Conditions we treat in Woodside, NY

No before-and-after photographs, and no promised outcome. There are no before-and-after photographs on this website and there never will be. Every set you have seen somewhere else was chosen from a much larger pile, and the second picture is usually taken in different light, at a different angle, at a different point in a flare cycle. In dermatology the dishonesty is sharper than in most fields, because nearly every condition here fluctuates on its own — photograph any relapsing skin disease at its worst and again at its best and you have a persuasive pair of images that demonstrates nothing about the treatment in between. What we publish instead is what a treatment typically achieves, in how long, in what proportion of people, and how often it does not work.

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.

• Start from what you would actually say

  Almost nobody arrives with a diagnosis. This page starts from the sentence people say at the desk and maps it to what is usually behind it. /concerns.html

• Why we will not look at a photograph

  The firmest rule in the practice, at length: what an examination does that an image cannot, what mole-checking applications actually sell, and the limited things a photograph is genuinely good for. /no-diagnosis-online.html

• What results really look like

  Why there are no before-and-after photographs anywhere on this site — the argument is stronger in dermatology than anywhere else, because nearly every condition here fluctuates on its own. /results-and-expectations.html

• Safety and risks

  What can go wrong with each family of treatment, how likely it is, and how we screen for it — including the risk of doing nothing, which belongs on the same page. /safety-and-risks.html

• Scope of care

  What leaves this building and where it goes, plus the six things we refuse to do at all. Printed out rather than left to be inferred. /scope-of-care.html

• How an appointment actually runs

  Six stages, and the second — the history — is where most of the diagnosis is made. /process.html

• Sun protection

  The only genuinely preventive page here, and the one we would keep if we could keep one. No product is named. /sun-protection.html