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March 18, 1998

Clinical Crossroads: A Young Light-Skinned Woman With Multiple Moles

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(11):837-838. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-11-jac80001

To the Editor.—Dr Robinson1 discusses the epidemiology and pathogenesis of malignant melanoma and risk factors for development of this malignancy, and provides highly useful guidance for the primary care physician regarding screening for malignant melanoma. In her discussion, Robinson recommends triage of pigmented lesions and refers to a table that describes a 6-step algorithm for this purpose (Table 3, page 1696). This algorithm closely resembles one we published in the Journal of the American Academy of Dermatology in 1996.2 Our 9-step algorithm was designed to be a component of a skin cancer prevention and early detection curriculum for primary care providers that we developed under a grant from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases. Our algorithm for basic skin cancer triage is somewhat more detailed than the one published in Robinson's article, including steps to triage lesions that met criteria for basal cell and squamous cell carcinoma, as well as specific examples of common lesions that could be safely ignored (eg, cherry angiomas, dermal nevi, dermatofibromas, freckles, lentigenes, cafe-au-lait macules, and seborrheic keratoses). The remaining steps in our algorithm are similar to those listed by Robinson, including virtually the same recommendations for the "Watch" and "Act" outcomes.