SKIN MELANOMA: THE ROLE OF THE GENERAL PRACTITIONER
Dermatology & Aesthetics
“Nobody should die of melanoma”: this is the provocative, but at the same time exciting and meaningful statement, made by the famous American dermatopathologist Bernard Ackerman, whose work has emphasized the important role of an early diagnosis that should be pursued by the General Practitioner.
In fact, there are two types of melanoma: an invasive kind, that has a poor prognosis in most cases, and a benign kind that is much easier to treat, and that, if diagnosed in time, provides a survival of more than 5 years in 95% of the cases.
Firstly, the General Practitioner must be capable of detecting patients at risk of melanoma, and, secondly, must be able to predict the evolution of the disease through the ABCDE rule.
Patients at risk of melanoma, have a light skin complexion (the so-called phototype I and II), live in countries near the equator, and are at increased risk of ultraviolet rays exposure.
However, in regard to patients who live in Italy,
an interesting and frequent risk factor is the presence of large amount of nevi, a sort of "early", rather than "direct precursors” of the neoplasm. Finally, a great role is played by the type of work the person does: if the work is constantly played outdoors (as in farmers and sailors, etc…), there is increased risk of non-melanoma skin cancer (basal and squamous cell epithelioma), while melanoma occurs more in those people that are exposed to the sun in an acute and intermittent manner. Identify and take note of these risk factors is the first step that every general practitioner should take, and then apply the ABCDE rule, where A stands for Asymmetry, B for irregular Border
, C for variegated Color, D for dimensions greater than 5 mm, and E stands for evolution of the basic lesion.
If these parameters are present, the task is to pursue the diagnosis utilizing dermoscopy, which is a new technique introduced in the 90s for the diagnosis of melanoma.
This technique, allows not only to diagnose melanomas about 20 percent more than the clinical examination alone, but also to avoid many unnecessary removals of benign nevi, and should be reserved for the large group of clinically suspicious pigmented lesions that it would be necessary to remove, if a further diagnostic step, such as dermoscopy, was not available.
But the task of the GP "stops here”: understanding the evolution of a suspicious nevus, and undertaking further investigations relies on the dermatologist.
Gabriele Luca Punziano
Medico Generico specializzando in Igiene e Medicina Preventiva all'Umberto I di Roma
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“Nobody should die of melanoma”: this is the provocative, but at the same time exciting and meaningful statement, made by the famous American dermatopathologist Bernard Ackerman, whose work has emphasized the important role of an early diagnosis that should be pursued by the General Practitioner.
In fact, there are two types of melanoma: an invasive kind, that has a poor prognosis in most...read
“Nobody should die of melanoma”: this is the provocative, but at the same time exciting and meaningful statement, made by the famous American dermatopathologist Bernard Ackerman, whose work has emphasized the important role of an early diagnosis that should be pursued by the General Practitioner. 
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Actinic Keratosis, or Solar Keratosis, is a lesion that generally affects adults, over 40 years of age, who often work outdoors. The lesions are located anywhere in the body, but particularly in the areas exposed to the sun, like the face and the back of the hands.
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