Rice & Bloomfield Jan. 4, 2007

Two trends we see in medicine, especially in Southern California, are putting an entire population of patients at serious risk: the alarming increase in the incidence of malignant melanoma in the general population during the past twenty-five years and the reliance by most managed care organizations on primary care providers to determine under what circumstances a patient should be referred to a specialist. In no other area of medicine is the restriction of access potentially as deadly as it is in cases involving malignant melanoma.

Failure by primary health care providers, who do not have the extensive training that a dermatologist has, to diagnose and order a biopsy of a suspicious mole can be a potentially fatal medical mistake. Many or most family doctors are not aware of the incidence of malignant melanoma in the population, which has been rising over the past thirty years and is currently estimated to affect 1 in about 85 people in the United States. Alarmingly, while death from most other cancers has stabilized or declined, the mortality rate associated with malignant melanoma continues to rise.

Although fair-skinned individuals and those with many large moles have generally been thought to be at higher risk for developing the disease, an increase in melanoma among Hispanics, especially Hispanic men, has recently been documented. No one should be complacent about irregular-looking skin moles.

I would encourage anyone who has a suspicious-looking mole to immediately consult a dermatologist for evaluation. The National Cancer Institute explains what traits in a mole should cause some concern on the part of a patient. http://www.mpip.org/guide/suspindex.html

If you get your health care through an HMO which requires referral to a specialist, insist that such a referral be made promptly. Most of the cases I have handled over the years in which a failure to diagnose melanoma has occurred involved general practitioners, internists or physicians’ assistants.

Melanoma is easily and successfully treated if detected early. Although there are new treatment protocols being developed for treatment of advanced melanoma, a delay in diagnosis is potentially deadly.