Latest / Skin Anarchy / Dr Orit Markowitz, Board Certified Dermatologist and Skin Cancer Expert, founder of OptiSkin

Transcript

Dr Orit Markowitz, Board Certified Dermatologist and Skin Cancer Expert, founder of OptiSkin · Skin Anarchy

• 0:04
  SPEAKER_00: Hi guys, welcome back to Skincare Anarchy.
• 0:07
  SPEAKER_00: This is your host, Ekka, and today's guest is a very, very special guest.
• 0:12
  SPEAKER_00: Um, I truly look up to her as a medical professional.
• 0:15
  SPEAKER_00: Um, she is genuinely a uh a leader in medicine.
• 0:20
  SPEAKER_00: She is a visionary and a pioneer in dermatology.
• 0:25
  SPEAKER_00: She is actually a New York City um board-certified dermatologist.
• 0:29
  SPEAKER_00: She's a leading published author in medical journals and is and an expert in skin cancers.
• 0:36
  SPEAKER_00: So without further ado, I want to introduce you guys to Dr.
• 0:40
  SPEAKER_00: Orrit Markowitz.
• 0:42
  SPEAKER_00: She has also, um, Dr.
• 0:44
  SPEAKER_00: Markowitz has also published a recent study that is now um, you know, dubbing her method and her new technology as the Markowitz method.
• 0:54
  SPEAKER_00: So, you know, I think you guys are gonna learn a lot from this episode.
• 0:57
  SPEAKER_00: I know I am.
• 0:58
  SPEAKER_00: So without further ado, I want to welcome you, Dr.
• 1:00
  SPEAKER_00: Markowitz.
• 1:01
  SPEAKER_00: Thank you so much for your time and for your willingness to come on the show.
• 1:05
  SPEAKER_00: I'm just so honored to host you.
• 1:10
  SPEAKER_00: Markowitz, um, I want to uh begin by your background and your um background in medicine and just how you got involved in you know um dermatology and all the all the stuff that led to this.
• 1:22
  SPEAKER_00: Sure.
• 1:23
  SPEAKER_01: Um so where to begin?
• 1:25
  SPEAKER_01: Uh I completed my dermatology residency um back in the early 2000s.
• 1:34
  SPEAKER_01: Uh and prior to um medical school, I've always had an interest in um sort of uh visual science.
• 1:45
  SPEAKER_01: Actually, my uh undergraduate degree was in psychology, and I ended up writing my thesis in the field of perception on something called the moon illusion.
• 1:59
  SPEAKER_01: And um yeah, and so uh, which you know, there are many theories and fields of perceptual visual science that uh begin with certain illusions like the moon illusion, where uh the moon at the zenith looks smaller than the moon at the horizon, when in fact the distance is the same, and why does that occur?
• 2:24
  SPEAKER_01: And the reason I bring that up is because I've always kind of had an interest in understanding um how we perceive things.
• 2:34
  SPEAKER_01: And when I went into medical school, it easily became very clear that I had a real interest in uh the largest organ on the body, the skin, and sort of how we further understand looking at our skin.
• 2:51
  SPEAKER_01: Um, and early in my career, I ended up focusing on non-invasive imaging, different ways to visualize the skin, and uh ended up sort of doing a fellowship um in the field of skin cancer, which at the time was really where we were utilizing a lot of these uh early imaging techniques, beginning with dermoscopy, which I ended up writing a textbook in and publishing and lecturing.
• 3:23
  SPEAKER_01: Yes.
• 3:23
  SPEAKER_01: And this is this is just a handheld microscope that has uh different types of uh polarized lighting.
• 3:33
  SPEAKER_01: Um, and it just you know gives information under the skin.
• 3:38
  SPEAKER_01: And then as I kind of finished my residency and and finished a fellowship in in skin cancer, I ended up joining um the Mount Sinai Department of Dermatology as well as the Downstate Department of Dermatology, uh, where I completed my residency.
• 3:58
  SPEAKER_01: I ended up leading in both locations their uh pigmented lesions, also known as melanoma and skin cancer divisions back then.
• 4:10
  SPEAKER_01: And uh and at the same time, uh around that time, companies in England and Europe were developing technologies that went further than dermoscopy looking under the skin.
• 4:26
  SPEAKER_01: And uh these, you know, one of these devices, which I helped back then pioneer in the United States, is called an optical coherence tomography device.
• 4:37
  SPEAKER_01: And uh this device was utilized in the ophthalmologic space and actually a standard of care when you go see your ophthalmologist, that they're gonna use this device to look into the eye to understand uh a lot of diseases.
• 4:52
  SPEAKER_01: And so it made sense for these companies to say, hey, why don't we start looking at other organs of the body?
• 4:59
  SPEAKER_01: And it, you know, the next organ that they sort of pursued was skin.
• 5:03
  SPEAKER_01: And I just happened to be early in my career um leading, you know, skin cancer at two major institutions in New York, and ended up with these devices.
• 5:17
  SPEAKER_01: And at the same time, some publications were uh coming out with another device that I also um was an early adapter of, but this technology was sort of um um its technology was progressed in Europe and then after that came to the US.
• 5:37
  SPEAKER_01: So rather than call myself a pioneer, I call myself an early adapter of cotton focal microscopy, which is also a device that looks into the skin and is used like more of a cellular cross-sectional imaging device that now we actually um can do as a non-cutting biopsy.
• 5:58
  SPEAKER_01: But back then there wasn't really, you know, reimbursement for this, there it wasn't really mainstream, it was only in a handful of people.
• 6:07
  SPEAKER_01: And OCT, I was the only one.
• 6:10
  SPEAKER_01: And so when I ended up working with these two tools and medications at the same time were coming out, and people were doing research to see, well, if someone has a basal cell, can I use a certain type of cream that I'm using for pre-cancers and maybe it's gonna help their skin cancer disappear?
• 6:32
  SPEAKER_01: And so all of this research was happening back then, and it just kind of made a lot of sense to me at the time.
• 6:39
  SPEAKER_01: I said, okay, people are looking at this, but they're not really using tools to look under the skin.
• 6:45
  SPEAKER_01: Um, I I have all these tools to look under the skin, uh, starting with dermoscopy.
• 6:51
  SPEAKER_01: Why don't I, you know, look at the same thing that they're doing, but really understand it using technology to get a really good visualization under the skin so that I can understand what's actually happening and whether the patients are really clearing or whether, you know, they're just kind of seem to be clearing and then are going to end up recurring with their skin cancer.
• 7:15
  SPEAKER_01: So this was all happening back in the early 2000s.
• 7:20
  SPEAKER_01: Um and it was exciting at that time because many patients were looking for alternative options so that they one wouldn't have to get their skin cancers treated, you know, through uh surgery or uh electrodesication, which is something that's still commonly used for superficial basal cells.
• 7:44
  SPEAKER_01: And these techniques tend to leave a lot of scarring and downtime.
• 7:49
  SPEAKER_01: And so early on, um, especially patients that had had, for example, MOS surgery and then would have a recurrence right in the middle of a scar on their face, were were really desperately seeking alternative treatments.
• 8:05
  SPEAKER_01: And back then this was new and so was considered kind of alternative.
• 8:12
  SPEAKER_01: And uh and at the same time, you know, as I was developing uh ways to early detect and monitor and treat, I also had an interest in using lasers for cosmetics.
• 8:29
  SPEAKER_01: Like I just I love technology, I love uh innovations in technology and lasers and medicine.
• 8:37
  SPEAKER_01: And so I it it the the two kind of meshed in my mind, and I said, hey, why not use rather than these creams that take weeks and weeks and weeks and and all sorts of downtime, although it certainly was a much better option than surgery, which took even more downtime.
• 8:57
  SPEAKER_01: I said, maybe we might be able to use some of these lasers uh that we use, for example, to treat rosacea or to do some basic skin resurfacing through thermal heat.
• 9:09
  SPEAKER_01: And maybe we can target some of the, you know, issues that we know tumors require, like vessels to grow or yeah, like and maybe we do a milder version of what seems to be desiccation, but we target other things.
• 9:28
  SPEAKER_01: Maybe we make the environment of the skin too healthy for a tumor to survive.
• 9:33
  SPEAKER_01: And so that was what I started working on back then with mainly patients that were desperately seeking uh alternative treatments because they'd already gone through extensive surgery.
• 9:47
  SPEAKER_00: Yeah, I mean, that's that's really interesting.
• 9:49
  SPEAKER_00: And I have a question actually about um the in terms of the diagnostic, you know, like aspect of all of this, because I know that with you know uh like biopsies, you have to obviously, you know, you take the biopsy, excisional biopsy, you have to stain it, you go through the whole pathology thing, you know, all that good stuff.
• 10:08
  SPEAKER_00: So how does this work in terms of really um, you know, looking for certain markers and certain things that people often, you know, have or you know, physicians have to look for in terms of cancer, you know, this kind of uh this approach.
• 10:23
  SPEAKER_01: So so that's a good question.
• 10:25
  SPEAKER_01: So with you know, technology, the more superficial the technology is, the more limited the the view, the field of view.
• 10:34
  SPEAKER_01: So you're really stuck with like very small field of view with very cellular technology, and the deeper a technology goes, the the less cellular, so the less specific, but the much larger field of view.
• 10:49
  SPEAKER_01: So when you think of like an ultrasound device, an ultrasound device has a lot of depth, it's a very big probe, and you're getting a like visualization of a very large area.
• 11:02
  SPEAKER_01: But when you're looking at skin, skin looks like a thin white line.
• 11:05
  SPEAKER_01: So, how on earth would you translate a thin white line to you know this histologic section, which is like a vertical section through the skin that has all this architecture and cellular data and staining to call you know something a basal?
• 11:23
  SPEAKER_01: And and frankly, back then people were actually using ultrasound.
• 11:28
  SPEAKER_01: A lot of the cosmetic companies were using it to say, look, here's why this cream works, here's why, you know, you're getting less collagen.
• 11:37
  SPEAKER_01: And still to this day, I think a lot of people still are able to kind of say, here's this thin white line, look at the density, look at the you know, quality of the signal, look at these changes and make translations as to what's happening on the skin.
• 11:52
  SPEAKER_00: With these Well, I mean, the thin white the thin white line can be, you know, it can turn into a thick white line based on the technology and advancing, you know what I mean?
• 12:02
  SPEAKER_01: So, like the thick white line, a thin white line, how bright's the line.
• 12:07
  SPEAKER_01: So, with these technologies, you know, you're not as deep, you're not looking at as large an area, but you're actually getting a lot more information.
• 12:17
  SPEAKER_01: So with a confocal microscope, you're looking to about 300 micrometers, maybe at most, 600 micrometers of depth, but you're actually looking at the same thing that you look at on astology in the sense that you're looking at all the minutiae cellular information that helps in defining a tumor and making a diagnosis.
• 12:40
  SPEAKER_01: The limitations of this technology is that you know it's limited in depth and it's also somewhat limited in field of view, and that's where then optical coherence tomography comes in, where you get to about two millimeters of depth and you're also getting a broader field of view.
• 12:59
  SPEAKER_01: But there's another component.
• 13:02
  SPEAKER_01: When you're looking at the skin with your naked eye, you're actually looking at it from the top down, and so you're looking at it almost like a cross-section, like when you look at a freckle, you're looking at the freckle cross-sectionally.
• 13:16
  SPEAKER_01: And then when you take your handheld dermatoscope, you're looking at it to a depth of about, say, you know, a hundred micrometers, probably less, and you're looking at all these details within the lesion cross-sectionally.
• 13:30
  SPEAKER_01: So then you take the confocal microscope and it's like a bridge, they say, between that detail and pathology, you're getting all this cellular information also cross-sectionally with some more depth.
• 13:44
  SPEAKER_01: Well, when you're looking at pathology, it's not cross-sectional, it's actually a vertical section, a very thin vertical sliver of the of the whole lesion.
• 13:53
  SPEAKER_01: You're looking at a portion of that lesion on a vertical sliver.
• 13:57
  SPEAKER_01: When you take optical coherence tomography, it's about 160 path slides in a black and white flipbook animation.
• 14:06
  SPEAKER_01: So while you're missing exactly, so it's a movie, it's a movie of the lesion, but in depth architecture.
• 14:16
  SPEAKER_01: So when you take the combination of this confocal microscope, which has all this wonderful cellular data, and then and also goes across the whole lesion, and then you take the vertical sections of the optical coherence tomography device, which also goes across the whole lesion, but vertically.
• 14:37
  SPEAKER_01: So, like instead of one or two path slides, like 160.
• 14:40
  SPEAKER_01: So sometimes taking these two things together often gives us almost more information than what we see when we cut the skin and process it into that tiny little vertical section of histology.
• 14:55
  SPEAKER_00: That's so brilliant.
• 14:57
  SPEAKER_00: Wow.
• 14:58
  SPEAKER_00: I I had no idea this technology existed.
• 15:00
  SPEAKER_00: And I, you know, I can only imagine how much more information you're able to gather about, you know, the the what you're looking at.
• 15:08
  SPEAKER_00: You know, that that's really the crux of I think any medical problem is, you know, getting more information as we can, you know, whether it's through biopsy or whatever we do, our goal is to attain as much knowledge as we can before we treat.
• 15:22
  SPEAKER_00: So I want you to actually kind of um simplify a little bit for us, Dr.
• 15:26
  SPEAKER_00: Markovitz, and and talk to us about, you know, how skin cancer really begins.
• 15:30
  SPEAKER_00: And, you know, just for people to understand, because I know there's a lot of misunderstanding around, you know, things like, for example, um, you know, like the overuse of sunscreen or the overuse of certain products or certain things leading to skin cancer.
• 15:43
  SPEAKER_00: Can you give us some um information about that for the general consumer?
• 15:47
  SPEAKER_01: Sure.
• 15:48
  SPEAKER_01: Um so you know, there are different types of skin cancers.
• 15:52
  SPEAKER_01: And just to kind of break it down into, let's say, two important categories, you have melanoma and you have non-melanoma skin cancers.
• 16:02
  SPEAKER_01: So skin cancer is the most common type of cancer that a person can get.
• 16:08
  SPEAKER_01: In fact, every year you're gonna see as many cases, you're gonna see more cases of skin cancer than you do breast, colon, lung, and prostate cancers combined.
• 16:20
  SPEAKER_01: But melanoma, yeah, which is I I don't I don't know if everybody kind of realizes or recognizes that fact.
• 16:28
  SPEAKER_01: And, you know, uh melanoma, which is not the most common cancer, it's actually the least common type of skin cancer, but it's also one of the deadliest types of cancers.
• 16:39
  SPEAKER_01: So with melanoma, we, you know, the goal is to catch it before it's meant to be caught, because that's not only life-saving, but it's also going to save the patient, you know, a need for a very large surgery.
• 16:54
  SPEAKER_01: And and, you know, further than that, the need for like chemotherapy and radiation and uh and pretty substantially, you know, kind of uh dismal prognosis.
• 17:06
  SPEAKER_01: So that fortunately is only 2% of skin cancers, but because skin cancers are so common, it's still a pretty common cancer and it's a big concern.
• 17:17
  SPEAKER_01: And it tends to affect, you know, people in all age groups, but is the number one cause of cancer death for people in their 20s.
• 17:27
  SPEAKER_01: So when we say exactly, so when we say to people, you know, you need to wear sunscreen and things like that, you also need to go and get a skin exam.
• 17:38
  SPEAKER_01: Because, you know, for someone who's like 18, 19, even 16, 20, 25, it can be life saving, any age, it can be life-saving.
• 17:48
  SPEAKER_01: But often I find that younger age groups don't really quite realize that they can get impacted by this particular skin cancer.
• 17:58
  SPEAKER_00: So what is your so what is your like advice to that age group, especially Gen Z, like, you know, in terms of like just preventative, you know, measures that we need to start taking.
• 18:08
  SPEAKER_00: At what age do you recommend, you know, seeing a dermatologist and you know, just any advice you have for that uh population of patients?
• 18:15
  SPEAKER_01: Sure.
• 18:16
  SPEAKER_01: So that population is also my two children.
• 18:19
  SPEAKER_01: Um and I I give that population the same advice I give them, which is, you know, you need to you need to protect your skin from the sun.
• 18:28
  SPEAKER_01: Um, and fortunately, I do see that popul, in my opinion, that generation really takes a lot of um, they take the health of their skin quite seriously.
• 18:39
  SPEAKER_01: I think they actually take their overall health quite quite seriously.
• 18:43
  SPEAKER_01: And so they they recognize that if they protect their skin, their their skin is going to look better, feel better, age better.
• 18:52
  SPEAKER_01: And and I I do think that generation, I I hope, cares about that.
• 18:58
  SPEAKER_01: Um, but from a skin cancer perspective, it's reminding them that as they're getting, you know, kind of into that um early adulthood, that they actually also, just like anything else, they just need to go and get a checkup.
• 19:13
  SPEAKER_01: The good thing is that when you're going to see someone who is going to do an exam, they can manage all sorts of other things for you.
• 19:20
  SPEAKER_01: Like if your acne is misbehaving, we can always give some advice.
• 19:24
  SPEAKER_01: We have all sorts of wonderful, you know, little tricks up our sleeves for helping with things.
• 19:31
  SPEAKER_01: So there's a a lot of benefit, but it's also life-saving.
• 19:36
  SPEAKER_01: And that's that kind of, you know, that's that important melanoma category.
• 19:41
  SPEAKER_01: But the most common cancer is non-melanoma skin cancers, and of and they also affect maybe not as young as teenagers, but certainly I've treated a lot of patients in their late 20s, 30s, 40s for basal cell skin cancer, which is the most common of the non-melanoma skin cancers.
• 20:04
  SPEAKER_01: And 80% of non-melanoma skin cancers occur on your face and neck.
• 20:11
  SPEAKER_01: So these are very cosmetically important areas for us, right?
• 20:17
  SPEAKER_01: Like we suddenly get this pimple that doesn't seem to want to go away.
• 20:22
  SPEAKER_01: And if we kind of ignore it, let's say we don't get it checked out, now all of a sudden the pimple starts bleeding.
• 20:28
  SPEAKER_01: We're basically sitting there for a year, two years, maybe months, with a basal cell skin cancer on the face.
• 20:35
  SPEAKER_01: That's sometimes how these get diagnosed.
• 20:38
  SPEAKER_01: And so then the question is, you know, how are we gonna, how are we gonna manage this?
• 20:42
  SPEAKER_01: Especially, I think at any age, but certainly when you're in your 30s, like do you really, you know, are you ready to suddenly go have a surgery and end up with a a substantial scar on the face?
• 20:56
  SPEAKER_01: Yes, you are because it's skin cancer, and we and you're gonna need to treat it, and you're not gonna leave it because it's gonna wreak havoc.
• 21:03
  SPEAKER_01: Um but what I started working on utilizing technology that allows me to look under the skin are very uh effective and efficient ways to treat the skin cancer and to look at all of the margins and the depth of the cancer so that people can have an option to have it treated without having to go through um surgery and cutting.
• 21:32
  SPEAKER_01: And even to diagnose it without cutting, right?
• 21:35
  SPEAKER_01: Right.
• 21:36
  SPEAKER_01: So that's a very stranger as well.
• 21:39
  SPEAKER_00: No, it's definitely a game changer.
• 21:41
  SPEAKER_00: That's actually, you know, it's beyond brilliant.
• 21:43
  SPEAKER_00: I I absolutely want to commend you on your you know, your fantastic work in this field.
• 21:48
  SPEAKER_00: I mean, that's that's very, very game changing for I think um multiple fields of medicine.
• 21:54
  SPEAKER_00: And you know, I I one of my biggest questions though, you know, when it comes to cancer, um obviously is this.
• 22:00
  SPEAKER_00: Reoccurrence of cancer, right?
• 22:02
  SPEAKER_00: So I think that a lot of people, you know, they it it really comes down to the question of how do you figure out if a freckle is a freckle versus is it something worse?
• 22:13
  SPEAKER_00: You know what I mean?
• 22:14
  SPEAKER_00: So for everyone listening, I want you to like kind of give us some some tips.
• 22:18
  SPEAKER_00: Like, you know, if we see something on our skin, when is it that we need to go see a doctor and you know really take care of it?
• 22:24
  SPEAKER_01: I I love that question.
• 22:26
  SPEAKER_01: And part of the reason why is because back in the 1980s is when, you know, we developed present-day Moe's surgery.
• 22:34
  SPEAKER_01: And back in the 1980s is also when we came up with this ABCDE kind of scenario of look for asymmetry, look if something's changing.
• 22:44
  SPEAKER_01: And I no longer subscribe, frankly, to what we did back then.
• 22:48
  SPEAKER_01: I think we've kind of evolved to some degree.
• 22:51
  SPEAKER_01: Obviously, it's great that we created these um different very important factors in skin cancer detection and skin cancer treatment, but now we also have additional options.
• 23:03
  SPEAKER_01: So, what I tell people, because if you're if I'm using non-invasive technology to look at your skin, I'm not waiting for a freckle to start changing because potentially then you're coming to me with something that might be a little too advanced.
• 23:19
  SPEAKER_01: And I'm also not waiting for it to, you know, one of the ABCDEs is diameter greater than six millimeters, which doesn't sound that large, but in my opinion, it's pretty large.
• 23:30
  SPEAKER_01: Like I'm not waiting for freckles to get I mean, I don't know, huge.
• 23:34
  SPEAKER_01: It's still in the, you know, six millimeters, probably about the size of a pencil eraser, but in but I'm catching most of my melanomas are less than the size of a pencil eraser, right?
• 23:45
  SPEAKER_01: They're really small.
• 23:46
  SPEAKER_01: And the only reason why is because I'm not using my eyes to diagnose, I'm using technology.
• 23:53
  SPEAKER_01: It's like saying, come to me, I'm a cardiologist, I'm gonna take my ear and I'm gonna listen to your chest.
• 23:59
  SPEAKER_01: Well, probably 30 years ago, that's what we did.
• 24:02
  SPEAKER_01: And today we have stethoscopes.
• 24:04
  SPEAKER_01: So, as dermatologists, you know, I have a dermatoscope.
• 24:09
  SPEAKER_01: So I use that first to take a look at your skin.
• 24:12
  SPEAKER_01: And then if I'm not sure, if I think it's a malignancy, am I then go gonna go ahead and cut you?
• 24:17
  SPEAKER_01: Only if I'm certain.
• 24:18
  SPEAKER_01: But if I'm not certain, I have smart tape technology.
• 24:22
  SPEAKER_01: It's literally like a little piece of scotch tape that I can put on the lesion and send it to a lab to look at the RNA and DNA sequence.
• 24:30
  SPEAKER_01: I have a confocal microscope where I can do a non-cutting biopsy, I can use the dermoscopy and I can monitor the lesion.
• 24:38
  SPEAKER_01: I mean, there's so many things that I can do.
• 24:40
  SPEAKER_01: So it's not that people have to worry, oh my gosh, you know, I'm gonna start looking at my skin.
• 24:46
  SPEAKER_01: I don't want to go see a dermatologist, is they're gonna start cutting everything.
• 24:49
  SPEAKER_01: And absolutely not.
• 24:51
  SPEAKER_01: So, number one, what I tell my patients, you see something new, dark, and concerning, or even not concerning, but it's new and it's dark, or it's new and it's pink and it's kind of crusty, or it's like the kind of the pimple that doesn't want to heal.
• 25:05
  SPEAKER_01: I don't care how small it is, don't wait for it to grow.
• 25:08
  SPEAKER_01: Just come in and let me deal with it.
• 25:10
  SPEAKER_01: Do you really want to keep it?
• 25:11
  SPEAKER_01: Do you want to make, you know, what if it's something?
• 25:14
  SPEAKER_01: Wouldn't you rather me catch it at that stage than when it's suddenly this large kind of oozing lesion?
• 25:20
  SPEAKER_01: So the bottom line is if you're coming in for screenings, these things are gonna get caught before you've even noticed them.
• 25:27
  SPEAKER_01: And that's the goal.
• 25:28
  SPEAKER_01: But if you're for whatever reason, you know, wanting to kind of do your own exams, then just look for things that you haven't seen before.
• 25:36
  SPEAKER_01: And if there are things popping up and they're kind of dark or they're kind of crusty, then go see somebody who's who has these tools so they can properly diagnose this for you very early on.
• 25:50
  SPEAKER_00: That makes sense.
• 25:51
  SPEAKER_00: That makes a lot of sense.
• 25:52
  SPEAKER_00: And I love that you you said that because I think a lot of people, um, you know, especially with skin health, it's a very um new area for a lot of people, you know, and patients.
• 26:02
  SPEAKER_00: I think, you know, when you have a cancer of, for example, you know, something more internal, it's it manifests in so many different ways in terms of symptoms and you know, um, it progresses in a way that it impacts your life, you know, just so dramatically.
• 26:17
  SPEAKER_00: So people are more inclined to go seek out help for that.
• 26:20
  SPEAKER_00: But then with skin, I noticed that people will wait and wait and wait.
• 26:24
  SPEAKER_00: Like I know I have friends who have these, like, you know, they've come to me and they've been like, and I'm not a dermatologist, not you know, trained in this field, but it they've come to me and said, you know, well, this is just a skin tag.
• 26:35
  SPEAKER_00: And I'm like, are you sure that's just a skin tag?
• 26:38
  SPEAKER_00: Like you should really go check that out, you know.
• 26:40
  SPEAKER_00: So exactly.
• 26:41
  SPEAKER_01: Yeah.
• 26:42
  SPEAKER_01: And it's good that you do that.
• 26:44
  SPEAKER_01: It's good that you do that because even if it was the skin tag, I'm potentially gonna catch the melanoma on the back because I'm gonna convince them to have a skin exam.
• 26:53
  SPEAKER_00: Yeah, exactly.
• 26:55
  SPEAKER_00: Right?
• 26:55
  SPEAKER_00: Exactly, yeah, absolutely.
• 26:57
  SPEAKER_00: And I think that that's the real key here is to get people to understand that going to a dermatologist is not just about getting acutane or getting antibiotics for acne, or you know, because for I'm not gonna lie, you know, being a millennial, that's really what it was, you know, the the idea of seeing a germ.
• 27:13
  SPEAKER_00: Like you go, you get accutane, or you go get, you know, something like that.
• 27:16
  SPEAKER_00: But it's like there are just so many reasons to actually go and see a professional and to really understand what the skin is.
• 27:23
  SPEAKER_00: I mean, it's I think it's one of the organs that we know the least about, you know, when I think about it.
• 27:28
  SPEAKER_00: And I, you know, I cut I often compare it to the brain because I'm like, you know, we know very little about the skin, and we know very little in terms of molecular um, you know, pathways and and things that are leading to progression of skin cancers, progression of, you know, certain diseases.
• 27:43
  SPEAKER_00: So I think it's very, very important for us to be more mindful and you know, as general patients and consumers.
• 27:50
  SPEAKER_01: I agree.
• 27:51
  SPEAKER_01: And because we see the skin, often we think that we understand it, right?
• 27:56
  SPEAKER_01: We can't really see our brains.
• 27:58
  SPEAKER_01: So it's easier to kind of accept that there are many things that we don't understand.
• 28:03
  SPEAKER_01: But because it's so easy for us to look at our skin and to see it, that we sometimes think that we understand all the processes happening on it.
• 28:14
  SPEAKER_01: And then by the time we go and seek help for it, you know, it's just we we all you do hear people say, Oh, I wish I would have come to see you six months ago.
• 28:25
  SPEAKER_01: Okay, we're gonna get there, we're gonna fix it, we're gonna, we're gonna do what we need to do.
• 28:30
  SPEAKER_01: But yes, I think, but but that's you know, that's a good scenario.
• 28:36
  SPEAKER_01: But you're right, there are scenarios where it's the difference between life and death.
• 28:41
  SPEAKER_01: It really is.
• 28:42
  SPEAKER_01: Right.
• 28:42
  SPEAKER_01: And you're not gonna diagnose that melanoma on the leg, and then by the time you come in, because someone else might notice it, it might be already too noticeable.
• 28:53
  SPEAKER_01: And yeah, it becomes a more dire.
• 28:56
  SPEAKER_01: Yes, and exactly.
• 28:58
  SPEAKER_01: And then, you know, well, by being the deadliest cancer, if we don't catch it early, that's it.
• 29:04
  SPEAKER_01: It starts to spread, and then it becomes a very dire conversation.
• 29:10
  SPEAKER_01: Um, and one that I, you know, spend a lot of energy wanting to avoid and can thankfully say that people who are coming to see me regularly, we will never have that conversation.
• 29:23
  SPEAKER_01: That's the commitment I make to them.
• 29:25
  SPEAKER_01: You come in for screenings, you and I are not talking about the things that you don't want to talk about.
• 29:30
  SPEAKER_01: We get to talk about the fun stuff and we'll deal with the other stuff and we'll catch it so early, it's gonna be very unimpactful for you.
• 29:39
  SPEAKER_01: Um, and on that note, I've also had patients referred to me because, of course, as dermatologists, and we have all these wonderful new, you know, and old technologies that can treat freckles and treat acne and do all sorts of things that back in the day, you're right, like all we had was here's your acutane.
• 29:58
  SPEAKER_01: Now it's like we have so many things we can do for acne, for freckles, for whatever.
• 30:04
  SPEAKER_01: But one, you know, I get patients coming in and they're like, you know, coming in for something else.
• 30:10
  SPEAKER_01: And I look at their face, I said, okay, and this is a true story.
• 30:13
  SPEAKER_01: Um, what about that freckle?
• 30:15
  SPEAKER_01: Oh no, you know, I I had that lasered and and it came back, and I I don't want, you know, I don't care about that.
• 30:22
  SPEAKER_01: That's fine.
• 30:23
  SPEAKER_01: I said, no, um, I think that's a melanoma.
• 30:26
  SPEAKER_01: Well, how can it be a melanoma?
• 30:27
  SPEAKER_01: You know, I had it lasered.
• 30:29
  SPEAKER_01: I saw, you know, Dr.
• 30:30
  SPEAKER_01: So-and-so or whatever.
• 30:32
  SPEAKER_01: So, unless you're using these tools, you could potentially end up lasering things that shouldn't be lasered.
• 30:40
  SPEAKER_01: Right.
• 30:41
  SPEAKER_01: So that's an, you know, so yes, I love lasering and and removing and helping with, you know, cosmetic things as well, freckles and whatever that's bothering patients.
• 30:52
  SPEAKER_01: But I'm gonna make sure that I grab my dermatoscope, I take a look, and if I'm not sure, I use other technology to understand it before I ever go to get rid of it, right?
• 31:03
  SPEAKER_00: That's yeah, yeah.
• 31:04
  SPEAKER_00: And that's truly, you know, I think that is really at the heart of medical science, is this, is this, you know, drive to really understand.
• 31:14
  SPEAKER_00: I think that, you know, one of my biggest, you know, being a fellow medical professional, like I, one of my biggest pet peeves is when doctors, you know, they say, well, this is this is going to be treated this way, and that's it.
• 31:25
  SPEAKER_00: You know, they don't want to acknowledge the fact that there are different ways, there are different approaches.
• 31:29
  SPEAKER_00: You have to be, you know, you have to be well read, you have to be well-rounded, you have to understand there are other methodologies.
• 31:36
  SPEAKER_00: And if you don't know them and if you're not trained in them, then you need to go get trained and you need to go expand your horizon so that you can further treat your patients in the right way.
• 31:44
  SPEAKER_00: So I, you know, I think that's uh one of the biggest reasons why, you know, I really want to just commend you on your work and your, you know, your dedication in this field, because there's not a lot of, you know, physicians out there that I, you know, come in contact with day to day, even in my peer group, my colleague group, that are willing to do that, you know, that are willing to go out there and learn these new techniques.
• 32:04
  SPEAKER_00: You know, that just the other day, for example, you know, um, aside from dermatology, I was talking to a colleague and we were talking about these endosc um endoscopic techniques that are trained, people go to Japan just to train for them because that's where most gastric cancers are occurring, right?
• 32:18
  SPEAKER_00: And they were arguing with me, like, well, why would I need to do that?
• 32:22
  SPEAKER_00: You know, we've got our own method here in America.
• 32:24
  SPEAKER_00: And I'm like, well, do you want to save lives?
• 32:26
  SPEAKER_00: Like, in you know, what what do you mean?
• 32:28
  SPEAKER_00: What does saving lives to you mean?
• 32:30
  SPEAKER_00: You know what I'm saying?
• 32:30
  SPEAKER_00: Like, what does that really mean to you?
• 32:32
  SPEAKER_00: Does that mean like, you know, you go in, you do it one day and you you're done, or are you really trying to be preventative and practice medicine on a different level?
• 32:40
  SPEAKER_00: So yeah, yeah.
• 32:42
  SPEAKER_01: Reactive versus proactive, right?
• 32:45
  SPEAKER_01: But but absolutely I think part of it too is compensation.
• 32:49
  SPEAKER_01: Like, you know, if you if you look at some of the payment models, like perhaps this particular endoscopic technique hasn't really yet received reimbursement in the US.
• 33:01
  SPEAKER_01: So it's gonna take time to not only learn it, which is kind of where I found myself with a lot of these technologies, there was no compensation, there was no reimbursement.
• 33:12
  SPEAKER_01: And so you're not only pushing forward the envelope of understanding them, utilizing them, showing how much it helps the patients, but then you're also putting together all these publications, all this energy, all this time, so that perhaps insurers recognize how important these tools are, how much it's helping these patients, so that then they there is reimbursement so that you, you know, that it can be something that's more mainstream and that more people are going to be able to adapt.
• 33:42
  SPEAKER_01: But that's a lot of work.
• 33:44
  SPEAKER_01: Um being very motivated.
• 33:47
  SPEAKER_00: Yeah, and also you need support of your medical colleagues, right?
• 33:50
  SPEAKER_00: I mean, it's at the end of the day, one of you know, just one person cannot, of course, you know, you being a pioneer yourself, you know, you've done so much, but it's like if no one um, you know, if our our colleagues don't support us and they don't back this up, when are we ever gonna get to that point of normalization of using advanced technologies?
• 34:07
  SPEAKER_00: You know, so it's a it's really a a question of, you know, you have to have this ethical responsibility of wanting to advance medical technology.
• 34:16
  SPEAKER_00: I I really wholeheartedly believe that, regardless of what field you know of medicine it is.
• 34:22
  SPEAKER_00: And, you know, it really does come back to your point of, you know, yeah, okay, the compensation part will come in if there's enough people supporting it.
• 34:30
  SPEAKER_00: So yeah, I I like what you said.
• 34:32
  SPEAKER_00: And I, you know, I I just I I rant a lot, so I'm sorry.
• 34:35
  SPEAKER_00: I just swept.
• 34:36
  SPEAKER_01: No, I love it and I agree.
• 34:38
  SPEAKER_01: I agree with you completely.
• 34:39
  SPEAKER_01: I I think we're a bit like-minded here, and it's true, you know, you have to collaborate, you you have to have people supporting and excited about the work.
• 34:49
  SPEAKER_01: And I have to say, for me, early on, because the payment model does kind of, you know, speak to this in Europe, like they get compensated for dermoscopy, they get compensated regardless of how they choose to treat a patient.
• 35:04
  SPEAKER_01: A lot of these technologies were were um early adapted there as well.
• 35:09
  SPEAKER_01: And so we would have these like weekly calls with like, I would have, I'm saying we, I, I would have weekly calls with like England and Germany, and we'd be working on projects and you know, discussing and looking at images.
• 35:23
  SPEAKER_01: And back then we didn't really have Zoom, so we did it in like more creative ways.
• 35:27
  SPEAKER_01: We had to like all send each other the pictures in advance and kind of look through them as we were talking on our respective computers.
• 35:35
  SPEAKER_01: But where there's a will, there's a way.
• 35:37
  SPEAKER_01: And um, and it was definitely wonderful to have those colleagues and a handful of people in the US as well.
• 35:45
  SPEAKER_01: And now that we were able to get compensation for optical biopsies, I'm seeing more and more adapters um in the US.
• 35:55
  SPEAKER_01: And, you know, recently I chaired uh the second World Congress of Confocal Microscopy, where I want to say every I want with the exception of Antarctica, pretty much every continent was represented.
• 36:10
  SPEAKER_01: Um we were going to have it in person, uh, and everybody was actually planning on coming.
• 36:16
  SPEAKER_01: But of course, with COVID, we ended up going virtual.
• 36:20
  SPEAKER_01: But I had, you know, with along with my co-chair, over a hundred speakers from all over the world, tons of people from the United States logging in, sitting through like three days of lectures, very eager, very interested.
• 36:35
  SPEAKER_01: Australia, we were in three time zones.
• 36:38
  SPEAKER_01: We had Australia, we had Europe, and it's just amazing to see like all that enthusiasm and all of these people just as excited about this and all you know, sharing all the research they're doing, all the you know, all the benefits to patients.
• 36:54
  SPEAKER_01: Because with technology, the excitement is there's always room for growth, there's always room for more.
• 37:00
  SPEAKER_01: It there's it just never, there's never really an end point, right?
• 37:04
  SPEAKER_00: Yeah, yeah.
• 37:06
  SPEAKER_00: Absolutely.
• 37:06
  SPEAKER_00: No, absolutely.
• 37:07
  SPEAKER_00: And I think that that's that's absolutely amazing.
• 37:10
  SPEAKER_00: You know, I love seeing, you know, science minds come together and you know, especially in terms of like just gaining more wisdom and knowledge and just you know moving forward.
• 37:20
  SPEAKER_00: It's a beautiful thing, and it's really the essence of just you know, discovery.
• 37:25
  SPEAKER_00: So I I love that.
• 37:26
  SPEAKER_00: And you know, Dr.
• 37:27
  SPEAKER_00: Markovitz, I want to thank you so much for this.
• 37:28
  SPEAKER_00: This has been such a special interview for me.
• 37:31
  SPEAKER_00: I don't get the opportunity to talk to such great minds like you every day.
• 37:35
  SPEAKER_00: So thank you so much for your time and your your immense amount of knowledge that you've shared with us.
• 37:41
  SPEAKER_00: Um, everyone listening, I hope you've gained a lot of information and knowledge from from you know this conversation.
• 37:46
  SPEAKER_00: If you have any questions and you go if you want to continue this conversation, please leave some comments in the comments section and let us know.
• 37:54
  SPEAKER_00: Um, and yeah, thank you so much, Doc.
• 37:57
  SPEAKER_01: Oh, my pleasure.
• 37:58
  SPEAKER_01: Thank you.
• 38:05
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