348 - introduction to dermoscopy in primary care · 2018-04-27 · society of rural physicians of...

35
Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR APRIL 12 - 14, 2018 • 348 Dr. Paula Ryan SALT SPRING ISLAND • BC INTRODUCTION TO DERMOSCOPY IN PRIMARY CARE

Upload: others

Post on 04-Aug-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE

ST. JOHN'S NEWFOUNDLAND AND LABRADOR APRIL 12 - 14, 2018

• 348

Dr. Paula Ryan • SALT SPRING ISLAND • BC

INTRODUCTION TO DERMOSCOPY IN PRIMARY CARE

Page 2: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

1

Approach to the pigmented skin lesion

Prepared byPaula Ryan

Conflicts of Interest

None.

Page 3: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

2

Overview1. What is a dermoscope?2. Role for dermoscopy in

primary care practice3. The Dermoscopy ‘Alphabet’4. 2-Step Algorithms 5. Melanocytic criteria 6. Features of melanoma 7. Clinical cases 8. Next steps

What is a dermoscope?

Hand held device which uses illumination and magnification to visualize subsurface skin structures not visible to the unaided eye.

Polarized vs non-polarized

Page 4: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

3

Dermoscope

Dermoscope with attachement

Page 5: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

4

Dermoscopy in Primary Care

ALGORITHMS

Page 6: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

5

Rete Ridges

Page 7: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

6

2 step algorithm

2-Step AlgorithmThe pigmented lesion

Page 8: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

7

Step 1 of algorithm –dermoscopic alphabet

1. Reticular (pigmented) Network

2. Globules – aggregated or peripheral

3. Streaks

4. Homogenous Patch

5. Parallel pattern (volar skin)

6. pseudo-network (face)

(brown, blue, black, red)

The dermoscopic alphabetReticular Globular Homogeneous

Page 9: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

8

The dermoscopic alphabetStreaks/Starburst Parallel lines Cobblestone

Melanocytic criteria Homogeneous Parallel lines Cobblestone

Streaks or starburst Globule Pigment network

Page 10: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

9

Melanocytic Criteria

Homogeneous/Blue pigmentationParallel Lines

Cobblestone

Starburst or streaks

Dots/Globules (aggregate or peripheral rim)

Pigmented network/negative network

Simplified Version

Second Step

If the pattern fits one of the ‘melanocytic’ criteria, does it have a benign appearance?

Page 11: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

10

2-Step Algorithm

Benign Nevi Patterns

Page 12: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

11

Diffuse Reticular

Reticular with central hypopigmentation

Page 13: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

12

Diffuse Globules

Peripheral rim of globules

Page 14: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

13

Homogenous

Naevi by age

Globular Teens

Reticular30’s-40’s

Homogeneous> 50’s

Page 15: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

14

Streaks

Page 16: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

15

If the lesion has none of the benign patterns,

does it fit one of the ‘melanoma’ pattern criteria?

Features of MelanomaAtypical vessels Eccentric

homogeneous pigment

Asymmetric pigmented dots and globules

Irregular streaks

Regression structures

Blue-white veil

Eccentric atypical pigmented network

Page 17: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

16

Melanoma Specific Structures

Atypical network

Page 18: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

17

Atypical Pigmented network

Atypical dots and globules

Page 19: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

18

Page 20: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

19

Atypical Vessels

Page 21: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

20

Blue White Veil

Multicomponent Naevi

Multicomponent morphology is a risk factor for melanoma.

Page 22: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

21

Clinical Cases

Benign versus Melanoma

Melanoma – eccentric reticular pattern, blue veil, asymmetric dots and globules

Page 23: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

22

Benign Homogeneous naevi

Page 24: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

23

Melanoma – regression structure, blue veil, asymmetric network

Benign – Peripheral Reticular with central hypopigmentation

Page 25: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

24

Melanoma – regression structure/white, blue/white veil, atypical eccentric network.

Benign naevi– diffuse reticular pattern with peripheral globules

Page 26: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

25

Melanoma – asymmetric globules, regression structure, blue veil

Melanoma – regression structure, atypical vessels

Page 27: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

26

Melanoma – irregular dots and globules, asymmetric, blue veil

Benign – globular reticular naevi

Page 28: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

27

Melanoma – blue white veil, asymmetric globules, regression structure

Melanoma – eccentric pigment, globules and streaks

Page 29: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

28

Benign naevus

Melanoma – asymmetric dots and globules, regression structure

Page 30: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

29

Dysplastic compound naevus – needs biopsy

Melanoma – regression with blue veil, asymmetric dots,

Page 31: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

30

Melanoma – atypical pigment, radial streaming, pseudopods, +/- asymmetric blotches and hint of blue veil at 2 o’clock

Melanoma – asymmetric pigment, early central regression.

Page 32: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

31

Benign blue naevus

Benign compound naevus

This naevus has a striking target like pattern with peripheral and central dark areas separated by a paler ring. The dermoscopy reveals a symmetrical and uniform peripheral network, amorphous ring, and globular central area.

Page 33: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

32

Teledermoscopy

Good option for second opinion

Need adaptor on ipad or iphone

Dermoscope is more expensive

Could also consider serial dermoscopy if equipment available (only for non-raised lesions)

Page 34: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

33

What’s next?Dermoscopy courses

1. Online courses/blogs

2. Local options - Divisions

3. Dermoscopy workshops

ONLINE

Page 35: 348 - Introduction to Dermoscopy in Primary Care · 2018-04-27 · Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR

4/26/2018

34