Skin exam still gold standard

It is noble that Mr. Eckley Keach (June 2006) wishes to alleviate the morbidity and mortality from melanoma, but is he on target in stating that the best way to accomplish this is by utilizing photography as a substitute for patient education, careful serial skin exams and biopsies?

We are presently following more than 1,000 patients with melanoma (>95 percent are early-stage) and feel our considerable experience and data from the medical literature support our approach to the management of these individuals. Early diagnosis greatly increases the patients' chances of survival. At this time, none of the noninvasive, in vivo techniques, including photography, dermoscopy, confocal scanning, laser microscopy, computerized image analysis systems, ultraviolet photography, magnetic resonance imaging, high-frequency ultrasound or optical coherence tomography have proved to be as useful as the gold standard for early diagnosis of melanoma - a biopsy of a suspicious skin lesion. In fact, some of these technologies may, if relied upon, actually delay the removal of a lesion that is changing or has actually already become a melanoma.

In some cases, as found in the literature, photography may, in fact, delay the diagnosis of melanoma. To quote a retired oncologist, "What is placed in the biopsy bottle will seldom hurt the patient; on the other hand, what is left on the patient may do great harm." On more than one occasion, patients have reported to us, "My previous doctor told me to observe the skin lesion. When it (melanoma) was finally diagnosed, it had already spread to my lymph nodes."

We provide our patient on their first visit:

Richard Essner, M.D.
Assistant Director, Surgical Oncology

Stan Alfred, M.D.
Dermatologist
John Wayne Cancer Institute
Santa Monica, Calif.