I'm speaking for you on your behalf. That would be my argument because I deal with it every day.

Right. And I've learned over time that if you're not doing stuff for other people, what are you doing? True. Yeah. I mean, that's the whole purpose. Really, we should be helping. everybody out, right?

Well, in medicine, you should be, you're doing the best, you should be providing the best care. But with anything, standardization matters. Requirements matter. And if the requirement is not there, unfortunately, no matter what, no matter what level of achievement people decide to get to, there are going to be people that are going to do what is standard. Yeah, of course. And that is not wrong.

That is what our governing bodies have, you know, established as this is the standard grade, this is what is expected. But to me, because I see the difference, and that is lives. Like I firmly believe if everybody was a dermoscopist as a dermatologist, that we would reduce melanoma mortality. I don't know if you have an exact percentage on this or not, but what percentage of dermatologists use that? I would say a majority of them use it. And I would say it's probably majority is loose. It's at least over half. Oh.

But the training, right, almost every attending, I went to University of Wisconsin, it was a very good institution to learn dermatology. Most of the dermatologists here use a dermatoscope, right? So they had that handheld tool. But the knowledge within it, this is just based on lectureship and what I know, it's just not there. Yeah. And that is what needs to be implemented. So people can harbor a tool. But if the understanding of those structures are not present, then even if you're utilizing

something, it is not going to help you as much if you actually knew what you're doing with it. So like obviously the dermatology would be the core thing. So that would just be like a subsect of what you're learning, basically. Correct. But this applies, you know, think about what do most people go to dermatologists for, right? skin cancer screen. I mean, I see patients for all the other stuff, you know, acne, psoriasis, atopic dermatitis, or eczema. But in general, you know, and obviously my specialty, my area of

expertise is finding skin cancer. That is people are coming in to get their skin examined to make sure that they are okay. I want to utilize a couple other questions since we did so many melanoma and given that you have so many other things that you're able to. I've always had this curiosity about certain skin issues like psoriasis, like eczema. What, what's, is it, is it cellular? Is it nerves? Is it something mental? Is it gut health?

What are some of the main culprits that cause these problems? So great question. They're absolutism of trying to say that there is no association with stuff is not where I'm at. There is definitely a gut access. there is a mental health aspect that is associated. And I think they actually play off each other. People that are itchy, they make their itch.

Honestly, I feel like you can drive people mad. Like if you're itchy, you get a bug bite and it's itching. Look, imagine your whole body itching. You know, you have atopic dermatitis or eczema and you're scratching your skin constantly. That would drive me nuts, right? So there is some association, I think, in particular of driving the level of severity or symptoms of it. And some of it's inflammatory, right?

You know, we know that psoriasis technically is an autoimmune process. You have a over-prolifference condition. If we're just looking at the skin, it's not breaking down tissue. It's causing excess growth to cause plaques that are thickened on the skin. When you look at psoriotic arthritis, so that's essentially you're looking at that disease entity as psoriasis. Some people get arthritis with it. Other people do not.

But when you have psoriotic arthritis, you're actually doing. destroying the joint. You have to treat it. If you don't treat, say, skin psoriasis and you have less than 10% body surface area, you can look at certain inflammatory markers to assess what is their level of inflammation. Is it elevated or not? Once they're above 10% body surface area, there is a signal of, you can look at blood-based markers and say, hey, look, they have internal inflammation. You need to treat that. And that's where you have, there's systemic drugs, turn on your TV, which I really don't watch, but turn out and look at, there are just numerous drugs that work. And the good thing is it actually works.

So a lot of the, a lot of the drugs that we have psoriasis, for psoriasis are exceptionally good and they're low risk, which is great. Exima is a little bit different. We have good drugs for atopic dermatitis, much better than what we had, you know, even 10 years ago. But the drugs for psoriasis, and I don't work for any drug companies at all. I don't sell drugs and nothing with pharma. I prescribe things that work for people. I've had quite a few pretty highly intelligent guests on here, but they'll come on and say,

oh, this cure psoriasis and this does this, and I've yet to really see that come to fruition. And that's why I ask, because I'm one of those people. I don't love conventional medicine, but I'm certainly not against it because I use some, and I know the efficacy of some, and I know the benefits. It's like anything else. Something good comes along and it gets screwed up along the way because somebody tries to make a lot of money off of it. It's just like anything else.

It's not just medicine. And so I'm always temperate in terms of what I believe and what I don't. Even though in my sphere, it's more frowned upon to get behind stuff like that. I'm a realist. Yeah. Which is good. I think that you should have that. You should do the things that you can do naturally that are healthy for you.

Exercise, try to get good sleep, eat well. Those are healthy. Those are things that can help you. But if you, there are things that you cannot say control, that is, use pharmacology, you look at randomized controlled trials, which when you look at evidence for interventions, and you look at studies that remove, say they peel off the epidemiology component, well, what else did this person have?

How old were they? And you just look at, is this drug effective in these cohorts of similar people that are, you know, similar, and you can see what the data shows. Yeah. That is why it is very expensive for pharmaceutical companies to bring a drug to the market. And, but ultimately you want to do stuff that is safe and you want to take care of yourself. Yeah, 100%.

I got fascinated with psoriasis. When my dad passed away and my mom, you know, obviously had a meltdown and she developed it. So I always, and her correlation was to the stress and everything that just happened out of nowhere. So I got kind of fascinated with learning about it and learning that, because I didn't even really know what it was at the time. Yeah. And so I studied into it and everything.

Do you find that people that get those skin conditions, are they normally older or does it vary? So there's a kind of a bimonal distribution with psoriasis, but I definitely would say I see it more, you know, 35, 40 years old where they start developing it more frequently. And then there are other things that are associated with psoriasis, which look at your metabolic health, right? So obesity, alcohol consumption, smoking,

those are all factors for people to develop. They say they're predisposed already have it, but they have been in good health their whole life. You know, they don't smoke, they don't drink alcohol, and their normal BMI, right? And they exercise. Well, their psoriasis may be they have just a teeny little pink spot on their skin. They don't even think anything of it. But then they become overweight, drink access to alcohol, smoke cigarettes, and boom, they're coming to the dermatol. I got this itchiness in my scalper.

I'm getting these thick, you know, bumps on the back of my arms. and they already had it, but their metabolic health was under good control. Yeah. And there are a good subset of those patients. Like there are a lot of, obviously I'm sure you've, everybody is aware of like OZempic and, you know, looking at semi-glutide, treseptide, these JLP medications.

Well, what have I seen in my own cohorts of patients who are on those, not me prescribing them, taking care of their skin? They metabolically become healthier. and their psoriasis is getting better, you know, which is awesome. You know, I'm happy for them along the way. Yeah. So there is association with that. Okay.

So when it comes to like acne issues, is that a hormonal problem or what is the general cause there? So hormones absolutely play a role, right? So that's why when we look at like pre-puberty, if a child comes in before puberty, before they say if women starts having their men seize, right? You would consider working up why that individual is getting acne, right? Because when do they start to develop acne when they're going through puberty, right?

You have sebaceous glands, these little oil glands, those oil glands become activated or grow with androgens in your body, so things like testosterone. And so that is a primary driver of it. but there are other components that are associated with it. Yeah, because for example, one major side effect with anabolic steroids, a lot of acne buildup. Vast. Correct. Yeah.

What about foods that, because, I mean, you know, and I say this when you're a kid, it was always, oh, if you eat something greasy or potato chips, you're going to get a Zit. Is that true or is that just mythical BS? So I would say that there, it depends. So if you, if there is something that you consume. say it was dairy. Yeah. And every time you had dairy, you got pimples with it.

Well, maybe for you, dairy was a problem. But as a whole, it is a lower issue because it's not really adjusting your level of testosterone. You know, think about foods that you can eat that are going to raise your testosterone. Everybody would be doing it, right, if they were trying to, if they wanted to get more muscle. So there's very few things that are going to impact that level.

So, yeah, for me, I don't really, you know, I try to recommend and just clean eating with my patients. Is acne more of a prevalent problem for younger people than it is older people? It is, but I definitely have, I mean, I have an 86-year-old on acutane. You know, I have multiple older 80-year-olds on isotronin.

And at that point in time, it's not technically acne. It's what we call rhino-five-ness rosacea, which is, you look at rosacea, it's kind of a sibling of what acne is. And acutane or isotroninininisotinone is unbelievably helpful for it. And these patients, they never want to go off of it.

Because if you look at, look up rhinofima and look at what the nose looks like, it is not, it is not something you would want to have. So if we could treat it, you want to treat it. So you mentioned acutane. I spoke to you about that a little bit when we talked. So I would like to just ask you, what is acutane? And is it dangerous? Obviously, people, if you misuse anything and do it in the wrong way,

it's gonna be dangerous, but what do you notice with side effects wise on that? Because I've seen some people have issues with it, but I also don't know how they were using it. Yeah, so isotrinoin, which is the actual drug, which is the brand is acutane. Yeah. Is an oral derivative of a vitamin A, right?

So it's a vitamin A derivative medication that works at the sebaceous gland and it causes those sebaceous glands, which are in their hormone responsive, to shrink and it causes some of them to actually imbulute and go away. As a dermatologist, it is one of the best drugs that you could possibly have for acne.

And I cannot imagine that not being universal amongst dermatologists, 99 out of 100 would tell you it has saved so many patients' scars, reduce their depression, you know, and unfortunately when a lot of kids get, when a lot of people get acne, teenage years, right? So they're going through puberty. Unfortunately, I've, you know,

11 and 13 year old and I kids are mean man you know unfortunately and you know some kids are blessed they have very few pimples and some some kids are not and you can unfortunately because of social pressures they are very heavily impacted by how they look and what people say and do and you can help reduce their acne and also reduce scarring with to me essentially no risk excluding the biggest risk with Acutane, the disclaimer, pregnancy, we know it causes birth effects. That is a guarantee and that is why the medicine is regulated extensively because it will cause a birth effect. Extremely important.

Excluding that. So 30 days post acutane, so I tell my patients as females, 30 days post acutane, you want to have kids and say 27-year-old woman, there's no risk, no issue associated with it. Completely okay. But when you're on the medicine and within 30 days of it being discontinued, that risk of a birth effect is real, and that's because excess vitamin A will create a birth effect. I see.

But other than that, if you use sunscreen, sun protection in general, you moisturize your skin, you use, you know, lip balm, have a humidifier in your house, reduce the side effects that are associated with it, which are really sun sensitivity and dryness are the two biggest things. It is very easy. So if you were to talk to my patients, which unfortunately, HIPAA cannot, but I'm sure they would actually line up and say they would recommend it. Yeah. Because it works so well. And once you know how to utilize it, it's not hard. It's easy. Okay. One more here about like not drugs, but I want your thoughts on Sunblock in general because I, you know, once again, you see a lot of people.

These are great questions. Yeah, a lot of people that will say, man, you better. wear that every single day and there's other people that will tell you it is like poison to wear it i mean literally and i don't know how much social media you look at but i mean it is like don't go near it so you know in all honesty over the past year i've been trying to identify more sources for what i'm hearing in society right so from my patient population of telling me sunscreen's bad for you or the sun is good for you. And I'd be happy to go over some of these studies, which I think are actually very important for people to be aware of what the data shows. Now, when it comes to using sunblock and using chemical or physical-based sunscreen, I use both personally. I do recommend them both

to my patients to utilize the studies that we have, people are particularly worried about oxybenzone as one of the common ones that I hear daily. Like, you stay away. from that that's going to cause cancer. It's an endocrine disruptor. We have no human-based evidence or study that has shown that it actually does cause cancer or that it is harmful. It is absorbed. We know that it is absorbed into the skin. But something being absorbed does not mean it's going to cause harm. And I think that people need to be aware of that in general. It's like we are concerned about chemicals in general, you know, dihydrogen monoxide is water. But if I were to say that to you and say, could you imagine putting that on your skin?

People would say, oh, they would freak out because they don't know what it is. But that is two hydrogen Oatis and one oxygen Oat, and it is technically water can be harmful. You drink too much of it right away, right? And you can actually die from that. But the studies that we have when it comes to actual chemical-based sunscreens that are currently on the market, okay, the amount of volume that you would, have to utilize day in, day out for not just our lifetime, meaning, you know, what does the average human live? 80 years, if we're lucky. But if you get to be a centenarian and you're 100, great.

None of the studies show that there would be toxicity. This is looking at equivalent like animal models of where would it be toxic or, you know, one of the animal studies looked at the endocrine disruptors of a rat uterus. And that's how they get, well, we know this. is an occur in disruptor. Well, for potentially that to occur, you're looking at 130 years to like 250 years of use of sunscreen. We don't live that long.

And because we don't live that long, and it's a theoretical risk, it is not actually a real risk. My concern is very low. With that being said, I always pay attention to literature. So if literature comes out and shows me, hey, this is potentially harmful,

I will, I would like to have the chance to pivot and tell people don't use it. And if people say, just use mineral sunscreen, I am completely fine with that. The mineral sunscreen for everybody does not always work. It makes their skin look white and chalky, right? And that is their appearance. They don't want to look like they have toothpaste on their skin. And, you know, in particular, if you have, say, a darker skin tone, a lot of the chemical

blockers, there's a new one. And once again, I don't work for any company, Bimotrizoanol, which has been around for 26 years in Europe, in Korea, we have very good safety profiles. It blocks. It's a photostable sunscreen. It has a large molecular weight. It's over 500 Dalton. So the absorption is low into the skin. And it is actually the first chemical-based sunscreen that is recognized Grace 1, generally recognized the safe and effective by the FDA. The others are zinc oxide titanium dioxide. So that is a chemical-based sunscreen. But just so people know, chemical-based sunscreens are actually organic.

So they are organic compounds and physical-based sunscreens are inorganic. And this is where words, this is kind of where people, I don't want to say get in trouble, they utilize words to make things seem scarier than they are. They're organic. And my concern is somebody who I see skin cancer every day, I know what UV radiation does, my recommendation is you protect it when you need to. That doesn't mean you need sunscreen on every day. You know, you may not need to.

That's my stance on it where I feel like it's like, okay, it's too much, but I'll tell you this. I don't want to get burnt ever again when I go to the beach or if I'm out and I put that shit on. You should. I'm glad you do. Yeah. And the volume matters, right? Yeah. So one of the things that we look at because a lot of people are like, well, there was a study where they showed people who used sunscreen got more skin cancer.

Yeah. Well, how much did they actually use? You know, you can use a two-finger rule for your face. So put a strip of sunscreen on this finger, strip of sunscreen on that finger. That is how much sunscreen you need to utilize for your face. Most people do not do that. They put a couple dabs there.

You know, if you look at your body of the sun exposures, it's a shot glass. It's an ounce of sunscreen. People don't utilize that either. Oh, I slather that on when I go to the beach. I got burned too many times. Yeah. So you know, you know what you need.

Yeah. Oh, yeah. Yeah. Trust me, get burnt once or twice and have your whole trip ruined, you tend to not do it again. Yeah. So, man, this has been so enlightening. I got like seven million more questions for you. We might have to do another dive on.

Oh, man, I'd be happy to come on. Absolutely. You have been phenomenal. I mean, just everything and how quick the answers are. I can always tell when I'm talking to a real pro by how they answer in the quickness and they don't dance like a politician and you didn't on anything. And I appreciate all of the insight and just your work in general. I mean, what an asset to the community you are.

I'm really glad that I got to meet you, man. I appreciate. Thank you for having me on. Absolutely. Well, where can people follow you and then, I mean, your clinics in Tucson, right, if somebody wants to actually see you in person. Yeah. So Tucson, Arizona, but Instagram is, I mean, I'm on all the outlets.

It's just my name, Michael underscore Christopher underscore MD. Okay. Yeah, sweet. Thanks again for the time, brother. Absolutely. So valuable. Such an ask. set and it's been a real honor and pleasure to have you here.

Yeah, appreciate it. Thank you so much. Absolutely. All right, everybody. I hope that you pay close attention to that. And this has been one of the most highly impactful conversations I've ever had. So listen closely. Take a lot from this.

And stay tuned for plenty more to come. Dylan Jameli, signing off.