Dermoscopy Workshop An Introduction to Dermoscopy

1. Dermoscopy Workshop An Introduction to Dermoscopy Dr Nicky Jackson GPwSI Dermatology

2. Aims • To understand the role of a dermatoscope in clinical practice. • To gain more confidence in using a dermatoscope to help diagnose skin lesions.

3. Objectives • To review the role of the dermatoscope • To look at the common features of lesions • 1. Dermatofibroma • 2. Haemangioma • 3. Seborrhoeic Wart • 4. Naevus • 5. Melanoma • To review with a quiz!

4. Dermatoscopes

5. Dermatoscopes

6. The Role of the Dermatoscope?

7. Dermoscopy • Magnify & Illuminate skin lesions to assess structures more easily • To show patients images of their lesions • A diagnostic aid • Benign vs malignant • To add to clinical records to keep lesions under review • To aid referral/ triage

8. Dermatofibroma • Dermatofibromas most often occur on the legs and arms, but may also arise on trunk or any site of the body • People may have 1 or up to 15 lesions. • Size varies from 0.5–1.5 cm diameter; most lesions are 7–10 mm diameter. • They are firm nodules tethered to the skin surface and mobile over subcutaneous tissue. • The skin dimples on pinching the lesion. • Colour may be pink to light brown in white skin, and dark brown to black in dark skin; some appear paler in the centre. • They do not usually cause symptoms, but they are sometimes painful or itchy.

9. Dermatofibroma

10. Dermatofibroma

11. Dermatobibroma

12. Dermatofibroma under Dermatoscope

13. Dermatofibroma under Dermatoscope

14. Angioma • Angioma or haemangioma describes a benign overgrowth of blood vessels in the skin.  • Angiomas are due to proliferating endothelial cells; these are the cells that line blood vessels. • Acquired angiomas include: • Cherry angioma • Spider angioma (spider naevus) • Venous lake

15. Haemangiomas

16. Haemangiomas

17. Haemangiomas under Dermatoscope • Red/ Purple Lacunars easily seen. • Spider naevi blanche under pressure

18. Haemangiomas Under Dermatoscope

19. Diagnosis?

20. Haemangioma

21. Seborrhoeic Wart • SeborrhoeicKeratoses, Basal Cell Paplillomas • Estimated 90% people aged over 60 have them. Uncommon <20yrs old • Can arise on any part of skin except palms, soles and mucous membranes • Often Multiple • Classic stuck on warty appearance

22. Seborrhoeic Wart

23. Seborrhoeic Wart

24. Seborrhoeic Wart • Milia-like cysts – there are two types: • Tiny white starry • Larger yellowish cloudy • Irregular crypts/ fissures/ ridges • Comedo like openings • Light brown fingerprint-like parallel structures • Ceribriform Surface • Hairpin vessels

25. Starry & cloudy milia like cysts

26. Milia Like cysts

27. Comedo like openings, Milia, Irregular fissures

28. Seborrhoeic Wart Under Dermatoscope • Cerebriform Surface

29. Fingerprint & Fat Fingers Pattern

30. Hairpin vessels

31. Naevi • Very common, can be multiple • Acquired/ Congenital • Colour van range pink to black • Multiple types • Intradermal • Junctional • Compound • Blue naevi

32. Naevus Pigment Network

33. Naevi

34. Naevi

35. Naevus - Wobble sign

36. Globular & Homogenous

37. Blue Naevi

38. Melanoma • ABCDE Rule?

39. Melanoma • ABCDE Rule • A Asymmetry • B Border - irregular • C Colour • D Diameter >7mm • E Elevation/ Evolution

40. 3 Point Dermoscopy Checklist • Asymmetry: asymmetry of colour and structure in one or two perpendicular axes • Atypical network: pigment network with irregular holes and thick lines • Blue-white structures: any type of blue and/or white colour, i.e. combination of blue-white veil and regression structures

41. Melanoma Macroscopic Under dermatoscope

42. Melanoma

43. Melanoma

44. Melanoma

45. Benign vs Malignant

46. Benign vs Malignant

47. Benign vs Malignant

48. Benign vs Malignant

49. Quiz! • 10 Images • Choice of 5 following:- • Dermatofibroma • Haemangioma • Seborrhoeic Wart • Naevus • Melanoma

50. 1.