- Skin Checks
- Prevention of Skin Cancer
- Medical & Surgical Treatment
- PDT (Photo dynamic Therapy)
The most important approach is to recognise a significant skin lesion! You need to know all the variants of the common skin cancers such as BCC, SCC and melanoma but you also need to be able to recognise common benign lesions for what they are and benign lesion that may signify an underlying non skin malignancy associated with various syndromes.
Dermatoscopy is one part of a diagnosis process. It is a tool which I personally use to increase the amount of information which is available.
The most fundamental tool early in doctors’ career is the stethoscope. For doctors who look for skin cancer it is the dermatoscope.
I have used the analogy of the crime detective. Detectives gather evidence then they apply a cognitive process to solve the crime. The character Sherlock Holmes always seemed to come up with an unpredictable and very clever solution. His methods did not appear teachable. His assistant Watson never seemed to get any closer to the effectiveness of his master.
Neville Davis made a statement in 1978 in a paper he published which I have found very useful.
Neville Davis was in fact a Brisbane general surgeon. He was later chairman of the Brisbane Melanoma Project. He was involved in research and published over 90 papers. The statement by Neville Davis introduces the concept of the “Melanoma Signature”.
It suggests that melanomas can be recognised by their unique visual impact on the observer. It is so obvious how did it get to be so big? That is where the second part of Neville Davis’ statement is relevant. “Some see but do not comprehend”.
Looking at a lesion and applying a dermatoscope to get more information allows me to “see” the signature. Applying an algorithmic process assists me to “decode” and “read” the signature.
The melanoma signature is not just an ornate calligraphic creation. It is the signature of an assassin.
My job is to recognise and decode the “melanoma signature” and then to “take out’ the assassin.
