I spent this past weekend in New York City at the Summer American Academy of Dermatology (AAD) conference. What a nice well-run set of events the AAD put together. Although smaller in size compared to the annual meeting, there was a good selection of forums and events. It’s always nice to see everyone catching up at these conferences and working together to promote knowledge and innovation in the field. What continues to strike me is how diverse dermatology is. Dermatologists are interested in skin cancer, surgeries, cosmetic procedures, pediatrics, etc. Going to the AAD conference is like being a kid at the fair — you get to take sample talks in all these different parts of dermatology.
The other aspect of the conference that struck me is that people are really paying attention to the patient’s experience and talking about it. How do we blend quality care with customer service and patient satisfaction at the same time? The patient-doctor relationship is a complex one. The patient of course is no mere customer. But sometimes physicians can be overly focused on the medicine and forget that patient needs transcend purely medical needs. We need to communicate with patients and understand that personalization of the patient-doctor relationship makes it a successful relationship. And we need to be able to step back and assess when we aren’t doing the best job that we can do and improve upon that. It’s great to see people talking directly about it and coming up with solutions.
Does the phrase “pigmented lesion” mean something to you? Or does is it sound strangely foreign? The online Merriam-Webster dictionary defines lesion as, “1. Injury, harm. 2. an abnormal change in structure of an organ orpart due to injury or disease; especially: one that is circumscribed and well defined.” So in the skin, a lesion is an area that presents with a change from the surrounding normal skin. Pigmented lesions account for a large proportion of referrals from primary care physicians. Many patients also self-refer after noticing a funny looking pigmented spot on their skin. The majority of these referred pigmented lesions do not turn out to be melanoma, but I still believe in better safe than sorry. Dermatologists are trained to distinguish a concerning pigmented lesion from a benign (safe) spot. We do this by looking at the spot and we might use a special lens to look at the spot (dermoscopy). If we’re concerned enough about the spot, we may biopsy it (cut out a small piece of it) or cut it out all together and send the skin to a pathologist. The pathologist is a doctor who looks at the cells of the tissue and tells us what the lesion is.
Pigmented lesions can be many things. Of course, we’re most concerned about catching a melanoma, which is a serious type of skin cancer that can spread to other parts of the body and cause all sorts of problems including death. Then there are atypical moles, which we call “dysplastic nevi.” We believe that some percentage of these can turn into melanomas. That’s why if the pathologist tells us that your mole is atypical with a certain degree of atypia (usually moderate atypia or worse), then we may suggest that you get your mole cut out. Keep in mind though that melanomas don’t have to evolve from moles. They can arise from a part of your skin that never had a mole before! This type of melanoma is said to arise de novo. A pigmented lesion can also be many other things. Again, better safe than sorry. When in doubt, find someone who is trained to distinguish the good, the bad, and the ugly pigmented lesions.