TAMPA — Dr. Neil Fenske arrived at the University of South Florida in 1977, when he and the division head were the only full-time dermatologists on the medical school faculty. He founded the USF Dermatology Residency Program in 1980. He was department chairman from 2006 till 2019. He has served as president of seven local, regional and national dermatology organizations.
He received the inaugural “Lifetime Achievement Award’' in 2018 from the Florida Society of Dermatology & Dermatologic Surgery. He has authored or co-authored more than 200 articles for medical journals and has given hundreds of interviews on skin diseases with mostly bay area media but also the New York Times, Wall Street Journal, Vogue, Glamour and Ladies Home Journal.
Fenske, 73, who is on administrative leave from the university for a health condition, talked with the Tampa Bay Times about his career, the nature of skin cancer and skin cancer horror stories.
You’ve taught a lot of dermatologists in your time at USF.
I’ve taught over 100 dermatologists in the department. ...
When I started the residency program, my goal was to have trained, highly qualified residents who were clinically competent, clinically confident and ethical. And many of them are right here in the greater Tampa Bay area. ...
My goal was to create a legacy of all these wonderfully well-trained, ethical dermatologists to help serve the community.
In the academic realm of dermatology, you see the most neglected and severe cases of skin cancer, you say.
There’s just incredible things that you see... that you just can’t imagine coming in your office. Not the little basal cells – horrendous things. There were patients where the cancer would eat off their whole nose or the side of their face before they’d come to see you because they lived out in the sticks.
I had one patient come in one time, because his son drug him in, and the son said he’s got a problem with his ear. And he peeled off the dressing and the ear fell to the floor.
Another guy brought in his father and took the dressing off and he had no eye. He had a basal cell. ... It had eaten through his eye and I could see right through the socket (to) his tongue below. … (It ate) through the bones that surround the socket all the way down. ...
These are the kind of horren-nomas (horrendous carcinomas), I call them, that you see only in academic medicine. …
Basal cells are very easy to treat and no one should have an outcome like the couple of examples I gave you, if they have it treated early. You have to profoundly, profoundly neglect it for it to get to that point.
Are basal cell carcinomas worse than squamous cell carcinomas?
No, squamous has the ability to metastasize, so squamous are potentially worse. Now, those that are caused by sun aren’t as likely to metastasize as a squamous that’s inside the mouth that’s caused by chewing tobacco or human papillomavirus virus. Those are very aggressive.
Basal cells can metastasize, but extremely rarely.
What should people look for?
Forgetting all the prevention, the single most important thing for a patient to be concerned about is if they have a sore that won’t heal. A sore that won’t heal, we’re talking about basal cell, typically, but it can also be melanoma.
But all melanomas aren’t black. For melanomas, remember the colors of the American flag, red, white and blue, plus black with variations of brown. That’s what you see with melanoma.
Could it be all red, white, blue or black and mixtures?
Any other combination. They could be black... black mole cancer. They could be various shades of brown. They could be red because the body’s mounted a tremendous immune response, so they’re inflamed, They could be blue because – it’s called the Tyndall effect – as it grows downward it reflects back a blue color. … And it can even be white, where the body has defeated (parts of) it. Within the melanoma you’ll see spots of white. …
Basal cells are actually harder to diagnose if they’re small because... they look like your skin. So we stretch the skin and you get a pearly, translucent appearance. So it takes a keen eye to pick up an early basal cell. Melanomas, they’ve got to be about the size of a pencil eraser before they start to look like a melanoma … That’s why you’ve got to go see your dermatologist at least once a year, that’s the key, and then sooner if something new pops up. ...
Squamous, they’re more scaly. Basal cells are not scaly.
Is the increase in skin cancer cases a nationwide phenomenon?
Yes, it is. Obviously, the epidemic – we’ll talk about melanoma mainly, because that’s the one that’s the real killer. If you were born in 1935 as an American, your risk of getting melanoma at that time was one in 1,500. Now, today, one in 40. … maybe less.
So that’s a scary statistic. That’s an incredible rise. So does the depletion of the ozone layer, which has occurred due to fluorocarbons, has that played some role? Yes, quite possibly, but that’s mainly at the poles. It’s probably more related to recreational (activities outside). ...
Here’s why melanoma’s unique: Most melanomas (occur) on lily white skin. ... The highest risk is lily white skin, red hair, blue eyes and then people who have many moles, especially funny-looking moles. … You work all year and then you take two weeks to go to the Don Cesar and you get burned. ...
Most regular cancers occur on the backs of your hands, your arms, your face, stuff that’s exposed to the sun. Melanomas we found out – it wasn’t that long ago – they occur on your legs and back and chest, places that are normally covered. … People started to say, hey, maybe it’s intermittent exposure. So, melanoma, the thing to understand, most melanomas – there are some that are caused by chronic sun damage, but they’re not the common ones – most melanomas that people die of, we call it acute intermittent sun exposure as opposed to chronic cumulative.
When did getting a suntan become popular?
That all happened back with… Coco Chanel. … Coco Chanel comes out and popularizes the tanned skin, which is beautiful when you’re young. Then one day you look in the mirror at about 40 and go, “What the hell happened to me?’'... Your skin is all wrinkled like leather.