In 2007, I undertook a project looking at malignant melanoma and the foot. It came up as a clinical observation that many early lesions arising on the foot were not being recognised and or referred on in a timely manner for diagnosis and treatment, particularly when compared with melanoma arising elsewhere on the body. Working with Dr Katharine Acland, a dermatologist, at St Thomas’ Hospital in London (1, 2) the culmination of this work was the development and publication in 2010 of clinical guidelines for the early recognition of melanoma of the foot and nail, published in the Journal of Foot and Ankle Research (3, 4).
This paper subsequently became the most downloaded paper in the 10-year history of the journal (5) with nearly 120,000 downloads to date along with translation into several languages. This was followed with the publication of a poster and aide memoire for podiatrists using the “CUBED” acronym which was distributed with Podiatry Now (6). Latterly, the introduction of podiatrists to dermoscopy (7) has equipped podiatrists further with a simple technique which can improve assessment of suspicious lesions arising on the foot.
Eleven years on, with much research and education, I believe that this has raised awareness amongst podiatrists and has saved many lives. However, one of the potential barriers that seems evident from practitioners’ feedback is the referral pathway. Currently, most practitioners would have to refer a patient with a suspicious lesion back to the patient’s general practitioner for review, as direct referral by the podiatrist to dermatology is not an option. Consequently, this may lead to undue delay for the patient with a concerning lesion on their foot.
As a consequence, working with the British Association of Dermatologists, myself and a colleague at Southampton General Hospital, Consultant Dermatologist Dr Catriona Henderson, are looking to see if this can be improved for all podiatrists in practice.
As the first part of this project, we are looking for your views and any cases with your patients where you may have come across a suspicious lesion but for whatever reason have encountered delays in getting the patient referred to the dermatology team. If so, we would like to hear from you. Please can you e-mail me directly.
Please e-mail me through the contact page (click here)
Please note to comply with consent and confidentiality, please ensure that patient details are anonymised, and you have the relevant permissions, where required.
Many thanks for your help.
References
1. Bristow I, Acland K. Acral lentiginous melanoma of the foot: a review of 27 cases. J Foot Ankle Res. 2008;1:11(11).
2. Bristow I, Acland K. 37 cases of acral lentiginous melanoma (poster). British Association of Dermatologists 88th Annual Conference SECC, Glasgow 2009.
3. Bristow I, de Berker D. Development of a practical guide for the early recognition of malignant melanoma of the foot and nail unit. J Foot Ankle Res. 2010;3(22).
4. Bristow IR, de Berker DA, Acland KM, Turner RJ, Bowling J. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res. 2010;3(25).
5. Menz HB, Borthwick AM, Bowen CJ. Journal of Foot and Ankle Research: the first ten years. J Foot Ankle Res. 2018;11(1):44.
6. Bristow I, Bower C. Melanoma of the Foot. Clin Podiatr Med Surg. 2016;33(3):409-22.
7. Bristow IR, Bowling J. Dermoscopy as a technique for the early identification of foot melanoma: a review. J Foot Ankle Res. 2009;2(14).