Author: idil_baran

My last day at the clinic could not have been better! I had the privilege of spending today in the lab, which was a unique experience considering that many dermatologist offices do not have labs. I witnessed a whole plethora of things that the histologists (histology: study of tissue) do, and needless to say, I was very impressed. The day started off with a diligent recording of the temperature of every piece of equipment in the lab from the fridge to the water bath. Afterwards, some machinery had to be self-cleaned, so while they were cleaning, the cell fragments from the night before were carefully removed and placed in paraffin wax and set to cool. While they were cooling, we moved on to paperwork and to filing the new extractions that came in this morning. After getting all of the paperwork out of the way, I was introduced to a super cool printer that prints out customized slides for the cell slivers to be transferred on. After all of the slides were printed, the real fun began as we started to shave thin slivers of the extractions trapped in wax. Each block of paraffin wax containing slivers of skin extractions is shaved down and carefully placed into a temperature controlled water bath. From there, the specific patient slide is submerged in water and the histologist determines which shavings should end up on the final slide. Once all of the slides have been filled, the slides are transferred to an automated stainer and the process begins anew. I have included a picture of the shavings of skin in a water bath that were extracted using the method of punching. The method is exactly how it sounds with a device punching out a small cylinder of skin. Overall, the lab was super fun and I’m glad that’s how I ended my fun run!

Today was super cool! I was privileged enough to get to spend some time with the wonderful ladies at triage and at the front desk. They were all very welcoming and taught me the value of the work that is done behind the scenes. Triage was always working nonstop answering calls, reporting diagnoses, scheduling people, and following up on procedures. Their ability to multitask was incredible and I was definitely blown away watching the efficiency at which they answered calls while filling out extensive patient information forms. The women who worked at the front desk were amazing too! Aside from checking in patients, they also took and transferred calls, scheduled patients, sold cosmetics, and dealt with bills and the schedules for their specific providers. They have to juggle a lot, between phone calls and scheduling and forms and papers, but they graciously took the time to explain each process and their system of functioning. I was amazed to see the orderliness and specific schedule layout each provider has, and they really taught me the importance of crafting the perfect schedule. Their job may seem minuscule, but without them there would be no foundation for everything to run smoothly off of. I am very thankful that I got to spend my day with those wonderful women! I also got to do some interesting reading thanks to fact that they let me borrow some literature! I read up on the Pocket Atlas of Dermatology by Gerd Klaus Steigler and Howard I. Maibach, and I have to say that some of the things in that book were very intriguing. The book covers everything from acne to bacterial disorders and viral diseases. It is a brief book due to its small size, but still worth a read! I have included a picture of the book below!

Day 5 went by super quickly! Today I was in the care of Dr. May again, and I could not be more grateful! She always takes the time to explain concepts to me and makes sure I am always included. Today we had more biopsies of moles and full body checks. In addition to those, we had a couple unique cases! There was a case of an autoimmune disease that manifested as a rash and flaky skin that would occur whenever the sun or heat was present. Another unique case was one of yeast overgrowth in response to moist environments, in this case caused by sweat. The yeast impacted the skin pigmentation, causing the white discolorations on the back. Another patient came in with a wart on the foot that had been over medicated with salicylic acid. As a result, a callous formed on the foot that had to be scraped off. Overall, today was a great day! Below is a photo of the yeast overgrowth called Tinea versicolor.

https://www.aad.org/public/diseases/color-problems/tinea-versicolor#causes

Day 4 was super educational! I had the privilege of shadowing Dr. G, who is an amazing dermatologist! He was very patient and took every opportunity to explain and teach me new things! I appreciated the diagrams he drew and advice he gave me about dermatology and medical school in general. We saw a total of 8 patients with varying concerns. A couple of the patients just came in for general body checks, but others came in for irritant contact dermatitis in the form of a rash, discolored patches of skin, and biopsies. One of the biopsies was originally going to be an ED & C of previously biopsied areas but ended up being biopsies of new places. As a result, I got to witness some cool biopsies and also learn about the difference between biopsies and ED & Cs. ED & C “scoops” deeper into the skin, past the epidermis to the dermis, to remove the cancerous basal or squamous skin cells entirely. Biopsies, on the other hand, only scrape the surface layer, the epidermis, and take a sample of the skin tissue instead. This is because biopsies are used to obtain a sample of tissue to determine, most often, whether cancer is present. We also had a couple of people who got age spots treated with liquid nitrogen, and I got to look at skin cells treated with KOH under a microscope to check for bacteria. Today was a good day and I’m gracious for all of Dr. G’s help! Below is a picture of a basal cell carcinoma that would be removed with ED & C.

Picture 1: https://westcancercenter.org/cancer-type/non-melanoma/

Day 3 was a lot of fun! I was so honored to be in the care of Dr. May, who focuses on general dermatology! It was very fascinating to see the “general” side of dermatology such as the diagnoses of rashes and flare ups. We saw a total of 10 patients with ailments ranging from poison ivy to acne to allergic reactions. Watching Dr. May know which prescription to prescribe each time was very awe-inspiring. In addition, I got the honor of viewing full body check-ups and sun spot removals. It was interesting to see how the dark spots that people often discovered during their body exams could easily be frozen off. I learned from the body examinations that the spots we refer to as ‘dark spots’, are known as Seborrheic keratosis, and they are genetic benign marks. Two very interesting cases were one lady who had severe eczema on her hands, and had been prescribed faulty medication as a treatment, and a woman with a sun allergy. I was impressed by how quickly Dr. May was able to identify a faulty treatment and come up with a better alternative. As for the woman with the sun allergy, it was interesting to get insight on a situation that I have never had experience with. It helped me recognize the importance of sunscreen, not just for the patient, but for all of us. Overall, today was a great and exciting day! I have attached a picture of a sun rash below!

picture 1: https://www.makelifenatural.net/heat-rash-vs-sun-rash-know-difference/

Day 2 was an exciting day of many more new experiences! The patient count exceeded yesterday’s as we saw a total of 9 patients! Rather than solely focusing on moles, today, we extracted a plethora of concerns ranging from cysts on the back and the head, to marks and moles on the skin. Once again, I got to see the whole process from numbing, to extraction, to suturing! Seeing the cysts removed and their different consistencies depending on where on the body they were located was very cool! I learned that cysts on the head are specifically referred to as pilar cysts and when removed, they look like pearls or the lens of an eye! Another special activity I got to partake in today was patient check-up, where patients that had previously gotten procedures done came back so that Dr. Echt could observe their healing process. I enjoyed listening to the patients and learning about their lives and listening to their sage advice. While today was my last day with Dr. Echt, I am grateful for the short amount of time we spent together and I feel as though I truly learned a lot! Once again, I did not take any pictures of the patients, however, I have included a picture of a pilar cyst that has yet to be extracted! I look forward to tomorrow!

picture 1: https://healthfixit.com/pilar-cyst/

Today was my first day at the center and it was tons of fun! I was lucky enough to be involved with the nitty gritty from the start as Dr. Echt graciously invited me to tag along. We saw a total of 6 patients who all got extractions on various parts of their face using the Mohs surgery method, which is a method of removing and analyzing the problem area to keep as much healthy skin as possible. With each patient I observed the full process from numbing and extraction to analyzing the skin cells and suturing. It was truly fascinating to observe the extraction process and to get insight on what sorts of things people get removed. I had a lot of fun observing the process of mounting the different layers of the extraction onto slides and the staining process. Dr. Echt kindly allowed me to observe the skin cells as well and helped point out the anatomy of the cells. Having the privilege of being alongside Dr. Echt also helped me closely examine the process of closing the wounds and gave me a deep appreciation for the art of suturing. Unfortunately, I did not take any pictures, but I have included some to hopefully provide a helpful visual. Overall, today was an action packed day full of wonderful new people and brand new experiences!

photo 1: https://www.bvderm.com/mohs-surgery/

photo 2: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Integumentary/Integum.htm