Nothing is diagnosed from a photograph. We do not diagnose skin from photographs, and we do not answer "what is this?" by email, by message or through a form. This is not caution for its own sake. A photograph has no history attached to it, cannot be felt, cannot be stretched or pressed to see whether the colour blanches, cannot be examined under a dermatoscope, and misreports colour badly — which matters enormously on skin that is not pale. The examination that actually distinguishes a harmless growth from an early cancer involves magnification, cross-polarised light and, when there is any doubt at all, a biopsy. An application that offers to tell you whether a mole is dangerous from a picture taken on a telephone is selling reassurance, and reassurance is the one product in this field that is dangerous when it is wrong. Bring the mark to a room where somebody can look at it.
The list
Not treated here
Printed in full rather than left to be inferred, so that nobody books an appointment for something we were never going to do.
- Any diagnosis made from a photograph, a description or a message
- Prescriptions issued to somebody who has not been examined
- Advanced or recurrent skin cancers needing staged surgery or reconstruction
- Skin cancer on the eyelid, the lip margin, the ear cartilage or the nose tip
- Suspected melanoma beyond the biopsy — care moves to a cancer centre
- Inpatient care for severe drug reactions and widespread blistering disease
- Cosmetic surgery — lifts, eyelid surgery, liposuction, hair transplantation
- Injectable wrinkle treatment and dermal filler, which we refer out
- Laser tattoo removal and body contouring
- Emergency care — a spreading, febrile or blistering rash belongs in an emergency room
Where it goes
What we refer on, and the reasoning in each case
Melanoma, after we have biopsied it
Diagnosed here and then managed at a cancer centre, because staging, wider excision, lymph node assessment and any further treatment need a team. We make the referral ourselves with the pathology and the images rather than handing over a telephone number, and we continue your skin surveillance afterwards, which is lifelong.
Skin cancer on the eyelid, lip margin, nose tip or ear cartilage
Referred for staged microscopic surgery with margins checked during the procedure. Not because those cancers are worse, but because a few millimetres changes function and appearance permanently at those sites and the reconstruction is a speciality of its own. Doing it here would be doing it worse.
Anything recurrent, or with an aggressive growth pattern on the pathology
A cancer that has returned under scarred skin has an unpredictable footprint, and certain growth patterns extend much further than they look. Both need margin control as the surgery proceeds.
Severe drug reactions and widespread blistering disease
These are inpatient problems. A rash with fever, mouth or eye involvement, or skin that is peeling or coming away, after starting a new medicine, is an emergency and belongs in a hospital rather than in a clinic appointment.
Cosmetic surgery and injectable cosmetic treatment
We do not do lifts, eyelid surgery, liposuction or hair transplantation, and we do not do wrinkle injections or dermal filler. If that is what you want we will say so plainly and point you elsewhere rather than talk you into something we happen to offer.
Laser tattoo removal and body contouring
Not offered here. Neither is a medical dermatology service and we would rather not pretend otherwise.
Immediate allergy testing for foods, stings and pollens
Different from the patch testing done here, which finds delayed contact allergy. If your history is of swelling, hives or vomiting within minutes of a specific food or a sting, that needs an allergy service and possibly an adrenaline auto-injector.
Anything where the skin is the second problem
Skin change that is a manifestation of something systemic — a rash with joint pain, fevers, weight loss, or organ symptoms — needs a physician alongside us rather than instead of us. We will say so and write to them.
Refusals
Six things we will not do at all
These are not capability limits. They are decisions, and each one costs this practice bookings.
Diagnose from a photograph, a description or a message
The firmest rule in the practice, and /no-diagnosis-online.html sets out the whole reasoning at length.
Prescribe to somebody who has not been examined
Including repeat prescriptions for a condition we have never seen, and including requests passed on by a family member. A prescription without an examination is a guess with your name on it.
Give an antifungal for a nail we have not sampled
Roughly half of thickened toenails are not fungal. Months of tablets and blood tests for a nail that was never infected is a common, expensive and entirely avoidable outcome.
Promise that a screening examination finds everything
It finds most of what is present on the day it is performed. Implying otherwise is the single most common piece of overselling in this field, and it is harmful because a patient who believes they are covered stops looking at their own skin.
Use the word cured about a relapsing condition
Eczema, psoriasis, rosacea, vitiligo, hidradenitis and most alopecias are controlled rather than cured. Describing control as cure sets patients up to feel they have failed when the condition behaves normally.
Name a drug, a device or a board on a public page
Prescription medicines in this speciality are advertised to patients harder than almost anywhere in medicine, and naming one here is advertising a prescription drug to somebody nobody has examined. In the room, we will tell you exactly what and why.
We claim nobody else's approval, and we name nobody's product. Dermatology is regulated in New York State, every physician here is licensed, and the practice is inspected like any other medical office. What we will not do is decorate this website with the seal of a board, a college or an academy as though somebody outside this building has personally vouched for the care you are about to receive. Nobody outside this practice has reviewed it. So instead of a wall of logos, these pages tell you plainly who will examine you, what they will do, what they will not do, what it costs, what can go wrong and how often. Ask us about any of it before you book.
Questions
Scope of care — the questions we are asked most
Why send me elsewhere rather than treat me here?
Because a referral is a judgement about the right setting rather than about the seriousness. Certain sites need margins checked during surgery and a planned reconstruction; melanoma needs a team. A practice that treats everything it is technically able to treat is optimising for its own revenue rather than for your outcome.
Do you actually make the referral, or do I have to chase it?
We make it, with the pathology report and the images, and you leave knowing who it has gone to and roughly when to expect contact. If you have not heard within the time we told you, telephone us and we will chase it. Handing somebody a name and a number at the point they have just had bad news is not a referral.
I want a cosmetic treatment. Will you tell me where to go?
We will tell you plainly that it is not something we do, and we will tell you what to ask whoever you see: who will actually perform it, what their training is, what happens if there is a complication and who manages it, and whether you get the risks in writing before the day. What we will not do is steer you towards a particular practice.
Can you be my dermatologist if I am under a cancer centre?
Yes, and that is the usual arrangement after a melanoma. The centre manages the cancer; we do your ongoing skin surveillance, which is more frequent and more thorough than a routine check and continues for life.
A named diagnosis and a written plan you leave holding
Book an appointment
Pick a physician and a time from the calendar — it shows only the hours each of them genuinely has free. A new patient appointment is thirty minutes, a full skin examination forty-five, and you leave with a named diagnosis written down. If something on your skin has changed, telephone instead and say that word: it is triaged differently.