dermoscopy

or dermatoscopy

To help see with the eye what is in

front of the eye --> Dermoscopy
why perform dermoscopy?
 MELANOMA
VS
DYSPLASTIC NEVUS
Text
 CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF
MELANOMA IN AUSTRALIA AND NEW ZEALAND 2008-2009

Based of grade A evidence (the body of evidence that can be trusted to

guide practice) the guidelines committee published that training and
utilization of dermoscopy is recommended for clinicians routinely examining
pigmented skin lesions.
British Journal of dermatology 2008, 159, 669-686

TITLE: DERMOSCOPY COMPARED WITH NAKED EYE

EXAMINATION FOR THE DIAGNOSIS OF PRIMARY MELANOMA:
A META-ANALYSIS OF STUDIES PERFORMED IN A CLINICAL
SETTING

CONCLUSION: THERE IS NOT A SINGLE STUDY THAT SHOWS

THAT DERMOSCOPIC DIAGNOSIS IS WORSE THAN NAKED EYE
DIAGNOSIS!
NAKED EYE -> ABCDE
dermoscopy -> a pANiC
ASYMMETRICAL
PATTERN
ATYPICAL
NETWORK
interesting
CLUES
1. ASYMMETRICAL PATTERN

2. ATYPICAL NETWORK

3. INTERESTING CLUES
1. asymmetRICAL PATTERN
 PATTERN=
COLOR
+
STRUCTURE
PATTERN-->color
 PATTERN-->Structure

Lines or streaks and/or

Amorphous structureless areas (Blotches/Clods)

and/or

Globules and Dots

 STRUCTURE

....
dots
globules

amorphous structureless
pigment network
areas (clods or blotches)

(
1. melanocytic
2. melanoma

..
...
....
ASYMMETRICAL
PATTERN
ATYPICAL
NETWORK
interesting
CLUES
 PIGMENT Network

Reticular/branched

Pseudonetwork

Parallel
 PIGMENT NETWORK

Reticular network

Atypical nevus
Reticular network

nevus
 Pseudonetwork

Solar Lentigo
 Parallel furrow

plantar nevus
dermoscopic foundation -> 2
step algorithm
 FIRST STEP

SKIN LESION

MELANOCYTIC NON-MELANOCYTIC

DERMATOFIBROMA
BASAL CELL CA
SEBORRHEIC KERATOSIS
HEMANGIOMA/VASCULAR
 SECOND STEP
SKIN LESION

MELANOCYTIC NON-MELANOCYTIC

BENIGN OR MALIGNANT
 FIRST STEP

SKIN LESION

MELANOCYTIC NON-MELANOCYTIC

PIGMENT NETWORK (GRID), HOMOGENEOUS

(STRUCTURELESS) PIGMENT
(BLOTCHES/CLODS), PIGMENT GLOBULES OR
DOTS, PIGMENT STREAKS
First Step
 First Step

junctional nevus
First Step
First Step
First step
First Step
First Step
First Step
 SECOND STEP
SKIN LESION

MELANOCYTIC NON-MELANOCYTIC

BENIGN OR MALIGNANT
 benign vs melanoma

ABCD rule

Blums modified ABC-point list

Menzies method

7-point rule

3-point checklist
 Benign vs Malignant
ABCD RULE
Asymmetry
In perpendicular axes: contour, colours and structures
0-2
1.3
0 - 2.6
Borders
8 segments: abrupt ending of pigment pattern
0-8
0.1
0 - 0.8
Colors
White, red, light-brown (tan), dark-brown, blue-grey, black
1-6
0.5
0.5 - 3.0
Differential structural components
1-5
0.5
0.5 - 2.5
Total score
Benign

<4.76

Suspicious

4.76-5.45

Melanoma

>5.45
 BLUMS ABC-POINT LIST

A - ASYMMETRY OF OUTER SHAPE OR

DIFFERENTIAL STRUCTURES INSIDE THE
LESION IN AT LEAST 1 AXIS

B - THE ABRUPT CUTOFF OF A NETWORK AT

THE BORDER IN AT LEAST ONE QUARTER OF
CIRCUMFERENCE

C - 3 OR MORE COLORS

D - 3 OR MORE DIFFERENTIAL STRUCTURES

E - NOTICED CHANGE (EVOLUTION) IN < 3MOS

MONTHS
 MENZIES METHOD

Negative features (benign lesions)

Positive features (melanoma)

 menzies negative features

Symmetrical pattern (color & structure)

Single color
 menzies positive features
(clues)
Blue-white veil

Multiple brown dots

Pseudopods

Radial streaming

Scar-like depigmentation

Multiple (5-6) colors

Multiple blue/grey dots

Broadened network
 Seven-point rule
Score of 3 or more indicates melanoma
Atypical pigment network (2)

Blue-white veil (2)

Atypical vascular pattern (2)

Irregular streaks (1)

Irregular dots/globules (1)

Irregular blotches (1)

Regression structures (1)

 3 point checklist
biopsy if 2 are present

Asymmetry of color and structure in one or two

perpendicular axes (ASYMMETRICAL PATTERN)

Atypical pigment network: pigment network with

irregular holes and/or thick lines (ATYPICAL
NETWORK)

Blue-white structures: any type of blue and/or white

color, i.e., combination of blue-white veil and
regression structures (INTERESTING CLUES)
 clues to melanoma

Asymmetric radial lines and/or pseudopods

Asymmetric dots along the periphery

Polymorphous vessels

Chrysalis structures

Blue-white veil

Eccentric Location of: structureless areas, globules, clods, dots, pseudopods,

white lines, etc

Focal sharply cut-off border

Reverse pigment network

Eccentric location of globules, broadened network
Pseudopods
Radial streaming, broadened network

Melanoma
 Atypical pseudonetwork
radial streaming

Atypical pseudonetwork
Asymmetrical radial lines (streaming)

Asymmetric radial lines

blue white veil
lines-radial
 Radial streaming, eccentric
blotch, evidence of regression
scar-like regression, atypical vascular
pattern
chrysalis structures
 GUIDING PRINCIPLE

nevus melanoma
1 color > 1 color
1 structure > 1 structure
symmetric asymmetric
normal network atypical network
 Case Presentations
1st: naked eye
2nd: dermoscopy-->A PANIC
3rd: histology
0415362
0415362
0415362
0415362
Atypical Nevus
(Clarks nevus)
IF IN DOUBT, CUT IT OUT

OR AT LEAST BIOPSY IT
Atypical Nevus (Clarks nevus)
Ink spot lentigo
Recurrent (and persistent) nevus
Melanoma arising in a nevus
04116662
04116662
04116662
04116662
MELANOMA
 Dermoscopy

Asymmetric Pattern (color & structure)

Atypical Network

Important Clues

Avoid A PANIC & Biopsy all suspicious lesions.

 dermoscopy
or dermatoscopy

To help see with the eye what is in

front of the eye --> Dermoscopy

Avoid A PANIC
The End