Transcript dermoscopy
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 0415362 0415362 0415362 0415362 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 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