Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
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.
Goldstein MG, Weinstock MA, Dubé CK, Rhodes AR, Sober AJ. Clinical Crossroads: A Young Light-Skinned Woman With Multiple Moles. JAMA. 1998;279(11):837–838. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-11-jac80001
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