DermHelpCentral

Skin Cancer Grand Rounds

On April 10 - 11, I gave Grand Rounds on Skin Cancer at the Thayer Hospital in Waterville, Maine and the MId-Maine Medical Center in Augusta, Maine.  The handout is attached here:  Download grand_rounds_april_web.pdf  

Maine-Dartmouth Lecture

The Art and Science of Dermatology

Presented:  July 19 and 20th
Waterville and Augusta, Maine

David J. Elpern, M.D.
12 Meadow Street, Williamstown MA 01267
email: djelpern@gmail.com
URL: http://www.davidelpern.com

Grand Rounds is a time-honored institution.  In 1978, Franz Ingelfinger, then the editor of the New England Journal of Medicine wrote a brilliant Sounding Board piece entitled the "Graying of Grand Rounds."  I post it here for any who are interested to read it.  Download ingelfinger_graying.pdf

The following is intended as a guide for primary care residents to validate and facilitate their handling of most cutaneous disorders.

Continuing Medical Education (as typified by didactic lectures) may entertain physicians and trainees, but has no impact on performance. 
See Zeiger: Continuous Medical Education  Download zeiger_cme.pdf

Unacceptably Long Waits for Dermatology Appointment

See: Download Resneck.pdf  

Research has shown that PCPs perform poorly on diagnosis of skin disease:

I think the training need not be didactic, since didactic lectures have been shown not to be effective.  But can be case-specific.  Over three years, one can get a working knowledge of cutaneous disease one patient at a time.

The best part of the top 20 Skin Disorders seen in primary care can be handled by F.P.s

Resources to Aid in Dx and Rx
of Skin Disorders

• Dermnet:  The Mother of All Derm Sites
• eMedicine: Free Updated Online Derm Text
• Clinical Knowledge Summaries from the NIH

Image Banks:

I think Dermnet is the best (see above)
Others:

• DermIS has thousands of images
  
• Global Skin Atlas
• Dermatology Image Database:  University of Iowa
• DermAtlas.org

Web Sites and Blogs

• Virtual Grand Rounds in Dermatology
• VGRD Blog
• Skin Cancer Clinic
• DermCentral

We all work together



Illustrative Cases:

Procedures F.P.s should be comfortable with:

• Punch Biopsy
• Shave Biopsy
• KOH Prep
• Tzanck Prep
• Simple excisions

Punch Biopsy

3 and 4 mm punches
Needle holder
Scissors
Forceps (optional)
4-0 and 5-0 nylon sutures
Gauze
Non-sterile gloves





Shave Biopsy

Xylocalne 1% with epi
1 cc syringe + 30 guage needle for infiltration
1/2 of a "Blue Blade" razor
Guaze
Aluminum Chloride for hemostasis   

   

Hyfrecator (Electrosurgery - Coagulator)

This is one of many models you can choose from.

 

   

Because of the long waits for consultation, if you take the time you can make most diagnoses.  This is not quantum mechanics.  You can be the doctor who is there:

On Skin Cancer and Screening
New York Times, July 10, 2007
Doctors Balk at Cancer Ad, Citing Lack of Evidence
By CHRISTIE ASCHWANDEN
Some doctors are questioning a cancer society ad campaign on sunscreen because most skin cancer is not life-threatening.

The Thesis
Cancers follow three basic patterns: turtles, birds and bears.
1. Turtles move so slowly that you can still capture them while they’re moving slowly along;
2. The birds fly away so quickly that you can’t catch them in time;
3. The bears can escape if you ignore them, but if you catch them in time, you can capture them.

For the full article go to Permalink. 

If, at any time, you want to submit a case for suggestions to VGRD or VGRD 2.0, please follow this format:

• History
• Physical Exam
• Clinical Photo (please save and send as a small jpeg file)
  
• Lab Tests and Biopsies if done
• Specific Questions

What else would you like to know?

Contact me at any time:  David J Elpern