- Introduction to dermatoscopy CME
- Dermatoscopic features CME
- Three-point checklist CME
- Dermoscopy of benign melanocytic lesions CME
- Dermoscopy of atypical naevi CME
- Dermoscopy of malignant melanoma CME
- Dermatoscopy of seborrhoeic keratosis CME
- Dermoscopy of basal cell carcinoma CME
- Dermatoscopy of squamous cell carcinoma CME
- Dermatoscopy of other non-melanocytic lesions
- First step algorithm CME
- Pattern analysis CME
- Other algorithms for melanocytic lesions CME
- The dermatoscopy report CME
- Melanocytic naevi: new classification CME
- Dermoscopy of the nail CME
- Dermatoscopic-histologic correlation CME
- Blue naevus images CME
- Globular (congenital) naevus images CME
- Reticular (acquired) naevus images CME
Developed in collaboration with the University of Auckland Goodfellow Unit in 2007.
Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2008.
Images have been sourced from the following:
- Hon Assoc Prof Amanda Oakley
- The Department of Dermatology, Waikato Hospital
- MoleMap New Zealand (with permission)
- Dr Richard Williamson and coworkers (as indicated in dermatoscopic-histology page*)
The dermoscopy report CMENext Previous
- Create a dermoscopy report
An objective dermoscopy report may be issued for each lesion of concern, and is particularly necessary when the dermoscopy is not performed by the patient's usual primary health practitioner or dermatologist.
A standardised way of reporting dermoscopic findings was described at the 1st World Congress of the International Dermoscopy Society (IDS) in May 2006. A consensus document produced by the Board of the IDS is to be published in the Journal of the American Academy of Dermatology during 2006. It includes ten points, categorised as either recommended or optional.
Lesions of concern
A lesion of concern may be identified by the patient, a family member, a health professional or an expert dermoscopist. Reasons the patient may be concerned about the lesion may include:
- Cosmetic appearance
- Symptoms: itch, soreness, proneness to injury
- Recent trauma
- Belief that it resembles melanoma
- Growth of the lesion
- Apparent change in shape, size or appearance
Clinical concern relating to melanoma may arise because of:
- Past history of melanoma and/or other risk factors for skin cancer
- Single or multiple atypical naevi
- Reliable history of change
- Irregular shape
- Irregular colour
- Large lesion (diameter >6-7mm)
Alternatively, non-melanoma skin cancer may be present.
Dermoscopic concern may arise because of:
- Two or three criteria from 3-point checklist: asymmetry, atypical network, blue-white structures
- Observed growth or change in atypical lesion
- Specific dermoscopic features of melanoma
- Specific dermoscopic features of non-melanoma skin cancer
Which melanocytic lesions should be excised?
Lesions with the typical clinical and/or dermoscopic characteristics of melanoma should be excised with a 2-mm margin and the specimen sent for pathology. To guide the pathologist to evaluate a small area that is of concern, orientate the specimen using edge incisions, sutures or ink, and draw a map on the request form. Alternatively, make a superficial round incision using a 1 to 2-mm micropunch in the area of interest and leave the punch in place.
Atypical lesions that do not have diagnostic features for melanoma may also be excised for histology. Melanoma can arise from a naevus, but in about 70% of cases arises de novo. Initially de novo melanoma may lack diagnostic features of melanoma and may also lack features of naevi.
- Single atypical lesions
- Nodular atypical lesions
- Changing atypical lesions
Whole body photographs and digital dermoscopic monitoring may be preferred for:
- Multiple mildly atypical lesions (12-month intervals)
- Changing naevus without atypia (3- to 6-month intervals)
- Moderately atypical lesions (3-month interval)
If no dermoscopic change is noted at 12 months, the lesion can be confidently diagnosed as a naevus.
The International Dermoscopy Society considers that dermatologists should aim to receive histology reports of 5 to 10 benign melanocytic lesions to every melanoma. Less than that should prompt more excisions, and more than 10 benign lesions to every melanoma should prompt more monitoring. However there are inevitably differences in individual practices, and lesions may be removed for reasons that do not directly relate to the risk of malignancy (e.g. cosmetic reasons or to relieve anxiety).
A dermoscopy report should include the following information:
- Relevant clinical information about the patient
E.g. age, history of the lesion, personal and family history of skin cancer and the presence of atypical naevi (recommended).
- Clinical description of the lesion
Location, symmetry, borders, colour, size, elevation (recommended).
- The two-step method
List dermoscopic criteria that differentiate melanocytic from non-melanocytic tumours (I consider this optional).
- Dermoscopic description
Use the standardised terms listed in the Dermoscopy Consensus Report published in 2003, or terminology of modified pattern analysis, and define any new term used.
- Algorithm used
Name which algorithm was used to differente between benign and malignant melanocytic tumours (optional).
- Imaging equipment and magnification
State the brand name and manufacturer of the device (optional).
Include clinical and dermoscopic views of the tumour (optional).
State the diagnosis or differential diagnosis (recommended).
- Suggested management
Management of the lesion may include follow-up, biopsy or excision (recommended).
- Comments for the pathologist
It may be useful to orientate the lesion to guide appropriate sectioning of the specimen when it is excised (optional).
Compose a dermoscopy report for a lesion of concern.
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