MedSoup 0:04
Welcome to the MedSoup podcast, where we talk about trending healthcare topics. I’m your host, Laura Schumacher, let’s dig in. 

MedSoup 0:17
Today we are talking with Dr. Ben Schimdt, he’s a surgical oncologist with Paragon Surgical in Concord, North Carolina. Thank you for joining us. 

Dr. Benjamin Schmidt 0:25
Thank you for having me. 

MedSoup 0:27
So, Dr. Schmidt, would you talk about what differentiates a certified oncologist from a general surgeon?

Dr. Benjamin Schmidt 0:34
So, surgical oncology includes two additional years of training as well as a rigorous board certification process including a written and an oral examination. So, I’ve had two additional years of experience taking care of complex, surgical oncology cases at the University of North Carolina. 

MedSoup 0:52
So, why did you choose this specialty? 

Dr. Benjamin Schmidt 0:55
I enjoy being able to make the connections with patients that the diagnosis of cancer sometimes brings. It’s obviously a very emotionally charged time in someone’s life to have a diagnosis of cancer. But, when we’re able to offer surgery, we can bring people comfort and most of the time very good outcomes. 

MedSoup 1:15
So, you’re obviously a very vital member of the team dedicated to the patient's well being. So, how do you integrate your care with all of the other members of family of the patient, the patient, of course, the primary care, so how does that typically work? 

Dr. Benjamin Schmidt 1:36
So, very often patients are being referred to me after a diagnosis of cancer is made but frequently for the types of cancer I take care of, surgery is the first line of therapy that’s necessary. So, when I meet with patients I would have already reviewed imaging, oncology reports, and generally, they will come to me with family members or have loved ones present. So we can have a sit-down conversation about what this means. Majority of cancers I take care of still have surgery upfront but, we talk about the needs for other therapies like radiation and chemotherapy. Now, I work very closely with local radiation oncologists and medical oncologists to come up with the best plan. For patients that are fairly straight forward, I can usually offer a definitive plan at the time I see people. Patients that have more complex cases, we have two separate chemo boards at Atrium Health Cabarrus that meet weekly. So complex cases of breast cancer cases get discussed on Wednesday and other complex oncology cases get discussed on Thursdays. So that we can not only have the medical oncologists and radiation oncologists who provide the other arms of therapy available but we also have pathologists, radiologist, a wide array of disciplines to discuss the cases. 

MedSoup 2:56
So you’re one of the few surgical oncologists in this region, is that correct? 

Dr. Benjamin Schmidt 3:02
That is correct. 

MedSoup 3:04
So, you’re seeing patients from all over? I mean, how far away do your patients typically come from?

Dr. Benjamin Schmidt 3:11
I’ve seen plenty of patients from the Concord, Harrisburg area all the way out to Lake Norman, Lexington, areas in Salisbury, further north/ 

MedSoup 3:21
Yeah, that’s probably very nice so they can stay closer to home to receive their care.

Dr. Benjamin Schmidt 3:25
I think it’s excellent that we can provide patients with quality care closer to home. I know that the networks that we’re closely affiliated with have that as a goal as well and work very well closely with us to where we can provide quality care closer to home. 

MedSoup 3:40
Mhm, so what are the kind of cancers that you typically see or you’re addressing on a regular basis?

Dr. Benjamin Schmdit 3:47
So, I take care of Melanoma, breast cancer, thyroid cancer, and a wide array of intestinal types of cancer so that includes both colon cancer and stomach cancer is the main form of intestinal cancers that I see. 

MedSoup 4:02
So, what kinds of surgical procedures do you provide? I know there's an open procedure and then there’s robotic surgery that you can provide. Does it depend on what kind of cancer, individual case, how do you make that choice?

Dr. Benjamin Schmidt 4:16
It depends on the type of cancer but I try to offer minimally based approaches when it is feasible and safe to do so from a cancer standpoint. The vast majority of colon cancers for example are now treatable with minimally invasive techniques. And this enables patients to have a faster recovery and experience less discomfort at the time of their surgery. 

MedSoup 4:37
And does that typically give them less time in the hospital as well if you’re able to do robotic?

Dr. Benjamin Schmidt 4:43
Correct, robotic surgery tends to, for many colorectal cases, patients only spend two nights in the hospital and very often only needing full strength pain medications. 

MedSoup 4:56
So, in terms of the types of cancer you treat, Melanoma is one of the very common cancers that you see?

Dr. Benjamin Schmidt 5:06
It’s one of the most common cancers I see on a regular basis.

MedSoup 5:10
So are those Melanoma patients directly referred to you by primary care and dermatology?

Dr. Benjamin Schmidt 5:16
Correct, most patients will have come to me after a dermatologist has done a biopsy, have already established a diagnosis of Melanoma. Then there are patients who sometimes find it challenging to make an appointment with a dermatologist and I am happy to take a look at spots that are highly concerning.

MedSoup 5:36
Okay, so that is an option for a patient if they see something that looks suspicious or a mole that has changed, something that props up on their skin before, it is okay for them to self refer here?

Dr. Benjamin Schmidt 5:47
I will see patients who are self-referrals, if they can see a dermatologist I will encourage them to do that as well for the capability of the head to toe skin check. And there are also many new lesions that will turn out to not be Melanoma and I think many dermatologists have great expertise to deal with spots that turn out to not be cancer. But, for patients who don’t see the ability to have an evaluation quickly, I do see self-referred patients. 

MedSoup 6:17
So with a patient that has been diagnosed with melanoma, say, for instance, say been referred to you be a dermatologist, what is the procedure?

Dr. Benjamin Schmidt 6:25
So, we sit down and we review how they’re feeling if they’re any signs or symptoms with any other health issues they’re having related to the diagnosis of Melanoma. I examine that area and do an examination of all the lymph node-basins to evaluate if there’s any risk of cancer has already spread. Melanoma has a fairly predictable pattern where in most cases it spreads to the lymph nodes before it spreads to any other part of the body. Based on the risks of that person’s Melanoma, based on the pathology report, I will frequently perform a procedure called a sentinel lymph node biopsy at the time of their operation where we will be doing two operations really while they’re asleep. The first will be to take out the skin around where the Melanoma was found to make sure the Melanoma doesn’t come back. But, what’s most important in terms of treating a potentially deadly disease, is to sample the lymph nodes that would be at risk for having the cancer spread. Because that will tell us how high risk a patient’s Melanoma is and will tell us if it’s safe for observation with no other form of therapy or if more test or procedures need to be done. 

MedSoup 7:37
So is, someone who has ever had Melanoma, is that something that always shows up on their skin or something that’s easily missed unless they’re getting annual checks?

Dr. Benjamin Schmidt 7:50
For patients who live in this area where sun exposure is common, I recommend having regular dermatology visits particularly if they’ve ever had any issues having more than four or five blistering sunburns from when they were a child or any history of tanning bed use and there really isn’t an excellent substitute for having a head to toe skin check. I would also say in addition to dermatology exams, practicing self-awareness of any new spots on the skin are helpful. I think one common piece of advice is if they have a spot they’re worried about and it hasn’t been evaluated right away, in this day in age where everyone has a cellphone camera, just taking a picture of something you’re worried about and then coming back and comparing that picture six weeks later is something very practical you can do.

MedSoup 8:45
Oh yeah, that’s a really good point, I didn’t think about that. Then you also hear about, you know, if your spouse or you check your children, look on their backs,  and places you normally can’t see…

Dr. Benjamin Schmidt 8:56
I do think having a significant other is good protection to developing Melanoma on the back. 

MedSoup 9:02
And check on a monthly basis, would you recommend? Like, the Skin Cancer Foundation has recommendations about you know, staying on top of that because a lot can happen in a year, obviously. So, you have the be vigilant yourself but then you know also, have a second pair of eyes if you can. 

Dr. Benjamin Schmidt 9:20
A second pair of eyes and trying to sit down and on an organized basis in a month is an excellent idea. 

MedSoup 9:28
So, I have heard of cases of Melanoma where a small spot on the skin, but when it was surgically evaluated, it was very deep. 

Dr. Bejnamin Schmidt 9:38
Correct, so there are at least four different types of Melanoma in terms of their biology. And some of them spread superficially spreading across the skin, some of the spread downwards before they spread outwards. Any spot on your skin bigger than a pencil eraser, particularly anything that’s growing or bleeding, is something worth getting the attention of your providers. And going back to some of our previous conversations, I think it’s worth noting that most than half advanced Melanomas will be discovered by a patient practicing skin awareness in addition to regular dermatology checks and therefore, raising concerns you have about your skin is another important layer of safety when Melanoma is concerned. 

MedSoup 10:29
So that just proves the point, again,  how important it is for someone to be, you know, it’s not just about “oh my stomach hurts” or something else going on but they’ve got to pay attention to these things that might be silent, eventual killers if they’re not caught. I mean, in terms of a statistical cure for Melanoma, how would you define that if it’s caught early, is it typically curable?

Dr. Benjamin Schmidt 10:58
So the vast majority of Melanomas that are caught in stage one or two are curable and very often curable with surgery alone. Stage three and four Melanoma are becoming more and more curable due to the results of the technology breakthroughs but this can require some systematic treatments that are still a lot more to go there and surgical therapy.

MedSoup 11:23
So, and that goes back to your discussion about the sentinel lobes?

Dr. Benjamin Schmidt 11:27
Correct, so the main test that can determine a stage one or two Melanoma from a stage three Melanoma is that sentinel and that’s why it’s still so very important. 

MedSoup 11:39
What are the chances of someone who has been diagnosed with Melanoma once, having a recurrence somewhere else?

Dr. Benjamin Schmidt 11:47
Again that depends on the stage of which they were discovered. If the sentinel node comes back positive then depending on the situation, there then becomes a 5-30% chance of developing a recurrence far away from where the skin cancer initially developed. In stage one and stage two Melanomas, the majority of reoccurrences are going to be in the skin close to where the original Melanoma was developed. So that also means patients that we catch in early-stage Melanoma do not need to have a lot of time-consuming, expensive testings. You can look for distant reoccurrences as long as they’re seeing a clinical provider to check that area. 

MedSoup 12:30
And so in the cases of patients who’ve had it and patients who’ve not had anything diagnosed it’s important to protect their skin, correct? 

Dr. Benjamin Schmidt 12:41
Correct.

MedSoup 12:42
What would you recommend for that? You go to the drug store and see all these different numbers on sunscreen, what does that all mean?

Dr. Benjamin Schmidt 12:50
So, least a 30 SPF and remember, to reapply according to the directions on the bottle. There’s also, it’s important to practice sun-safe habits in addition to this to avoid direct sun exposure between the hours of 10 am-4 pm. If time can be limited in the sun at the time. There’s a lot of new technology coming out in terms of clothing that contains SPF. I actually have a five-year-old son that I go swimming with and I wear my long rash guard while he wears his. You’re in the water you stay just as cool.

MedSoup 13:31
Well, I think it’s kind of like helmets. It’s cool to wear a rash guard. They don’t care about the SPF but feel cool in the rash guard. So, you know when we’re in this area where people are out in the sun so much. Even in November - December,  does it really matter the time of year, or they should be thinking of SPF all year, correct?

Dr. Benjamin Schmidt 13:56
Correct, the risk is highest during the summer months but that risk never goes to zero with sun exposure. So, a daily sunscreen is something there’s really no downside too. 

MedSoup 14:10
So that really is something that somebody can have a large impact on. From the time, parents with their children, start very early with sun protection and get them in that cycle?

Dr. Benjamin Schmidt 14:22
Correct.

 MedSoup 14:24
Because that makes a big difference later on in life. What are the statistics to them having a severe sunburn?

Dr. Benjamin Schmidt 14:33
So, risk factors are obviously on a sliding scale. So one measure the amount of one blistering sunburn that somebody has increases the risk of future Melanoma development. 

Medsoup 14:50
It really is scary if you think about it. Because you think about this generation, people that are in their fifties, when you’re a kid, everybody was burned at the beach. So, when you’ve seen cases of Melanoma popping up, what ages? Have you seen all ages or is it more of a certain age group?

Dr. Benjamin Schmidt 15:11
I’ve seen all ages, I would say there are different peaks. Majority of patients are presenting between their fifties and their seventies with Melanoma but I have seen as young as twenties and thirties. 

MedSoup 15:24
Wow. So, what is a good way of understanding the different types of skin cancers because not all skin cancers are Melanoma?

Dr. Benjamin Schmidt  15:35
So that is correct. So, your skin has a number of different type of cells in them. So, each of those cells can eventually become a cancerous type of growth. Melanomas are the cancer of the cells that produce melanin or pigment in our skin. Due to the biology of those cells, is why Melanoma is the most dangerous type of skin cancer because they spread to other parts of the body much more commonly than the other types of skin cancer. 

MedSoup 16:09
And those other types of skin cancers, can they develop into Melanoma if they’re left untreated or…

Dr. Benjamin Schmidt 16:16
The other types of skin cancers in which the main ones I’ll talk about are basal cell and squamous cell because those are common, those cannot become a melanoma because they come from a different type of cell. If left untreated, they can become quite large and you have small risk of spreading to other parts of the body. However, this is very rare with those kinds of cancer and generally is when these tumors have gone untreated for years. 

MedSoup 16:48
So, bottom line is pay attention to your skin, talk to a qualified medical provider if you have a question about it, and get it treated or removed, correct?

Dr. Benjamin Schmidt 16:55
I think that’s an excellent take.

MedSoup 16:57
Okay, thank you for your time today. 

Dr. Benjamin Schmidt 17:01
Thank you.