The panel comments were, as you have no doubt confirmed for yourself, much more positive than the close vote would indicate. In fact there were three votes. Unfortunately the last and most important was the closest one. It is clear from panelist comments that their primary concern was use by non-derms. It is also clear that they did not consider the unevaluables to be false negatives as the FDA presentation and calculation did. These calculations were the basis for the FDA claim that MelaFind results were no better than chance.
The panel comments are largely history at this point and will only carry weight to the degree that someone NEW and/or higher up at the FDA or some other party is called upon to review them. I believe the current review team is fully capable of ignoring their input if left on their own. If the current review team is pressured to make an official decision they may find it difficult to defend their claims in writing. Especially if they are called upon to suggest a study design that answers the concerns they have put forth. It is unlikely that they can come up with a practical study design that does not entail the same kind of assumptions that were made on the first trial. In other words if they have to come up with a workable study design it is likely to look a lot like the one that was already done
It's not the panel that needs to be satisfied that MELA's committment to derm education and training is sufficient. It's the current investigators, and they are obviously not prone to give MELA the benefit of the doubt on this point. The panel made their recommendation and their comments but they have no further role, they will not be lobbying on behalf of MELA, the FDA can dismiss their comments or fail to acknowledge their intent if it suits them. Just as general_strawman can pretend to believe that early Melanoma diagnosis is not in need of improvement.
I'm condident that the post vote comments and few concerns were satisfactorily answered through open and continuous communications since Mela Sciences' commitment to establish and maintain close training and educational relationships with Dermatologists. A Mela Sciences' educated derm-customer is the best customer.