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

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

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Dr. Paula Ryan • SALT SPRING ISLAND • BC

INTRODUCTION TO DERMOSCOPY IN PRIMARY CARE

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Approach to the pigmented skin lesion

Prepared byPaula Ryan

Conflicts of Interest

None.

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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

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Dermoscope

Dermoscope with attachement

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Dermoscopy in Primary Care

ALGORITHMS

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Rete Ridges

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2 step algorithm

2-Step AlgorithmThe pigmented lesion

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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

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The dermoscopic alphabetStreaks/Starburst Parallel lines Cobblestone

Melanocytic criteria Homogeneous Parallel lines Cobblestone

Streaks or starburst Globule Pigment network

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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?

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2-Step Algorithm

Benign Nevi Patterns

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Diffuse Reticular

Reticular with central hypopigmentation

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Diffuse Globules

Peripheral rim of globules

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Homogenous

Naevi by age

Globular Teens

Reticular30’s-40’s

Homogeneous> 50’s

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Streaks

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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

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Melanoma Specific Structures

Atypical network

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Atypical Pigmented network

Atypical dots and globules

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Atypical Vessels

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Blue White Veil

Multicomponent Naevi

Multicomponent morphology is a risk factor for melanoma.

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Clinical Cases

Benign versus Melanoma

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

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Benign Homogeneous naevi

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Melanoma – regression structure, blue veil, asymmetric network

Benign – Peripheral Reticular with central hypopigmentation

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

Benign naevi– diffuse reticular pattern with peripheral globules

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Melanoma – asymmetric globules, regression structure, blue veil

Melanoma – regression structure, atypical vessels

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Melanoma – irregular dots and globules, asymmetric, blue veil

Benign – globular reticular naevi

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Melanoma – blue white veil, asymmetric globules, regression structure

Melanoma – eccentric pigment, globules and streaks

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Benign naevus

Melanoma – asymmetric dots and globules, regression structure

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Dysplastic compound naevus – needs biopsy

Melanoma – regression with blue veil, asymmetric dots,

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

Melanoma – asymmetric pigment, early central regression.

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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.

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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)

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What’s next?Dermoscopy courses

1. Online courses/blogs

2. Local options - Divisions

3. Dermoscopy workshops

ONLINE

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