The Reply

Abstract

We greatly appreciate the letter by Dr. De Giorgi et al, urging clinicians to "Consider the early diagnosis of melanoma in foot examinations of older adults" in response to our manuscript, "Foot Examination for Older Adults." 1 We agree that the skin examination of older adults is a critical part of the foot examination, and appreciate the importance of considering melanoma when examining the feet. Many older adults may have mobility limitations that make it difficult to examine the skin on their feet thoroughly and detect abnormalities, 2 and as the authors point out, this delay in diagnosis of a melanoma on the feet or toenails may lead to worse outcomes, and even death. Because the feet are often hidden from view, especially in colder climates when closed shoes are worn for much of the year, a thorough examination of the feet can yield important and potentially life-saving information, 3 from finding a melanoma to recognizing what we call "the long toenail sign" 4 as a potential warning of cognitive or functional decline in a patient in need of further support. 5