Cut it out!
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, May 1, 2025
For most of us, our first instinct after diagnosing a melanoma is to cut it out quickly and definitively. For thin melanomas, this response is still usually appropriate; however, just as our paradigms for how we treat more advanced stage melanomas have changed over the past decade, the timing regarding when we treat them may warrant careful consideration. As with many things in life, timing is key. The advent of immunotherapy has turned advanced stage melanoma from what was once uniformly assumed to be a fatal disease to one that, if not curable, may have a much more chronic course. More recent studies looking into the timing of immunotherapy have shown that neoadjuvant therapy given prior to excising a melanoma may offer both insight into the potential response to treatment, as well as be associated with better treatment outcomes. This is important for dermatologists to know, and now, more than ever, it is important for us to engage with our surgical and medical oncology colleagues to create an appropriate comprehensive treatment plan before we start treating advanced stage melanoma.
Are you, like many physicians, uncomfortable treating pregnant women? Pregnancy adds an additional layer of complexity to our therapeutic decision making and, perhaps because of the historical lack of good studies confirming safety of our treatments in pregnancy, the option to “not” treat may seem preferable than taking a risk by treating. Unfortunately, in our zeal to not harm mother or baby, we may hesitate to treat conditions whose undertreatment itself causes distress or even harm. Delaying biopsy of a changing pigmented lesion because of concern about using local anesthetic is one of the most obvious examples in which delay of care may cause harm; however, undertreating itchy dermatoses or other distressing skin conditions can also be miserable and, frankly, should not happen. Many of our treatments can be used safely during pregnancy. Our colleagues with expertise in this subject share their advice, which will hopefully make you more comfortable managing skin diseases during this special time in life.
So, when is the best time to get involved with the AAD? Well, now is a good time! Applications are open to apply for AAD committee and task force appointments. If you have read any of my columns in the past, you likely know that I am a big proponent of getting involved in our organization. Why? Because you have an incredible opportunity to engage in one of many different arenas that can have a positive impact on your colleagues and patients and even help frame your career. Member Communications Specialist Matthew Walsh has thoughtfully provided a roadmap of some of the many opportunities that members have to engage with our organization. The application period ends June 30, 2025, so think about it and consider putting your name out there. The application process is fully online and takes only a few minutes. I cannot promise that you will be appointed to a committee, but can assure you if you do engage, it will be a meaningful experience!
