I’ve Got Your Back
Look for Melanomas During Your Cardiovascular Exam
Most people cannot see what’s behind them. So, if you’re with a friend, especially if you are with a friend in a dangerous situation, you might reassure them, “I’ve got your back”.
Cardiologists, and all clinicians, should “have their patients’ backs” and look for melanomas. I have found eleven over the last 20 years. Most people cannot see their backs so I do it for them. You are more likely to find what you look for, so on everyone you examine, just take a minute and look at his/her back for melanomas. I do it after listening to the lungs in hospitalized patients, and I make a special effort in the office to take a look even if I am not listening to their lungs. This is less an issue now than when I started practice because many patients get full body examinations yearly by dermatologists, but some do not. Those in lower socioeconomic groups rarely have the luxury of seeing a dermatologist so be especially vigilant in that group.
I inserted the image below from What Does Melanoma Look Like? — NCI (cancer.gov) — www.cancer.gov/type/skin/melanoma because it has all 3 of characteristics of melanomas: variability in outline, variability in color, and it’s a raised lesion.
You don’t need all 3 of these characteristics. Change in size and change in color also suggest that it’s a melanoma. Most lesions adult cardiologist find are “senile keratoses”. But I don’t suggest you try to become a dermatologist. Just do what I do, when in doubt, send the patient to a dermatologist.
My friend, Tim Lepore, who for years was the only fulltime surgeon on the Island of Nantucket off the Massachusetts coast, always said that his job was to “save lives and stamp out disease”. Finding a melanoma can save a life.
Paul D. Thompson, MD
Chief of Cardiology, Emeritus
Hartford Hospital
This piece is from my “500 Rules of Cardiology”, not really rules, not really 500, and quite presumptuous on my part, but they are simple sayings and principles I have used clinically and in teaching. Please share them with trainees and colleagues. I send them out to an email list so if you send me your friends’ email, I will add them to the list. I publish them on my blogs on Medium and on Substack. Both are free.
