New research shows the benefit of education about how to check someone’s skin for abnormal moles can greatly increase the pick up rate of skin ancers at an early, therefore more curable, stage. I have been convinced of this for years and try to always to educate my patients, using on line images of melanoma.
More needs to be done by health care providers and others to educate the public. Earlier diagnosis saves more lives than drugs like nivolumab and vemurafenib, and saves them cheaper.
A middle aged white person presented with a story of a mole on an arm that had been changing and growing over 6 months. In the absence of a photograph, we have no objective way of being certain whether, and how much, a lesion has changed, so have to go on people’s stories. Here is the plain view.
And a close up
Not that worrying, but there is the history to consider and it is the largest mole. Dermoscopy.
Irregular globules can be seen, varying in size and mainly a greyish-blue in colour. Given the history of change, this was considered to be adequate grounds for excision. Note also the pale circles associated with hair shafts, these are of no concern and are termed perifollicular hypopigmentation.
Histology was of a benign dermal naevus.
On reflection, did this mole really need excising? I showed the picture to colleagues, some said yes, others said that photography and monitoring would be acceptable. This is a debate that will continue-we must not miss melanomas but should avoid excising excessive numbers of benign lesions. Sharing images like this where histology has been obtained should perhaps over time help us to be more confident in deciding to monitor-but many experts say, if there is doubt about a changing/suspicious solitary lesion then remove the doubt by getting histology. I am sure we will get to know better as time goes on PROVIDED that we photograph lesions before surgery and then learn from the photos when the histology report comes back. And we all need to audit our ‘hit rate’.
Just heard of yet another mobile phone based app for early detection of skin cancer. This one depends on sending an image of suspicious moles to a trained dermatologist.
I have heard of something similar being trialed in Britain.
One issue with apps like this is the whole skin isn’t evaluated, another is that an on line dermatologist is likely to be very anxious about saying ‘Yeah, nothing to worry about’ (and risk getting sued if it works out bad) on the basis of an imperfectly focused or badly lit image, so will say ‘better come along to make sure’.
I’m not against this sort of thing, but it seems to me to just say that our regular health care professionals aren’t well enough trained. If we find a suspicious, new or changing mole, we ought to be able to have easy access to a Primary Care clinician who can adequately triage the mole or spot as harmless or suspicious, and then quickly move the suspicious on to a specialist..
This ought to be routine, then we wouldn’t need short cuts and technological gimmicks.
Just to say that while the 2017 course is booking steadily, there are plenty of places available. I have had several enquiries from GPs, consultants and nurses asking if there are still places before they book. There are. Once the course is fully booked, I will place an announcement here to say so, until then , there are spaces. Fully electronic on line booking not available, but you can download and complete the form (see box in top right of this page) email it to me and pay by BACS as an alternative to printing it and posting with a cheque.
PS a survey of dermoscopy by French GPs and an editorial in the October 2017 British Journal of Dermatology further underline the need for courses like ours. Please consider getting dermoscopy training, health care professionals wherever you are.
More and more men and women are getting tattoos, sometimes very large and dark ones. There is no evidence, or reason to suppose, that tattoos increase the risk of a skin cancer (although there have been reports of infections) but if people are unlucky enough to get a skin cancer under a tattoo, it may make diagnosis more difficult.
This image shows part of a large tattoo, something was noted at the edge of it. This picture is not very well focused, but shows an area of slightly abnormal skin that presented as it was scabbing slightly. A skin lesion that scabs and never heals over 3 weeks or more may be a basal cell cancer (BCC). The lesion is indistinct, let’s get the dermoscope on it to see if we can discover any more detail.
The area blanches under pressure from the glass plate of the dermoscope, revealing a quite different texture to the surrounding normal skin. A few compressed blood vessels near the centre of the image can just be seen. but the most striking features are the blue-grey clods (or globules) in the bottom left, which vary considerably in size and shape. These are also known as blue grey ovoid nests, and are very typical of BCC. To the right, we see a micro ulcer, the well defined irregular red clod. This is ample to diagnose a BCC, which was confirmed on histology after the lesion was removed.
The blue-grey colour at the top of the picture is tattoo ink, which happens to be a very similar colour to the blue-grey clods seen in BCC. Once again, the dermoscope takes a rather nondescript skin lesion and enables us to make a positive diagnosis by revealing detail the naked eye cannot see.
The moral of the story is, tattoos can make skin cancers more difficult to diagnose. In this case it didn’t matter but if you had a melanoma come up under a dense black area of tattoo ink, it might grow for longer than it might otherwise have done before being spotted. I have seen a melanoma come up in a gap in a dark tattoo-lucky it came up in the gap and was caught early.
This PDF is posted for the benefit of delegates at the Kilkenny scientific conference of the PCSA of Ireland. Thanks for the invitation to your conference and thanks for being such an enthusiastic and engaged group of learners.
The dates of next year’s course are 10th March and 9th June. These are Friday afternoons at the Holiday Inn Fareham,. Please note, it is one course-learners attend both sessions and do private study and on line group learning for the 12 weeks in between.
For full details including prices click on the top right hand box. Good discounts for early bookers and nurses.NB this year it will be possible to pay by BACS if preferred, bank details South Coast Dermoscopy Associates, 30-90-85, 21513968. It will still be necessary to ether post or email a completed application form.