Have you ever found yourself worrying about the overall health of your skin? Or have you noticed some new bumps or lumps and you’re not sure if you should get them checked out? There are a few red flags to look out for, but it’s not crucial to run to the doctor every time you find a new abnormality on your skin. We had always been curious about that fine line of when and when not to go to the doctor… And then we heard about a new clinic of Board Certified Dermatologists opening up in Boise, and we knew just who to ask!
Near the corner of Chinden and Eagle Road is a new dermatology clinic that is well worth a visit - Treasure Valley Dermatology & Skin Cancer Center.
Recently, I was lucky enough to sit down with Dr. Dustin Portela - a Board Certified Dermatologist and Dermatologic Surgeon.
We discussed everything from his history, his advice to future medical students, the best option for removing skin cancer, old skin care myths, the one thing you need to be doing every day for healthy skin and more!
Let’s start with you; Can you tell us a little bit about yourself? And why you decided to open up a practice in Boise?
I grew up in Southeast Idaho. After completing my training in the Midwest I decided to come home and join my family. I was initially recruited to Boise to join another practice. I was there for a few months before deciding that opening my own practice would allow me to serve patients in the way that best fit with my style and my manner of care.
I saw on your website that you trained in Mohs micrographic surgery. What’s the difference between Mohs surgery and traditional excision surgery?
Mohs micrographic surgery is a specialized technique for removing skin cancer that is, in some ways, similar to a traditional excision surgery if you have a skin cancer that needs to be cut out.
We always want to be sure that we get it out completely, so we send it out to a pathologist to look under the microscope to be sure it’s edges are clear of any cancerous cells.
When we do Mohs surgery, we process the tissue here in our office and I look under the microscope at the same time as the visit. So, instead of waiting a week for a result from a pathologist, I’m able to provide results within a much shorter period of time. And then we have the confidence that the cancer has been removed completely and we can complete the procedure the same day, rather than waiting!
There’s some differences in the approach as well. Traditional excision is going to cut through the skin in a football shape and we’ll close it up with stitches. With Mohs, we cut at an angle and then we process the tissue when we cut microscope slides from the bottom up. So we see all the bottom of the tissue and the whole edge, so when we look under the microscope we are seeing the most important part. When they process the tissue from an excision at a regular pathologist lab - they slice it like a loaf of bread and they may only look at, well, 2% or less of the total margin. And so they are giving you a probability that it’s clear, but there’s still a chance that they didn’t see everything.
I look at 100% of the margin. Cure rates are much higher with Mohs surgery.
What does your own daily skincare routine look like? Do you have any trade-secrets you’d be willing to share with us?
*Laughs* So I laugh a little bit about that because there’s some simple things that everybody knows you need to do, but everyone wants a shortcut! The most important thing anybody can due for the best health of their skin is to wear sunscreen. Every day.
Every single day! Even if it’s overcast. Even if it’s wintertime. A thin layer of sunscreen that you like to wear is going to protect your skin more so than anything else for years down the road.
It’s important to find a sunscreen that you like to wear that feels good on your skin and that’s an obstacle for a lot of people. We always recommend at least 30 spf. Sometimes you can find benefit if you go with a higher spf, but they tend to be a lot greasier.
I generally put on a vitamin c serum by Skinceuticals and moisturizer if my skin is dry. In the evening time, using a retinoid medication is something that is beneficial to every patient - so I do that every night as well.
We are the only dermatologist practice in Boise that offers SkinCeuticals. It’s one of the top lines across the country, so that’s a unique thing that we are proud to carry.
How much of an effect does a diet have on the appearance of our skin?
It’s just like being healthy internally. When we look at blood pressure or cholesterol or diabetes or obesity, all of these things are tied together. The types of things you’ll do to be healthy on the inside tend to reflect on your skin, too. We generally recommend to eat a diet that is well balanced. If you eat a lot of simple carbs, those can tend to break you out with acne. In general, the things that keep you healthy on the inside are going to keep you healthy on the outside.
If someone starts noticing a new development on their skin, when do you think is the right time to see the dermatologist? Are there any big, red flags that people should be on the lookout for?
Any existing spot that’s been there for years that starts itching, bleeding or changing - that’s the red flag. If something totally new pops up that doesn’t go away in a month, that’s another good time to see a dermatologist. Every new spot that pops up… it’s not necessary to see one right away… But if something doesn’t behave in a normal fashion and go away in a normal amount of time, then you should see someone.
What is the most often requested procedure from your patients? Can you tell us a little bit about how it works?
This is going to be a cosmetic procedure, which is botox. Botox or Xeomin is considered a neuromodulator, so it stops the nerves from telling the muscles to fire so we get relaxation of the muscles and lessening of the wrinkles over time.
If you were to give some advice to a student who wants to become a dermatologist, what would it be?
There’s the standard response of, say, “Get good grades, score well on your medical exams, etcetera...” but one of the most important things I’ve learned for life, and to be well-rounded in life, is to find a project that you love to volunteer with and do it consistently. I would say it should be something that is not even necessarily related to medicine. Because you’ll need a diversion throughout your career. You’ll need some other passion to pursue, so having an activity to volunteer with and give yourself to that’s different than your day-to-day… That will look good to admission committees, and it will also help you be well-rounded.
In your mind, where do you expect the realm of skin care to go next? In terms of technological advancements, is there anything up and coming currently gets you excited?
There are a couple things coming up that I think will be exciting developments in the field of dermatology. Probably within five years we will be able to do biopsies without cutting the skin or having to do needle pokes! We’ll be able to apply a strip of tape and pull off just a few skin cells from the top and then send that off to the lab to get diagnosed. That will probably be enough to diagnose skin cancer and most skin diseases about five years from now. Right now there’s only one company that does it, they’re called DermTech, and they are marketing it just for moles. To see if a mole is melanoma or not. It’s not a guarantee, but it lets you know if the mole is low risk or high risk.
Are there any old anti-aging myths that you’d like to stomp out entirely?
We do see a lot of people that try essential oils… and I haven’t seen a lot of good results from those. Or coconut oils. There’s a lot of “natural” and “organic” substances that people are putting on their skin, and then we usually see those people because they will have an allergic reaction.
Not everything that’s natural is good for you. Poison ivy is natural, but nobody would voluntarily rub that on their skin! There are times when essential oils or coconut oils might be beneficial but it’s certainly not a cure-all.
And lastly, be honest - Is Head & Shoulders really the best shampoo for your scalp?
If you have dandruff, Head & Shoulders can be a really good product! Sometimes patients need more… but oftentimes I do, in fact, recommend using Head & Shoulders as an adjunct to treating dandruff!
Thanks for the great interview, Dr. Portela! We’ll be sure to start wearing our sunscreen and thinking more critically about our daily skincare routines!
If you know of any other interesting business owners, artists, musicians, or anyone else who has a fun history with Boise: Be sure to e-mail us at firstname.lastname@example.org for the chance at a fun interview like this one!
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