Spotting Skin Cancer in the Dental Chair: Melanoma, Dermoscopy & AI | Dr. Alexander Witkowski

Your patients see you twice a year, and a lot of skin cancer shows up from the neck up, so the dental office may be the first place a melanoma gets noticed. Dermatologist Dr. Alexander Witkowski, who holds the Guinness World Record for the smallest skin cancer ever detected, explains how dental teams can bring up a suspicious spot without overstepping, how dermoscopy and AI can triage a lesion in seconds, and why a biopsy can miss the cancer that's really there.

In this episode:
- Why the dental chair is a great place to catch skin cancer early
- How to bring up a spot on a patient's face without overstepping your scope
- Why it can take a year to see a dermatologist, and why that matters for melanoma
- Dermoscopy and the three-point checklist: green, orange or red
- AI that reads a skin lesion in five seconds
- Why only about 5% of a lesion gets seen by the pathologist, and AI heat maps that show where to biopsy
- Could the same tools work for oral lesions?
- Insurance denials for "poor prognosis," and the words that win appeals

📰 Plus dental news from spring 2024: bills to end EFT fees on insurance payments, the FBI's cybersecurity warning for oral surgeons, and the Department of Labor's new overtime rules for salaried staff.

Dr. Alexander Witkowski, MD, is a dermatologist and assistant professor of dermatology at Oregon Health & Science University, where he co-directs the skin imaging and technology center. He chairs the American Academy of Dermatology's cutaneous imaging expert resource group and is the founder and CEO of Sklip, a digital dermoscopy tool for skin cancer triage. He trained in medicine in Poland and in dermatology in Italy, and holds the Guinness World Record for the smallest skin cancer detected, a 0.65 mm melanoma in situ. His views are his own and not those of OHSU.

Chapters:
0:00 Intro
1:17 Insurance denials for "poor prognosis"
5:59 Chad's tips for winning insurance appeals
8:02 The words claims reviewers look for
9:35 Only 6% of patients use their max
10:40 News
11:04 News: bills to end EFT fees
12:47 News: FBI cyber warning for oral surgeons
14:34 News: new overtime pay rules
16:43 Why target oral surgeons?
18:38 Meet Dr. Alexander Witkowski
23:08 How he met Chad at the Hinman
27:43 Why a dermatologist goes to dental meetings
28:30 From medical school in Poland to dermatology
30:41 Italy, confocal microscopy and a world record
32:42 Building Sklip
35:08 Waiting a year to see a dermatologist
36:36 AI that reads a skin lesion in five seconds
37:48 Why dental offices matter for skin cancer
39:12 What would you say about a spot on a patient's cheek?
40:30 Extraoral skin checks and scope of practice
41:54 Being a health care advocate
44:38 Starting the conversation with patients
46:42 Building trust and word of mouth
48:16 Could this work inside the mouth?
50:07 Green, yellow or red for oral lesions
53:22 Do screening tools improve outcomes?
55:26 Why dentists embrace new tools
56:40 Green, orange, red: the three-point checklist
59:06 When the biopsy misses the cancer
1:01:30 Only 5% of a lesion gets read
1:03:12 AI heat maps that show where to biopsy
1:05:40 A discount for DINKs
1:06:56 Chad's spot after Cancun
1:08:41 Closing: physicians of the oral cavity
1:11:33 Modena, Ferrari and dermoscopy

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