DermHelpCentral

Sentinel Node Biopsy for Melanoma

There is probably no more controversial area of melanoma management than sentinel node biopsy.  Patients are routinely offered this procedure as if it improves outcome; which it emphatically does not.

Marvin Kanzler has written an important essay on this topic.  He writes" "Physicians who actually diagnose melanoma are in an ideal position to discuss these facts with their patients, because they are completely free of financial conflicts of interest (the Medicare reimbursement for the SNB procedure is approximately $19,0004). ‘‘Discussion’’ versus ‘‘recommendation’’ is an important distinction. The decision ultimately should be made by the patient. The physician’s role is to provide the unbiased information necessary for the patient to make this important decision."

Dr. Kanzler's article is important.  We have placed this article on Google Docs for those who want "discussion" not a biased "recommendation."

See: SNB and Standard of Care for MM.

About This Resource

The Internet is consulted by millions of people in search of for unbiased health information on a regular basis.  In 1995, a Pew Center survey found that 95 million Americans went to the WWW with health related queries, and the number has certainly risen in the past 15 years. Sadly, many of the pages they retrieve are selling products or procedures.  Government web sites. while often useful, are often constrained by arcane regulations.

We are attempting to provide as unbiased information as possible.  We do not accept any PhRMA monies, nor represent any society or organization.  We have nothing to sell.  The site is run by a dermatologist, David Elpern, whose name is writ in water.  If you have specific questions and have found this website helpful, please feel free to contact me.  DJE. (August 2010)

This Bedbug's Life

an Op-Ed piece in the August 8, 2010 NY TImes by entomologist May Berenbaum

Bedbugs (Cimex lectularius), once a rarity, over the past decade have become ubiquitous pests. "Global travelers now bring in a steady supply from around the world, inconspicuously undeclared in checked bags and carry-on luggage. Today, bedbugs have been found in all 50 states, as well as Guam, Puerto Rico and American Samoa, and bedbug-related calls to pest control operators are escalating at a fantastic rate. From June 2009 to June 2010, there were more than 31,000 calls in New York City alone."

Dr. Berenbaum's chatty, informative editorial, This Bedbug's Life,  is a must-read for anyone interested in or bothered by these unlovable vermin.

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Melanoma Resource

  Melanoma Center (labeled as "Your Source for Melanoma information") is the brain child of Dr. John Kirkwood, a melanoma researcher who has published almost 300 peer-reviewed articles on melanoma.  There is so much false information on the web, that it is refreshing to find such a resource.  However, one must recognize that controversy exists as to the best treatment for melanoma.  The utility of sentinel node biopsy is still controversial.  In the U.S. is is used far more often than in Europe or Australia and it's difficult to prove that there is any long-term survival value.  It's primarily a prognostic tool and this needs to be made clear to the patient. The bottom line is that treatment in the U.S. tends to be more aggressive than elsewhere with little evidence for its value.  Still.  Melanoma Center is an important resource.

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Infections and the Gym

by Jane Brody, NY Times, August 3, 2010

"When you go to the gym, do you wash your hands before and after using the equipment? Bring your own regularly cleaned mat for floor exercises? Shower with antibacterial soap and put on clean clothes immediately after your workout? Use only your own towels, razors, bar soap, water bottles?"

In these days when so many of us exercise in gyms outside of our homes there is risk of acquiring skin infections. Jane Brody's column "Be Sure Exercise Is All You Get at the Gym" is well-worth reading as it gives good advice on how to avoid many of these problems.

Melanoma Survival Calculator

This calculator gives the melanoma survival and other outcome information projected over time. It reflects the current state of knowledge.  You may want to discuss the findings with your physician. 

Access Melanoma Calculator.