Wednesday, February 3, 2010

Is it true, Dr House??

Many of you may have seen the episode of House that aired on Monday night. There was an African American football player who was sick with some bizarre symptoms as is usually the case on that show. Dr House is right on the money with his assessment of this patient. Do blacks get skin cancer? Absolutely. Is it usually on the palms and soles? Yes it is! We are talking about Malignant Melanoma which is the most deadly type of skin cancer. For reasons that aren't clear, the incidence is increasing at an alarming rate. It affects the white skin of darkly pigmented persons ( ie the palms and soles). When I see a brand new patient in my office, I offer them the opportunity to get a complete skin exam. It doesn't cost any extra, its just the way we get to know our patients . Many times we find something that the patient is not aware of ( eczema, infections, contact dermatitis and yes even skin cancer). I had a plastic surgeon colleague, now retired, whom I used to send a lot of my patients to when their skin tumors were too large for me to deal with in the office. He joked that I was a "cancer magnet" because I found the tumors that no one else did. When patients were reluctant to get completely undressed, I could usually get them to at least let me look at their feet and hands.

The only part of the tv show that did not really ring true was the end of the story. I think that symptomatic patients like the football player have metastatic disease which is not really compatible with long life. Cutting off his toe won't mean that his liver, brain etc will snap back to normal. Science is making strides with metastatic melanoma though. Clinical trials of new drugs are showing a lot of promise and vaccines are being developed. The last point we need to get out to folks is that this diagnosis should prompt every doctor and patient to inform their first degree relatives to get checked. Melanoma runs in families. For more information go to the American Academy of Derm website and look for "Information for patients".

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