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Learn Dermoscopy with Dermoscopy: The Essentials - Expert Consult Online and Print 2e 2nd Edition PRG pdf



Dermoscopy: The Essentials: Expert Consult - Online and Print 2e 2nd Edition PRG pdf




Do you want to learn how to diagnose skin lesions more accurately and less invasively? Do you want to master a technique that can save lives and reduce costs? Do you want to access the latest knowledge and guidance from four world-renowned experts in dermatology? If you answered yes to any of these questions, then you need to read this article.




DermoscopyTheEssentialsExpertConsultOnlineandPrint2e2ndEditionPRGpdf



In this article, I will introduce you to a book that covers all aspects of performing dermoscopy and interpreting results. The book is called Dermoscopy: The Essentials: Expert Consult - Online and Print 2e 2nd Edition PRG pdf, written by Drs. Peter Soyer, Giuseppe Argenziano, Rainer Hofmann-Wellenhof, and Iris Zalaudek. These authors are leaders in the field of dermoscopy, with decades of experience and hundreds of publications. They have distilled their wisdom and expertise into this concise and practical guide that will help you improve your skills and confidence in dermoscopy.


But what is dermoscopy exactly? And why is it so important? Let's find out.


What is dermoscopy and why is it important?




Dermoscopy is a technique that uses a handheld device called a dermatoscope to magnify the skin and reveal features that are not visible to the naked eye. It can help diagnose skin lesions such as melanoma, basal cell carcinoma, seborrheic keratosis, and more.


Dermoscopy is important because it can improve the accuracy and early detection of skin cancer, which is the most common and deadly form of cancer in the world. According to the World Health Organization, there are about 3 million new cases and 300,000 deaths from skin cancer every year. Melanoma, the most dangerous type of skin cancer, accounts for about 75% of skin cancer deaths. Early diagnosis and treatment of melanoma can significantly improve the survival rate and quality of life of patients.


Dermoscopy can also reduce the need for biopsies, which are invasive, costly, and time-consuming procedures that involve removing a piece of skin and examining it under a microscope. Biopsies can cause scarring, infection, bleeding, and pain. Dermoscopy can help avoid unnecessary biopsies by ruling out benign lesions that do not require further investigation. It can also help identify suspicious lesions that need to be biopsied or referred to a specialist.


The benefits of dermoscopy




Some of the benefits of dermoscopy are:



  • It can increase the sensitivity and specificity of diagnosing skin lesions, especially melanoma. Sensitivity is the ability to correctly identify positive cases, while specificity is the ability to correctly exclude negative cases. Studies have shown that dermoscopy can improve the sensitivity and specificity of diagnosing melanoma by up to 30% compared to naked eye examination.



  • It can reduce the number of unnecessary biopsies by up to 50%, saving money, time, and resources. It can also reduce the anxiety and stress of patients who are waiting for biopsy results.



  • It can enhance the communication and education between clinicians and patients. Dermoscopy can help explain the diagnosis and prognosis of skin lesions to patients, as well as provide visual feedback on the effectiveness of treatments. It can also help patients monitor their own skin and detect any changes or new lesions.



  • It can facilitate the learning and research in dermatology. Dermoscopy can help trainees and students improve their diagnostic skills and knowledge of skin diseases. It can also help researchers collect and analyze data on skin lesions, as well as develop new algorithms and tools for dermoscopic diagnosis.



The challenges of dermoscopy




Despite its benefits, dermoscopy also poses some challenges that need to be overcome. Some of these challenges are:



  • It requires proper training and experience to perform and interpret correctly. Dermoscopy is not a simple technique that anyone can use without guidance. It involves recognizing and analyzing complex patterns and criteria that vary depending on the type, location, and stage of the lesion. It also requires a good knowledge of the differential diagnosis and management of skin diseases. Without adequate training and experience, dermoscopy can lead to false positives or false negatives, which can have serious consequences for patients.



  • It requires appropriate equipment and settings to perform optimally. Dermoscopy needs a good quality dermatoscope that provides sufficient magnification, illumination, polarization, and resolution. It also needs a clear contact medium between the dermatoscope and the skin, such as oil, alcohol, or gel. The skin should be clean, dry, and hairless before performing dermoscopy. The ambient light should be dimmed to avoid glare and reflections.



  • It requires constant updating and learning to keep up with the advances in the field. Dermoscopy is a dynamic and evolving technique that is constantly being improved by new research and innovation. New patterns and criteria are being discovered and validated for different types of lesions and situations. New devices and software are being developed to enhance the performance and usability of dermoscopy. Clinicians who use dermoscopy need to stay updated on the latest developments and evidence in order to provide the best care for their patients.



How to perform dermoscopy and interpret results




Now that you know what dermoscopy is and why it is important, you may be wondering how to actually do it and what to look for. In this section, I will give you a brief overview of how to perform dermoscopy and interpret results, based on the book Dermoscopy: The Essentials: Expert Consult - Online and Print 2e 2nd Edition PRG pdf.


The equipment and settings for dermoscopy




The first thing you need for dermoscopy is a dermatoscope. A dermatoscope is a device that consists of a magnifying lens (usually 10x) and a light source (usually LED). There are two main types of dermatoscopes: contact dermatoscopes and non-contact dermatoscopes.


Contact dermatoscopes require direct contact between the device and the skin, using a liquid medium such as oil or gel. They provide a clear view of the epidermis ( the outermost layer of the skin) and the dermoepidermal junction (the interface between the epidermis and the dermis). They also eliminate the surface reflection of light, which can obscure the underlying structures. Contact dermatoscopes can be either polarized or non-polarized. Polarized dermatoscopes use cross-polarized filters to block the horizontally polarized light that causes surface reflection. Non-polarized dermatoscopes use a single light source without any filters.


Non-contact dermatoscopes do not require direct contact or liquid medium between the device and the skin. They provide a clear view of the dermis (the deeper layer of the skin) and the superficial vascular structures. They also allow for a larger field of view and easier maneuverability. Non-contact dermatoscopes are usually polarized, but some models can switch between polarized and non-polarized modes.


The choice of dermatoscope depends on personal preference, availability, and cost. Some clinicians may prefer to use both types of dermatoscopes for different purposes and situations. For example, contact dermatoscopy may be more suitable for pigmented lesions, while non-contact dermatoscopy may be more suitable for vascular lesions.


The settings for dermoscopy include the following:



  • The skin should be clean, dry, and hairless before performing dermoscopy. Any dirt, makeup, or creams should be removed with alcohol or water. Any hair should be shaved or clipped to avoid obscuring the lesion.



  • The contact medium should be clear and transparent, such as oil, alcohol, or gel. It should cover the entire lesion and create a smooth surface without bubbles or air pockets.



  • The ambient light should be dimmed to avoid glare and reflections. The room should be quiet and comfortable for both the clinician and the patient.



  • The dermatoscope should be held perpendicular to the skin surface and moved slowly and gently over the lesion. The clinician should adjust the focus, magnification, and illumination as needed to obtain a clear and sharp image.



  • The dermoscopic image should be observed carefully and systematically, looking for patterns, colors, structures, and features that are characteristic of different types of lesions.



The basic principles and terminology of dermoscopy




The basic principles of dermoscopy are based on the concept of optical properties of light and skin. When light hits the skin surface, it can be reflected, refracted, scattered, or absorbed by different structures within the skin layers. The amount and type of light that reaches the observer's eye determines the colors and patterns that are seen on dermoscopy.


The terminology of dermoscopy is based on the description of colors and structures that are seen on dermoscopic images. Colors are defined by their hue (eg, red, blue, black) and intensity (eg, light, dark). Structures are defined by their shape (eg, round, linear), size (eg, small, large), distribution (eg, diffuse, focal), arrangement (eg, regular, irregular), and location (eg, epidermis, dermoepidermal junction, papillary dermis). Structures are also classified by their significance (eg, specific, nonspecific, benign, malignant).


The most common colors and structures seen on dermoscopy are summarized in the following table:


Color Origin Examples of lesions ------------------------------------ Black Melanin in stratum corneum or upper epidermis Melanoma, seborrheic keratosis, solar lentigo Brown Melanin in mid or lower epidermis Melanocytic nevi, melanoma, lentigo simplex Blue Melanin in dermis Blue nevus, melanoma, Mongolian spot Gray Melanin in dermis or epidermis Melanoma, basal cell carcinoma, postinflammatory hyperpigmentation Red Hemoglobin in blood vessels Hemangioma, angiokeratoma, pyogenic granuloma White Collagen or keratin in dermis or epidermis Scar, regression structures, milia-like cysts Yellow Lipids or keratin in stratum corneum or epidermis Seborrheic keratosis, xanthoma, clear cell acanthoma Structure Shape Size Distribution Arrangement Location Examples of lesions ---------------------------------------------------------------------------------- Pigment network Mesh-like pattern of pigmented lines and holes Variable Diffuse or focal Regular or irregular Epidermis or dermoepidermal junction Melanocytic nevi, melanoma Dots and globules Small roundish structures 0.1 mm (globules) Diffuse or focal Regular or irregular Epidermis or papillary dermis Seborrheic keratosis, melanocytic nevi, melanoma Blotches (structureless areas) Amorphous areas of pigmentation without any specific shape or structure Variable Diffuse or focal Regular or irregular Epidermis or dermis Melanoma, basal cell carcinoma, seborrheic keratosis Streaks (radial streaming) Linear extensions of pigment at the periphery of a lesion Variable Peripheral or central Regular or irregular Epidermis or dermoepidermal junction Melanocytic nevi, melanoma Comedo-like openings (follicular openings) Small roundish brown to black structures corresponding to dilated follicular openings filled with keratin and/or melanin 0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) 0.1 mm (dots) or >0.1 mm (globules) Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Focal and clustered around follicles Regular or irregular Epidermis Seborrheic keratosis, solar lentigo, dermatofibroma Milia-like cysts Small roundish white to yellow structures corresponding to keratin-filled cysts 0.1 mm (globules) Diffuse or focal Regular or irregular Epidermis Seborrheic keratosis, basal cell carcinoma, melanocytic nevi Vascular structures Red to purple structures corresponding to blood vessels Variable Diffuse or focal Regular or irregular Papillary dermis Hemangioma, angiokeratoma, pyogenic granuloma, basal cell carcinoma The patterns and criteria of dermoscopic diagnosis




The patterns and criteria of dermoscopic diagnosis are based on the recognition and analysis of colors and structures that are characteristic of different types of lesions. There are different methods and algorithms that can help the clinician to classify lesions into melanocytic or non-melanocytic, benign or malignant, and specific diagnoses. Some of the most commonly used methods and algorithms are:



  • The two-step algorithm: This is a simple and practical method that consists of two steps. The first step is to differentiate melanocytic lesions from non-melanocytic lesions, based on the presence or absence of a pigment network. The second step is to differentiate benign melanocytic lesions from malignant melanocytic lesions, based on the presence or absence of specific criteria for melanoma.



  • The ABCD rule: This is a method that assigns scores to four criteria: Asymmetry, Border irregularity, Color variegation, and Dermoscopic structures. The scores are added up to obtain a total score that ranges from 0 to 8.5. A score of 4.75 or higher indicates a high probability of melanoma.



  • The seven-point checklist: This is a method that evaluates seven criteria: Atypical pigment network, Blue-whitish veil, Atypical vascular pattern, Irregular streaks, Irregular dots or globules, Irregular blotches, and Regression structures. The presence of any criterion counts as one point. A score of 3 or more points indicates a high probability of melanoma.



  • The revised pattern analysis: This is a method that involves a comprehensive analysis of colors, structures, patterns, and clues that are specific for different types of lesions. It requires a high level of expertise and experience in dermoscopy.



Melanocytic lesions




Melanocytic lesions are lesions that originate from melanocytes, the cells that produce melanin in the skin. They include benign lesions such as melanocytic nevi (moles), and malignant lesions such as melanoma.


By dermoscopy, melanocytic lesions are usually characterized by the presence of a pigment network, which is a mesh-like pattern of pigmented lines and holes that corresponds to the rete ridges and dermal papillae of the skin. However, not all melanocytic lesions have a pigment network, and not all lesions with a pigment network are melanocytic.


Other dermoscopic features that can help identify melanocytic lesions are dots and globules (small roundish structures), streaks (linear extensions of pigment), blotches (amorphous areas of pigmentation), blue-whitish veil (a bluish-white opaque area), regression structures (white scar-like areas), and milia-like cysts (small white-yellow structures).


Some examples of dermoscopic images of melanocytic lesions are shown below:


Melanocytic nevus with regular pigment network ----------------------------------------------- ![Melanocytic nevus with regular pigment network](https://dermnetnz.org/assets/Uploads/dermoscopy-course/dermoscopy-features/dermoscopy-features-1.jpg) Melanoma with irregular pigment network ---------------------------------------- ![Melanoma with irregular pigment network](https://dermnetnz.org/assets/Uploads/dermoscopy-course/dermoscopy-features/dermoscopy-features-2.jpg) Melanocytic nevus with dots and globules ------------------------------------------ ![Melanocytic nevus with dots and globules](https://dermnetnz.org/assets/Uploads/dermoscopy-course/dermoscopy-features/dermoscopy- features-3.jpg) Melanoma with blue-whitish veil --------------------------------- ![Melanoma with blue-whitish veil](https://dermnetnz.org/assets/Uploads/dermoscopy-course/dermoscopy-features/dermoscopy-features-4.jpg) Non-melanocytic lesions




Non-melanocytic lesions are lesions that do not originate from melanocytes, but from other cells or structures in the skin. They include benign lesions such as seborrheic keratosis, hemangioma, angiokeratoma, and pyogenic granuloma, and malignant lesions such as basal cell carcinoma and squamous cell carcinoma.


By dermoscopy, non-melanocytic lesions are usually characterized by the absence of a pigment network, and the presence of other colors and structures that are specific for each type of lesion. For example:



  • Seborrheic keratosis: This is a common benign lesion that appears as a warty or greasy plaque on the skin. By dermoscopy, it shows comedo-like openings (small roundish brown to black structures corresponding to dilated follicular openings filled with keratin and/or melanin), milia-like cysts (small roundish white to yellow structures corresponding to keratin-filled cysts), fissures and ridges (linear or branched structures forming a cerebriform or brain-like pattern), and moth-eaten borders (irregular peripheral margins with notches).



  • Hemangioma: This is a benign vascular tumor that appears as a red to purple nodule or plaque on the skin. By dermoscopy, it shows vascular structures (red to purple structures corresponding to blood vessels), such as lacunes (large roundish or oval structures), lagoons (large irregular structures), or red dots (small roundish structures).



  • Angiokeratoma: This is a benign vascular lesion that appears as a dark red to black papule or plaque on the skin. By dermoscopy, it shows lacunes (large roundish or oval structures) with a whitish veil (a white opaque area) covering part or all of the lesion.



  • Pyogenic granuloma: This is a benign vascular lesion that appears as a bright red papule or nodule on the skin. By dermoscopy, it shows vascular structures (red to purple structures corresponding to blood vessels), such as polymorphous vessels (various shapes and sizes of vessels), red dots and globules (small roundish structures), and white collarette (a white ring around the base of the lesion).



Basal cell carcinoma: This is a common malignant tumor that arises from the basal layer of the epidermis. It appears as a pearly or translucent nodule or plaque on the skin. By dermoscopy, it shows arborizing vessels (branching tree-like vessels), blue-gray ovo


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