The question of whether to undergo a SLN biopsy for melanoma is a difficult one. It is clear that some experts recommend it while others don’t. If you live in Boston you will be told one thing. If you live in Montreal you’ll be told another. Where does that leave a patient? In England the National Institute for Clinical Excellence (NICE) provides decision aids for many conditions. Here is their SLN Decision Aid for melanoma. Please give it thought and discuss it with your dermatologist or surgeon. The decision is really up to you. It boils down to “What Matters To You.” Option-Grid-Sentinel-Node-Biopsy-yes-or-no
by David J. Elpern, M.D. presented in shorter form at the Lown Institute Conference, Washington, D.C. April 9. 2018 Every peddler praises his needles. Portuguese proverb In November 2017, the NY Times published an expose about the current state of dermatology.1 It documented bizarre instances of over-diagnosis and over-treatment that are driven by ignorance and greed. Over the past 40 years, I have witnessed these changes in my specialty and am dismayed by the reluctance of my colleagues to address them. This trend began in the early 1980s when the Academy of Dermatology (AAD) assessed its members over 2 million dollars to hire a prominent New York advertising agency to … Continue reading
Deep multicolored hues emanating from its surface in all directions Voracious and cruel like a black hole, ripping the borders of lighter brown nearby Seeding and spreading through the crimson water Eventually arriving at the home of thought, pleasure, and personality Shutting it down like an ember drowned by the morning rain Pronounced dead shortly, his lifeless body calling my name Despite his protective pigment If only he had known If only he was told If only he wore the protective white paste He could have been saved from the black hole by Ajay Kailas, a third year medical student at University of Central Florida who is interested in dermatology, … Continue reading
Presented at Hot Spots in Dermatology, Turtle Bay, Kahuku, Hawaii August 22, 2015 Shane Y Morita and Svetomir N Markovic Molecular targets in melanoma: time for ‘ethnic personalization’ Expert Rev. Anticancer Ther. 12(5), 601–608 (2012) Abstract: Worldwide, the incidence of melanoma continues to rise. Although not the most common cutaneous malignancy, it is the most lethal. Until recently, while other oncologic patients benefited from the nuances of targeted therapy, those afflicted with melanoma lacked that option. In 2011, the US FDA approved an oral agent that targets the BRAF oncogene. As this information is promising, it is essential that other populations (in addition to Caucasians) are examined, in order to … Continue reading
“Stations of the Heart: Parting with a son” by Robert Lischer is a moving and important book by the father of a 33 yo man with metastatic melanoma. It chronicles the last three months of Adam Lischer’s life. The book describes the medical, spiritual and philosophical aspects of Adam’s death. It’s a valuable resource. I have typed out a few pages of quotations which may interest you.. There are many medical details that a dermatologist would like to know, but they are less important than the view from the family’s standpoint. See Book Review: Stations of the Heart. Quotations from Stations of the Heart.
Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal. Ivan Illich, Medical Nemesis Abstract: The incidence of malignant melanoma (MM) has risen sharply over the past few decades, while the melanoma death rate has barely budged. This suggests that lesions not formerly called MM are now labeled as such. The trend to reclassify benign lesions as malignant is called “diagnostic drift.” The lowering threshold of dermatopathologists for diagnosing MM and aggressive screening of the populace are key factors in this spurious epidemic. About author: Mary Iaculli is a third-year medical student at the University of … Continue reading
Hunting for Bear: A Melanoma Postscript by Tim Guetti Abstract: A 62 year-old man relates his experiences after being diagnosed with an acrolentiginous melanoma on his foot. The surgery interferes with his plans to go on a father-son bear hunt. We hear and read many stories about the diagnosis and treatment of melanoma, but few relate what is important to the patient with the disease. Keywords: hunting, bear, melanoma, foot, acrolentiginous, melanoma, father, son My story begins a few years back when my son Scott, now 39, said to me “Dad, we need to go on a hunt.” It had been many years since we had been on a “hunt” … Continue reading