Daniel Alan Chaskin DPM
63- 48 Forest Avenue Ridgewood, N.Y. 11385
718 417 4895

I believe that DERMOSCOPY IS SO IMPORTANT in determining
 which foot (nevi or lesions) to biopsy.
There are so many dermatoscopes out there. All my thoughts about the
 Dermlite DL4 are not yet complete: Some of my thoughts are that the
Dermlite DL4 has the best polarization so far. This is so needed to clearly
 see structures especially on the non volar surfaces of the foot. Structures
 are clearly seen by me when I use the Dermlite DL4. It also has a pigment
 boost as well as the ability to toggle between the polarized and non polarized
 views by pushing a button. I will be adding my thoughts regarding the
 Dermlite 4’s pigment boost. So far, I am very pleased with the features
 on the Dermlite 4 compared to what I was using before. The Dermlite
 DL4 is going to last me and I take it to the office, on house calls with me, etc…
Please to to    http://www.footdermatology.com

Opinions of Dr. Chaskin Podiatrist (718) 417 4895 
63-48 Forest Avenue 
Ridgewood, N.Y. 11385
Whenever I see a suspicious foot lesion, I explain to the patient the risks
and benefits of not
having a foot biopsy. Also I explain the risks and benefits of having a foot biopsy. One of the
 risks of
not having a foot biopsy of a foot melanoma is death. I believe that there is a problem that
exists when a patient refuses to give consent for a foot biopsy of a potential foot melanoma.
I feel the best course of action is that I want to do what is best for the patient. That is I refer
patient to ask their medical doctor to see a dermatologist for a second opinion or to get a
second opinion from another podiatrist. If the patient refuses this I believe this is a
 potential problem.
If a malignant melanoma were to be involved , if possible I would probably refer the patient
 to an oncologist
that specializes in foot melanomas. I believe that malignant foot melanoma is a team approach. I was
taught by some of my teachers that the podiatrist could be the first one to see a suspicious skin lesion,
 take a foot biopsy,
send that foot biopsy to a dermatopathologist. If a malignant foot melanoma is present, the choices
 are as follows: to treat it myself without any help, to treat it with help with another podiatrist,
 to send the
patient to a dermatologist or to send that patient to an oncologist that specializes in foot melanomas.
If a patient is homebound and refuses to go to the hospital, rather than not do anything
at all, why not treat such a problem myself if no one else is willing to do a house call for this patient? These
are all difficult questions to answer. What if an ischemic foot has a chronic foot ulcer in need of
a biopsy to rule out malignant foot melanoma, and the
patient is homebound and refuses to leave her house to go to the hospital to see a vascular surgeon
so that he can give vascular clearance to allow the patient to have a surgical debridement of
an infected foot ulcer. How does a podiatrist obtain that specimen to send to a dermatopathologist.
What about
the use of posterior tibial nerve blocks to improve such blood flow to allow for a home
debridement of such an ulcer? After the debridement of the ulcer, such a specimen can be
sent to a dermatopathologist. If a patient sees malignant melanoma on a pathology report
by a dermatopathologist, they will probably be more likely to accept hospitalization for treatment
of a foot melanoma.
disclaimer: Even with a posterior tibial nerve block, if there is a debridement of a foot ulcer in an ischemic
 foot there is a potential for a patient losing their foot or worse and this should be fully decribed to the
 patient and documented before any other treatment is done. In this day and age, I feel that all patients
 with PVD and
foot ulcers should understand the importance of seeing a vascular doctor. If a patient is in a hospital that
 does not have a team of specialists that is involved to completely remove the lesion, perform
the pre-operative evaluations, and manage the post-operative chemotherapy if required, why not
 tell your patient that such hospitals do exist? The patient has the right to choose to transfer to such a hospital.
I have to ask every podiatrist and other health care professional the following question: If there is a suspicious
 foot lesion why not biopsy it? What if your foot skin has an area that changed color, shape or size? How
 do you know that this is not a malignant foot melanoma. Sometimes people die from a malignant foot
 melanoma. I also have to ask one more question. Isn't it important a podiatric specimen to be seen by
a dermatopathologist?