‘I’m safe’
Terminology is a big problem in dermatology, and not just for dermatologists or other doctors. Years ago, many doctors avoided referring to basal cell carcinomas (BCC) as cancers. The reasons are obvious: whilst they are invasive and are carcinomas, their behaviour puts them in a class of their own. Once you say carcinoma to many patients, the baggage is so large, that you must then give a mini lecture explaining the inadequacy of generic terminology. And you then worry whether they believe you entirely. When the newspapers run the summer stories, what sort of cancer are they talking about: BCC or melanoma? Anyway, my point is that diagnosis is both positive and negative. Negative, in the sense that you have to explain what any entity is not.
I was reminded of this when I say a patient from East Asia for whom English was perhaps a second or third language. She had, what was for her, a frightening pigmented lesion. Fortunately it was medically banal and harmless. I gave the ‘positive name’, and then outlined the list of ‘negatives’: it wasn’t this, it wasn’t that etc. Suddenly, her eyes lit up, and a smile crossed her face. ‘I’m safe’ she said. Yes.