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
pigment network
amorphous structureless
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
BENIGN OR MALIGNANT
NON-MELANOCYTIC
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
BENIGN OR MALIGNANT
NON-MELANOCYTIC
benign vs melanoma
ABCD rule
Blum’s 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
BLUM’S 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
1 color
1 structure
symmetric
normal network
melanoma
> 1 color
> 1 structure
asymmetric
atypical network
Case Presentations
1st: naked eye
2nd: dermoscopy-->A PANIC
3rd: histology
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Atypical Nevus
(Clark’s nevus)
IF IN DOUBT, CUT IT OUT
OR AT LEAST BIOPSY IT
Atypical Nevus (Clark’s nevus)
Ink spot lentigo
Recurrent (and persistent) nevus
Melanoma arising in a nevus
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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