Introduction to Dermoscopy. Nicholas Compton, MD June 16, 2010
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1 Introduction to Dermoscopy Nicholas Compton, MD June 16, 2010
2 Overview What is dermoscopy Brief history Types of dermoscopy General approach to lesion of interest 2 step algorithm 3-point checklist Practice Conclusions
3 What is Dermoscopy Non-invasive diagnostic technique for the in-vivo observation of pigmented skin lesions. Permits the recognition of morphologic structures not visible by the naked eye.
4 History 1663: J. C. Kohlhaus: First observation of vessels of nail matrix with a microscope G. Unna: For the first time the term Diaskopie is used when studying a case of lupus vulgaris with a drop of immersion oil and a glass-slide I. Saphier: The term Dermatoskopie is coined and capillaries of normal and pathologic skin are studied for the first time L. Goldman: Analysis of nevi and melanomas using different monoocular epiluminescence tools L. Goldman: The first portable dermatoscope is produced P. Fritsch and R. Pechlaner: Benign and malignant skin lesions are differentiated on the basis of various pigment network features H.P. Soyer et al.: Dermoscopic criteria are correlated with underlying histopathologic structures J. Kreusch and G. Rassner: First Atlas of dermoscopy published in the literature.
5 Type of Dermoscopy Non-polarized light Requires liquid interface Requires contact w/ skin Polarized light Non-contact Contact
6 Differences: NPD & PD Colors Sharper w/ NPD Brown/Blue darker w/ PD Reds better seen w/ PD
7 Differences: NPD & PD Structures Vasculature better seen w/ PNCD Milia-like cysts (horn cysts) better w/ NPD
8 Differences: NPD & PD Features Vessel shape better w/ PNCD Peppering better w/ NPD
9 Your Dermatoscope
10 Technique Interface fluid (mineral oil, water, alcohol) Roll contact plate Eye close to eye piece Adjust focusing ring
11 Approach to Pigmented Lesions 2 Step Algorithm 1. Melanocytic vs. Non-melanocytic 2. Benign vs. Malignant
12 Step 1: Melanocytic vs. Non-Melanocytic Features of melanocytic lesions? Pigment network
13 Reticular Network
14 Dermatofibroma
15 Step 1: Melanocytic vs. Non-Melanocytic Features of melanocytic lesions? Pigment network Aggregated globules
16 Aggregated Globules
17 Step 1: Melanocytic vs. Non-Melanocytic Features of melanocytic lesions? Pigment network Aggregated globules Branched streaks
18 Branched Streaks
19 Step 1: Melanocytic vs. Non-Melanocytic Features of melanocytic lesions? Pigment network Aggregated globules Branched streaks Homogenized blue
20 Homogenous Blue
21 Step 1: Melanocytic vs. Non-Melanocytic Features of melanocytic lesions? Pigment network Aggregated globules Branched streaks Homogenized blue Parallel pattern (acral)
22 Parallel Pattern
23 Step 1: Melanocytic vs. Non-Melanocytic Features of seborrheic keratosis? Milia-like cysts
24 Milia-Like Cysts
25 Step 1: Melanocytic vs. Non-Melanocytic Features of seborrheic keratosis? Milia-like cysts Comedo-like openings
26 Comedo-like Openings
27 Step 1: Melanocytic vs. Non-Melanocytic Features of seborrheic keratosis? Milia-like cysts Comedo-like openings Fissures/ridges
28 Fissures/Ridges
29 Step 1: Melanocytic vs. Non-Melanocytic Features of seborrheic keratosis? Milia-like cysts Comedo-like openings Fissures/ridges Light brown fingerprint-like structures
30 Fingerprint-like Structures
31 Step 1: Melanocytic vs. Non-Melanocytic Features of Basal Cell Carcinoma? Absent pigment network & one of the following: Arborizing vessels
32 Arborizing Vessels
33 Step 1: Melanocytic vs. Non-Melanocytic Features of Basal Cell Carcinoma? Absent pigment network & one of the following: Arborizing vessels Leaf-like structures
34 Leaf-like Structures
35 Leaf-like Structures
36 Step 1: Melanocytic vs. Non-Melanocytic Features of Basal Cell Carcinoma? Absent pigment network & one of the following: Arborizing vessels Leaf-like structures Large blue-grey ovoid nests
37 Blue-grey Ovoid Nests
38 Step 1: Melanocytic vs. Non-Melanocytic Features of Basal Cell Carcinoma? Absent pigment network & one of the following: Arborizing vessels Leaf-like structures Large blue-grey ovoid nests
39 Multiple Blue-grey Globules
40 Multiple Blue-grey Globules
41 Step 1: Melanocytic vs. Non-Melanocytic Features of Basal Cell Carcinoma? Absent pigment network & one of the following: Arborizing vessels Leaf-like structures Large blue-grey ovoid nests Multiple blue-grey globules Spoke wheel areas
42 Spoke-wheel Areas
43 Spoke-wheel Areas
44 Step 1: Melanocytic vs. Non-Melanocytic Features of Basal Cell Carcinoma? Absent pigment network & one of the following: Arborizing vessels Leaf-like structures Large blue-grey ovoid nests Multiple blue-grey globules Spoke wheel areas Ulceration (exception: can be seen in melanoma)
45 Ulceration
46 Step 1: Melanocytic vs. Non-Melanocytic Features of vascular lesion? Red-blue lacunae
47 Red-Blue Lacunae
48 Step 1: Melanocytic vs. Non-Melanocytic Features of vascular lesion? Red-blue lacunae Red-blue to blue-black homogenous areas
49 Red-black Homogenous Areas
50 Step 1: Melanocytic vs. Non-Melanocytic None of the aforementioned criteria? = Melanocytic
51 Step 2: Benign vs. Malignant Melanocytic Lesion? Several algorithms 3-point checklist* Pattern Analysis Menzies ABCD 7-point checklist
52 3-point Checklist Distinguish malignant from benign Screening tool Novice dermoscopists
53 3-point Checklist Asymmetry Color & Structure Atypical network Blue-white structures
54 Pattern Analysis Complex Requires practice More advanced
55 Pattern Analysis 5 Global Patterns for melanocytic nevi 5 Patterns for Acral melanocytic nevi 5 Melanoma-specific local criteria 5 Site-specific melanoma-specific criteria 6 Criteria for non-melanocytic lesions
56 5 Patterns of Acral Melanocytic Nevi Parallel Furrow
57 Parallel Furrow
58 5 Patterns of Acral Melanocytic Nevi Parallel Furrow Lattice-like
59 Lattice-like
60 5 Patterns of Acral Melanocytic Nevi Parallel Furrow Lattice-like Fibrillar
61 Fibrillar
62 5 Patterns of Acral Melanocytic Nevi Parallel Furrow Lattice-like Fibrillar Parallel Ridge
63 Parallel Ridge
64 5 Patterns of Acral Melanocytic Nevi Parallel Furrow Lattice-like Fibrillar Parallel Ridge Non-specific
65 Practice!
66 Conclusions Dermoscopy is well entrenched Practice is required to improve 3-point checklist is easy to implement
67 Resources Color Atlas of Dermatoscopy, 2nd edition. Stoltz, et al. Blackwell Publishing, Dermoscopy: The Essentials. Johr, et al. Elsevier Limited, Advanced Course Next Year?
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