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LIVE BLOG: Dermoscopy: Is It For Me?

In this live blog from the Fall SDPA Confernce in Atlanta, GA, Jennifer Holman, MD, discusses “Dermoscopy: Is It For Me?” She starts with a definition of dermoscopy and highlights some of her favorite things about the practice of using dermoscopes. Be sure to visit to dermpa.org/businessdiscounts to find some great deals for SDPA members on dermoscopy equipment and other products.

Objectives: 

  • Define dermoscopy
  • Explain the applications of dermoscopy
  • Recognize dermoscopy basics
  • Identify dermatoscopic characteristics of melanoma
  • Identify dermatoscopic characteristics of common non-pigmented lesions
  • Investment vs Return

Is Dermoscopy for Me?

Dermoscopy is the examination of skin lesions with a dermatoscope. It is primarily used as a aid to differentiate benign and malignant lesions.

History of Dermoscopy:

  • 1663: Idea introduced by Kolhaus 
  • 1878: Improved by addition of oil immersion by Ernest Abbe
  • 1893: Transferred to skin surface by Unna
  • 1920: Johann Saphier added a built-in light source
  • 1950: Goldman coined the term “dermascopy” and looked at pigmented lesions
  • 1971: Rona MacKie used for diagnosis

Applications for Dermatoscopes:

  • Aid in melanoma diagnosis
  • Monitor pigmented lesions
  • Diagnosis of scabies or pubic lice
  • Wart diagnosis
  • Fungal diagnosis
  • Differentiate and diagnose tinea vs alopecia areata 
  • Trichoscopy
  • Differentiation of various papulosquamous disorders
  • Surgical margin determination 
  • Increase diagnostic accuracy for melanoma
  • Increased sensitivity by 20%
  • Increased specificity by 10%
  • Use of dermoscopy increases clinical diagnostic accuracy between 5 and 30% over clinical visual inspection, based on the type of skin lesion and the experience of the physician

“The evolution of dermoscopy has resulted in the development of a new generation of excellent and more confident clinicians. This ultimately advances our most important goal, namely the provision of the best possible care for our patients!”   – Ashfaq A Marghoob, MD J Am Acad Dermatol 2013;69:814-5

Dermoscopy Basics:

  • Melanocytic lesions are composed of 3 basic structures
  • Pigment Network
  • Dots and Globules
  • Streaks
  • Amorphous Areas
  • Blue Areas

Pigment Network:

  • A delicate regular grid of brownish lines over a light brown background
  • Correlates to rete ridges (pigment) and dermal papillae
  • A pigment network is the hallmark of a melanocytic lesion
  • Reticular Pattern
  • Lattice like structure
  • Localized or Diffuse

Melanocytic: Benign or Not? Things to consider:

  • Color
  • The Tyndall Effect
  • Symmetry
  • Shape
  • Pattern

Mulitple Methods for Dermascopy (is it melanocytic or not):

  • 3 point Rule – see below
  • Menzies Method 
  • 7 point Rule – see below 
  • Pattern Analysis 
  • ABCD 
  • Kittler Method – great, however the base is pattern recognition – look into it if you enjoy dermoscopy

3 point method: 
Scoring: 1 point for each. If you get 2 points then you should biopsy.

  • Asymmetry of color
  • Asymmetry of pattern
  • Blue or white structures

7 point method:
Scoring: majors get 2 points, minors get 1 point – if you get greater than 3 you should biopsy.

Major Criteria 

  • Irregular Pigment Network 
  • Blue White Veil 
  • Irregularvascularity

Minor Criteria 

  • Irregular dots and globules 
  • Irregularstreaks 
  • Irregularblotches 
  • RegressionStructures

Non melanoma lesions:

  • Seborrheic keratosis
  • BCC/pigmented bcc
  • Dermatofibramas

Determinations of non melanoma lesions:

  • No true network/globules
  • Milia like cysts
  • Clods
  • Fat fingers/cerebriform surface
  • Fissures/crypts

Basal cell carcinoma (things to look for):

  • Absence of pigment network
  • Linear and arborizing telangiectasia
  • Leaf like areas (typically more difficult to appreciate)
  • Blue-grey areas

Vascular lesions:

  • Widespread lacunae
  • Hemorrhage (need a history)

 

Image: Wikimedia Commons




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