Basics in Dermoscopy
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1 Basics in Dermoscopy Manal Bosseila Professor of Dermatology, Cairo University Member of European Academy Dermatology & Venereology EADV Member of International Dermoscopy Society IDS Member of Aesthetic Academy of Egypt AAEgy
2 Scope of Dermoscopy Usage Infectious Melanocytic Inflammatory/ Vascular Hair (Trichoscopy) Pigmented nonmelanocytic Nail affection
3 Dermoscopic Evaluation Global Features. Colors Local Features
4 COLORs Melanin. White. Red/purple. yellow
5 Melanin location and lesion color Upper epidermis (stratum corneum, stratum spinosum) - Black Dermoepidermal junction - Light-to-dark brown Papillary dermis - Slate blue Reticular dermis - Steel blue
6 Other Colors Keratin: Keratin cysts Blood Fibrosis
7
8 Pigmented Skin Lesion Melanocytic Non-Melanocytic Benign Nevus Melanoma No Pigment Network
9 Melanocytic Lesion PIGMENT NETWORK 3 point check list
10 Pigment network Consists of pigmented network lines and hypopigmented holes.
11 Pigment network
12 Pigment network In melanocytic nevi The distribution is symmetric and regular In melanoma PN has irregular holes, thickened and darkened network lines.
13 Pigmented globules Pigmented globules are round or oval, dark brown or black, and larger than 0.1 mm in diameter.
14 Pigmented globules 1. Nests of pigmented melanocytes (nevus or melanoma) 2. Or because of melanin storage, in melanophage clusters in the papillary dermis.
15 Two Step Algorithm Melanocytic Or Not Benign Nevus Melanoma
16 Pattern Analysis, Step 1 The first step to identifying a melanocytic lesion is to - look for the presence of aggregated globules, Pigment Network. - If absent, diagnosed as nonmelanocytic.
17 Pattern Analysis, Step 2 The main goal: to make an accurate DD between benign melanocytic lesions and melanomas. To distinguish: general appearance of color, architectural order, symmetry of pattern, and homogeneity, known by the acronym CASH.
18 Melanocytic Benign Nevus Melanocytic nevi have few colors, a regular design, and symmetrical patterns Melanoma Or Not MM often has several colors, architectural disorder, asymmetrical patterns, and heterogeneity
19 Algorithm for Melanocytic skin lesions The 3 Point Checklist : Asymmetry of color or structure. Atypical pigment network with irregular holes. Blue-white structures/veil.
20 Blue-white veil A blue-white veil is a ground-glass area of pigmentation that is blue-gray to blue-white in color. This feature is associated with thickening of the epidermis.
21 Blue-white veil It is correlated histologically with compact orthokeratosis and hypergranulosis, with confluent nests of heavily pigmented melanocytes in the dermis. A blue-white veil is often found in melanomas.
22 Regular pigmented net Some central brown dots. Melanocytic nevocellular nevus
23 Algorithm for Melanocytic skin lesions
24
25
26 Pigmented Skin Lesion Melanocytic Non-Melanocytic Benign Nevus Melanoma No Pigment Network
27 Ashfaq A. Marghoob, MD; Ralph Braun, MD; JAMA 2010
28 Blue Nevus Uniform blue color throughout the lesion= pigmented dendritic cells in dermis. Absence of Pigment Network. Absence of Vessels. Sometimes Mottled Scar-like area = Focal Fibrosis
29 Dermatofibroma Central white macule = fibrohistiocytic tumor in dermis close to epidermis. Peripheral fine network of pigmentation= pigmentation of basal layer.
30 Basal cell carcinoma No pigment network Arborizing telangiectasia= tumor angiogenesis. Blue-white color: nests of basal cells in the dermis.
31 Most Characteristic: Grey Structures
32 Seborrheic Keratosis No pigment network Milia-like cysts= intraepid. Keratin-like cysts
33 Angioma/Angiokeratoma Multiple red-blue Lacunae, may vary in size and color in a given lesion= dilated vascular spaces, that are partially or completely thrombosed.
34 Scope of Dermoscopy Usage Infectious Melanocytic Inflammatory/ Vascular Hair (Trichoscopy) Pigmented nonmelanocytic Nail affection
35 Practice Makes Perfect
36
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