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dermatology PA
probably playing dress up
millennial // new yorker
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To the naked eye, this mole checks all the “safe” boxes: 

✅ Small
✅ round
✅ regular 

Under dermoscopy, it isn’t.

Diagnosis: melanoma in-situ.

This is your reminder that not all melanoma looks like “ugly ducklings.” Melanoma can look like a normal mole, just as in this case.

If your skin exam doesn’t include dermoscopy, and if your clinician is not skilled in dermoscopy, melanomas like this get missed.

If this surprised you, it’ll surprise someone you love, share this post with them. 

#melanoma #dermatology #skincheck
58
This patient came in to see me for a skin exam. 

I came across this spot on her leg, and told her it was concerning for melanoma. 

Shockingly, she said she had it treated with a laser, but it did not go away- it grew. 

I asked her pointedly, did you have it cleared with a dermatologist, and did he put a dermatoscope on this spot.

Yes. A board certified dermatologist, applied a dermatoscope to the spot and cleared it for treatment with laser.

A mole, or in this case MELANOMA should never be treated with laser!!!

This case highlights what the public does not know.  We have a massive knowledge gap in understanding what may be melanoma, a mole, or a sunspot. 

And that could be the difference between someone thinking a brown spot didnt respond to a laser (like this patient), and someone getting late stage melanoma, because it was overlooked at an earlier stage. 

I am trying to change the standard for skin cancer screening so melanoma is not overlooked, or in this case, okay’d for treatment with a laser. 

But, I need help in bringing awareness to this issue. So share this message. 

Michelle Monaghan, The Skin Cancer Foundation, or anyone else who wants to help, I am ready for the challenge.

#melanoma #dermatology #dermoscopy #cancerscreening #patientcare
102
Every spot here is melanoma. Look at all the different ways it can present. 

Most melanoma i find daily is not actually obvious to see. And even with full body skin exams, some of these cases would be overlooked in most clinics across the country.

Why? Because use of a dermatoscope is not universal, and the education in this area is not standardized.

By showing you these cases, it is meant to educate the public on what melanoma actually looks likes, and the current gaps in skin cancer screening standards.

If you want your skin cancer screening to improve, become educated on what it’s missing.

If you didn’t know this was a problem, someone else you know and care about likely does not either. Share this with them.

#melanoma #skincancer #skincancerscreening #skincheck #health
439
The only way you will find micromelanomas (diameter < 2 mm) is if you look at *all lesions* with dermoscopy. I have made a post on this in the past, but to me, all pink and pigmented lesions (excluding obvious seborrheic keratosis) should be evaluated dermoscopically. Additionally, applying the inverse approach to pigmented facial lesions will help you discern if a lesion should be further investigated for melanoma. This approach looks for non-melanoma specific dermoscopic features found in pigmented actinic keratosis & solar Lentigo/macular SK. These findings must be predominant in all quadrants of a lesion. This includes the following:

PAK
-erythema
-scale
-white wide follicular opening

SL/macular SK
-parallel lines
-sharp border demarcation
-classic SK features (milia like cysts)

In this example, the inverse approach does not reveal these structures, and is by default suspicious for melanoma. On close examination of this just under 1 mm lesion, dermoscopy reveals brown globules arranged around a follicular opening.

Pathology revealed melanoma in-situ
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