Author's reply. Diagnostic discord with melanoma

, . 184: 115 (1998)

LETTER TO THE EDITOR

DIAGNOSTIC DISCORD WITH MELANOMA

Dr Martin Cook1 ably discusses numerous importantissues and problems surrounding the quality ofdiagnoses of malignant melanoma. I wholeheartedlyagree with Dr Cook that these should be addressed andresolved on a national basis. Sadly, however, Dr Cookmakes no mention of the unofficial ‘medico-politicalhierarchy of cancer’. Skin cancer, including melanoma,received a rightful place in the health of the nation. Sincethat time, however, melanoma has slipped in themedico-political cancer league table. Currently, unlessthe cancer in question belongs to a national screeningprogramme or is on a Calman accreditation list, healthcommissioners show remarkably little interest. Toachieve success in any of Dr Cook’s suggestions,

melanoma requires urgent reinstatement as a medico-politically important cancer. Unfortunately, however, aswith all aspects of health care, dermatologists will thenbe in direct competition with other colleagues attempt-ing to propagate interests in their own specialist field ofcancer.

D. N. SHistopathology DepartmentRotherham Hospital TrustRotherham S60 2UD, U.K.

REFERENCE1. Cook MG. Diagnostic discord with melanoma. J Pathol 1997; 182: 247–249.

AUTHOR’S REPLY

I am grateful for Dr David Slater’s supportivecomments but I must confess I was unaware of the‘medico–political hierarchy of cancer’. On the otherhand, I appreciate that those neoplasms which affectorgans with a higher profile in the mind of the generalpublic do seem more easily to generate publicity andsubsequently funding for diagnostic innovations.Part of the purpose of writing this editorial was to

maintain the importance of skin cancer, and melanomain particular, in the minds of an influential group of themedical profession, namely readers of this journal. Ifconvinced of the importance of melanoma as a tumour

with a potentially high mortality and increasingincidence across a wide spectrum of the population,perhaps those readers who have access to Dr Slater’shierarchy will emphasize in that forum the importanceof diagnosis and management of melanoma for thehealth of the nation.

M. G. CConsultant HistopathologistThe Royal County HospitalEgerton Road, GuildfordSurrey GU2 5XX, U.K.

? 1998 John Wiley & Sons, Ltd.