Did Podiatry Save My Life?

Life gives us the opportunity to live in the present, plan for the future and reflect on the past. These reflections in some instances seem to clarify decisions we made back then. In spite of us agonizing over what road to take, the passage of time usually points us in the realm of “It was meant to be.”

Does anyone grow up wanting to be podiatrist? I have not met anyone in that category. It seems somehow that we stumbled on the profession, gave it a go and made it a great career.

At the time of my college graduation, the number of applications to medical school was astronomical. Although my grade point average was competitive, the MCAT scores were less so. Someone mentioned podiatry and after a superficial investigation, I sent in the application. Way back then, we had our own entrance exam and lo and behold, I scored high. Then the Pennsylvania College of Podiatric Medicine (PCPM) accepted me and the rest is a 30-plus-year career.

Let us go back to the third year in podiatry school and the podiatric dermatology course taught by the brilliant Harvey Lemont, DPM. Any class should provide us with pearls and the pearl from his class was: Biopsy or remove any new pigmented lesion on the foot, especially the plantar surface. You file it away in your mind’s treasury and hopefully remember it. Then when the right clinical scenario comes along, you apply what you learned.

Fast forward to 14 years after graduation. As an avid runner, I developed metatarsalgia of the right foot. I did the ice, pad and nonsteroidal anti-inflammatory regimen, and the symptoms improved somewhat. However, in spite of the treatment, there was a day when the area was more tender. I did a self-exam and palpated the culprit as the second metatarsal.  

Much to my surprise, there was a new pigmented lesion between the first and second metatarsals plantarly. I raced through the ABCDs of a melanoma and even measured the spot with a pencil eraser. The criteria of a melanoma was not there. It was a relief but still a nagging remembrance of Dr. Lemont’s admonition.  

I showed the lesion to my friend Kevin, who sat next to me for the four years at PCPM and was well aware of our instruction. Kevin said, “Let’s give it a month and see what happens.” So every day for that month, I studied this nondescriptive spot and did not see a change, but I kept hearing Dr. Lemont’s advice.  

Kevin performed an excisional biopsy. It still was less than the diameter of the eraser (6 mm) and the other A, B and C characteristics were still not evident. The procedure was a piece of cake. The results were lousy.  

My little mole from the pathology report was now a bona fide acral lentiginous melanoma measuring 0.37 mm in depth. Naturally I read all I could about melanomas, which put me into a depression.

The wide excision happened a month later. Luckily, the surgeon did not have to remove any nodes and closed the incision primarily. Other than a faint scar that is painful every now and then, the foot is fine. Every six months, I strip for the dermatologist and have suspicious lesions removed all over the body. I am at the 20-year mark and to date, knock on wood, I have had many dysplastic nevi removed but no recurrences of that melanoma.

Suppose I didn’t discover podiatry, have Dr. Lemont as a professor and remember his teaching? No way would I have discovered the lesion in such an early stage. We do know when physicians discover pedal melanomas later in their maturation, the prognosis is more dire.  

Some of you may be considering whether Dr. Lemont lacked an evidence basis for his remark. For me, he was right on the mark and my life is all the evidence I need. Yes, I have removed new pigmented lesions from a handful of patients. One came back as a melanoma. Luckily, we caught it early. Unfortunately, I have excised other lesions on a handful of patients that I “diagnosed” as melanomas purely on a clinical basis with a confirmatory pathology report.   

Did podiatry and Dr. Lemont save my life? You cannot convince me otherwise. Without both, that spot becomes a very deep melanoma with a lousy five-year survival rate due to the late diagnosis.
Looking back, it was meant to be.

Dr. Wallace is the Director of the Podiatry Service and the Medical Director of Ambulatory Care Services at University Hospital in Newark, N.J.