I met Joey on the last day of the 69th Annual American Academy of Dermatology meeting, in February of this year. As soon as I got in his cab, I noticed the black nodule on his right cheek, and its irregular border and variegated color straight out of a textbook. I asked him if he'd seen a doctor about it, and he clapped his hands and laughed: "At least 20 doctors have asked me about it this week!"
Joey, about 70 years of age, (who nonetheless insisted I call him "Joey"), told me that he'd had the spot biopsied several months before; it was melanoma. He'd had a PET scan and other tests, and "everything checked out fine." He hadn't understood that he needed any more treatment, although he'd noticed the spot's getting bigger. "It's not bothering me at all," he said, rubbing his cheek to demonstrate. "I feel fine!" He said he'd driven one young dermatologist a few days before who was so concerned about it, "She made me promise to go back to my doctor. When she got out of the cab, she was real serious. 'Promise me,' she said. I called the doctor that same day." I called Joey later; he had the excision and was doing "fine." He said he wished he'd gotten the name of that nice young doctor, to thank her. I can't help wondering what might have happened if the melanoma had been on his left cheek, or if he hadn't been driving dermatologists that week.
We've all seen patients who decline full skin examinations, who vigorously question the need for biopsies because nothing is bothering them. Others constantly roam their skin with their fingertips for any irregularities, and can't leave it alone. (Over the last couple of years, I have noticed that more and more patients are volunteering that they are "pickers," and seem comfortable about discussing it openly. I discussed this with a dermatologist colleague, who had noticed the same trend, and I suggested that it may be a result of the several overlapping online communities devoted to compulsive skin picking that have arisen in the last few years.)
In providing the best dermatology care possible, we assess not just patients' skin but also their attitude toward it, their understanding of their skin condition, its significance, and possible treatments, and we tailor our patient education, management, and follow-up plans accordingly. We see one patient after another and must constantly customize our approaches. Are they obsessed with irregularities of the skin? Or do they think of their skin as needing attention, from them or from a healthcare provider, only if it is uncomfortable, and if it feels "fine," they ignore it completely?
This is my last editorial as editor-in-chief, as I am stepping down, to have time to devote to an expanding practice as a dermatology nurse practitioner. I am very pleased to report that Angela Borger, DNP, FNP, DNC, the editorial board member behind JDNA's New Author Mentorship Program, has agreed to serve as interim editor, starting June 1. Managing editor Melissa Derby will continue and is excited about working with the JDNA, which is the beneficiary of her 20 years as a managing editor, the last 12 with the Journal of the American Academy of Dermatology.
I want to emphasize how much your comments and feedback mean to an editor, especially in a journal's early years, and have meant to me. I encourage you to write to Angela Borger (http://email@example.com) with comments on the form and content of the journal and about how you and your colleagues might contribute. Your effort will be repaid; Angela is impressively attentive to readers (and writers) and their needs.
There are many I would like to thank, among them JDNA's editorial board, editorial assistant Courtney Spieler, and certainly, our authors, with whom I have so enjoyed working. For many of us, it has been a source of great satisfaction for many of us to watch the journal's features take shape since its inaugural issue in January 2009, and I expect it will continue to be so, in the future. Thank you.
Barbara B. Starr