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The Twentieth Century and Beyond
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
Since that time, dermatoscopy has become its own subdiscipline within dermatology, and article after article has been amassing in the dermatologic literature. Today, the modern dermatologist is equipped with this device in hand because it is extremely helpful with the physical examination. It can assist with the distinction of benign and malignant pigmented skin lesions (including melanoma), and it can also be used to diagnose countless benign lesions, BCC, SCC, rashes including psoriasis, types of hair loss, and skin infections and infestations such as scabies—all without a biopsy. Dermatoscopy has tremendous value for the modern dermatology patient: it screens out benign lesions, preventing unnecessary biopsies and reducing the cost of healthcare, and it helps identify problematic skin lesions at an early stage in which a lesion might otherwise appear unproblematic to the naked eye. Practicing dermatology without a dermatoscope may already be analogous to a cardiologist practicing cardiology without a stethoscope.
Triage Algorithms
Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Triage refers to the sorting out and classification of patients and lesions to determine priority of need and proper place of treatment. Triage can be performed during skin cancer screenings using dermoscopy. Dermoscopy enables identifying lesions that are suspicious for skin cancer and aiding in the correct management decision. Deciding whether or not to biopsy a skin lesion is paramount during screening, whereas making a specific diagnosis, such as differentiating between basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma, is less important. For triage purposes, to decide which lesion(s) should be biopsied, several simplified dermoscopic algorithms have been proposed, most of which include asymmetry and color variation in their criteria1–4 (Table 5c.1).
Diagnosing Skin Disease
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
With the advent of portable handheld dermatoscopes, the practice of dermatoscopy has become ubiquitous in dermatology. The technique involves rendering the cornified layer translucent either by using polarized light or immersion contact with the skin, thereby exposing subsurface structures that can be better visualized (Figure 2.11). The most widely utilized dermatoscope consists of polarized light capable of 10× magnification. Special attachments and adaptors for cameras and smartphones allow easy capture and sharing of dermatoscopic images.
Strategies to improve the diagnosis and clinical treatment of dermatophyte infections
Published in Expert Review of Anti-infective Therapy, 2023
At present, dermoscopy is used not only for the diagnosis of pigmented lesions but also for the diagnosis and follow-up of many infectious diseases, such as molluscum contagiosum, scabies, warts, pediculosis, and dermatophyte infections, especially tinea capitis. In addition, dermoscopy is very important in patients with tinea corporis for determining vellus-type hair involvement, which necessitates systemic antifungal therapy because the use of only topical antifungal therapy would prove ineffective (Figures 6A and 6B) [18]. Dermoscopy is used to differentiate onychomycosis from other nail dystrophies, such as traumatic nail dystrophy and psoriasis. Artificial intelligence programs trained with dermoscopic images can diagnose onychomycosis with high accuracy (95.7%), which was greater than that of 54 dermatologists [19].
The diagnosis and management of extramammary Paget’s disease
Published in Expert Review of Anticancer Therapy, 2018
Takamichi Ito, Yumiko Kaku-Ito, Masutaka Furue
EMPD can be a diagnostic challenge to clinicians because of its nonspecific clinical presentation and low incidence. Recently, some reports described dermoscopy and reflectance confocal microscopy as ancillary diagnostic tools for EMPD [18–21]. Dermoscopy is now widely acknowledged as a powerful tool for the diagnosis of various pigmented or nonpigmented diseases. A retrospective study examined the dermoscopic features of 35 EMPD lesions in comparison with eczema, fungal infection, and Bowen’s disease, and found that the vascular patterns of EMPD on dermoscopy differ from those of benign inflammatory skin diseases, suggesting their utility for distinguishing EMPD from eczema and fungal infection [19]. Reflectance confocal microscopy is a noninvasive, high-resolution imaging tool. In a study of 14 EMPD lesions, reflectance confocal microscopic images of typical Paget’s cells were found to be characterized by dark cytoplasm, a mild bright nucleus, and a larger size than keratinocytes, and the images corresponded well to the histopathology [18]. The authors also suggested the potential for the early detection of EMPD and the delineation of surgical margins. Other two case series also reported the efficacy of reflectance confocal microscopy for EMPD management [22,23]. These two devices offer additional in vivo information, which may facilitate the correct diagnosis and accurate detection of tumor borders.
Optimal diagnosis and management of common nail disorders
Published in Annals of Medicine, 2022
Subungual haematoma is the most common cause of dark nail pigmentation. While some patients do recall trauma, many may not recall a prior incident. A true linear band is rare; however, a chronic subungual haematoma can mimic a longitudinal streak [97]. On dermoscopy, a homogenous pattern and globules are typically visualized. A distinguishing feature of a subungual haematoma is that the blood will grow out with nail plate growth (Figure 5). If there is no outgrowth of pigment, further evaluation for subungual melanoma is necessary. It should be noted, that the presence of blood does not necessarily rule out a nail unit melanoma, since melanomas may also bleed [98,99].