EP 56: Derm Confessions — Close Calls, Missed Diagnoses and What Changed How We Practice — Part 2

Part one was the absurd and the unexpected. Part two is the stuff that keeps clinicians up at night. Dr. Dustin Portela and Austin Lee go somewhere more vulnerable in this episode, sharing the near misses, the misdiagnoses, and the moments that quietly but permanently changed how they practice. The cases are real. The self-reflection is genuine. And the honesty about what it actually feels like to carry those moments forward is something you won't often hear from medical professionals willing to say it out loud. Austin walks through a case that should be familiar to anyone who has ever been treated for something that kept getting worse: a patient whose scaly rash had been treated as eczema for years before a biopsy revealed it was cutaneous T-cell lymphoma, a skin-confined lymphoma that takes an average of seven to eight years to diagnose. Dr. Portela follows with a drug interaction he prescribed that almost cost a patient her life, a known but poorly documented risk between tetracycline antibiotics and myasthenia gravis that neither he nor his attending had ever heard of. She survived. He has never prescribed it the same way since. The conversation on near misses is candid in a way that matters for patients too. Both hosts have caught melanomas on their way out the door, in lighting that was just slightly different, because something made them turn around. Austin recounts missing a nodular melanoma on a patient's scalp during a thorough skin check, only for the patient to find it herself. That case changed how he examines hair permanently. The did-you-know this week covers amelanotic melanoma, the pink or flesh-colored variant that doesn't follow the classic ABCDE rules and that even experienced clinicians can mistake for something benign. It's one of the more important two minutes in this series. The episode ends where it probably should: a reminder that patients who advocate for themselves, point out the spot the doctor glossed over, or simply say they don't feel right about something, are not being difficult. They are part of the process. Product of the Week CurrentBody LED Hair Growth Helmet A multi-wavelength red light therapy helmet with built-in Bluetooth headphones designed for at-home hair regrowth. Link in the show notes. The code to use at checkout is DRPORTELA Follow Us Dr. Dustin Portela TikTok | Instagram | YouTube (Reactions) | YouTube (Educational) | Pinterest Austin Lee, PA-C Instagram: @austinleepac Skinfluence Podcast Instagram: @skinfluence_pod