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July 11, 2018 / molehunter

The patient who is worried about sun, skin and moles

This PDF is for the 80 doctors and nurses expected at the Botley park Hotel tomorrow afternoon.

Botley 12th July 2018 the patient worried about sun, skin and moles

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July 4, 2018 / molehunter

PDF of short presentation on colours red and yellow in dermoscopy

This is a PDF of a short presentation I am due to make at the annual meeting of the British Association of Dermatologists in Edinburgh, Scotland, tomorrow. It’s a bit narrow, part of 4 short talks to an advanced audience, but any clinician is welcome to make what use of it they can.

FINAL EDIT colours yellow and red in dermoscopy

June 21, 2018 / molehunter

A tricky pigmented lesion

This lesion was presented by an older white female who noticed change after a sunshine holiday.

Three experienced dermoscopists had a careful look at it but could not reassure themselves it was safe. It was removed for histology by shave excision.

female 70 (2)

 

 

female 70 (1)

The plain view appears to show some fissuring and a stuck on appearance, suggestive of a seborrheic keratosis (seb k, or ‘crusty wart’ as I tend to describe these lesions to my patients). The dermoscopy however is more worrying. The overall impression is chaos. I can see dots and globules, angular lines (arguably disordered pigment network), and although I can see nothing that positively persuades me this is a melanoma, I didn’t think I could entirely rule it out, and my colleagues agreed.

The lesion was removed by shave (saucerization) rather than full excision as I thought most likely seb k and did not want to create a big surgical wound on the lower leg unless necessary.

Histology was an irritated pigmented seb k.

Just to show, however clever you think you are, there is a grey area that will only be resolved by histopathology. I would have made a modest bet this was seb k, but I will not bet the patient’s health on my judgment when there is genuine doubt, as in this case.

PS I have also posted this case on the Facebook page of the International Dermoscopy Society, which is for doctors only. For those who look at both sites, a mild apology for duplication, but it’s easier for me to double post cases, it reaches a bigger audience for little more effort. All patients have given permission for their images to be used anonymously in order to improve education for the benefit of others. My images are not earning interest sitting on my laptop, and as I will be retiring in 42 months intend to share them as much as possible.

June 20, 2018 / molehunter

Australian and New Zealand dermoscopy experts to visit Oxford, England, October 2018

I recently heard about this 2 day weekend course in Oxford this 26/27 October.

https://www.skincancersymposiums.co.uk/symposium/oxford/

The course is taught by Cliff Rosendahl from Brisbane, Australia, Amanda Oakley, Andrew McGill and Chris Boberg from Auckland, New Zealand. Click on the links for details.

 

 

At the recent 5th world dermoscopy congress in Thessaloniki, Greece, (of which much more later) I had the privilege of meeting all of the above except Amanda Oakley whom I missed among the 2,500 international delegates. Professor Oakley is well known as the author and editor of the outstandingly good dermatology web site dermnetnz.org.

Cliff Rosendahl worked with Professor Harald Kittler on the Chaos and Clues algorithm, and is an outstanding dermoscopy innovator, practitioner and teacher on the world stage.

Compared to other UK courses, this course is a bit pricey at £745 for 2 days (although early bookers get a free dermoscope thrown in) but should be excellent. With the pressure on dermatology departments from ever increasing ‘worried well’ referrals of benign lesions sent up on urgent skin cancer pathways, it represents great value for money to Clinical Commissioning Groups, who should all send some of their GPs on it. Every pointless referral of a benign lesion costs about £120 and the cost of a missed melanoma is incalculably greater.

Declaration of interest. I have been offered a complementary place on the course. On the other hand, this course potentially competes with a course I am running a few weeks later! It will be a brilliant and successful introduction to dermoscopy from world experts.

May 30, 2018 / molehunter

A thick melanoma

A middle aged female presented with this solitary lesion on the trunk which had been growing steadily for a couple of years . There was no other history, and no moles anything like this anywhere else on the body.

The plain image is not well focused, but clearly shows asymmetry and 3 colours.

4.4mm invasive nodular melanoma shoulder (2) - Copy

The above is enough to justify urgent excision, the dermoscopy adds to this.

4.4mm invasive nodular melanoma shoulder (1)

We see colours red, brown, blue and white in a multicomponent lesion. Despite the lack of reticular network (although there are a few brown globules), this can only be viewed as a melanocytic lesion as there are no clues to a seborrheic keratosis, dermatofibroma, basal cell cancer, haemangioma or any other kind of non-melanocytic skin lesion. So it is therefore melanocytic (i.e. a tumour derived from melanocytes) by default (diagnosis of exclusion) and also as multicomponent.

Could it be benign? Hardly, with so many colours.

Histopathology unhappily confirmed a melanoma of 4.4mm Breslow thickness, a poor prognosis lesion.

Working in a skin lesion clinic, every day I see people who are worried sick about skin lesions which, to my trained eye, look entirely innocent.  At the same time, we still see people with the most obvious melanomas who have sat and watched them grow for a year or more. How to fix this? My proposal is that all Primary Care centres should offer easy access to a trained doctor or specialist nurse who can evaluate suspicious moles with a dermoscope.

April 11, 2018 / molehunter

Dermoscopy expert videos on YouTube

I have just posted this learning aid out to the doctors and nurses on my course at present. It costs me nothing to post it here too. Lots of brilliant expert teachers have put very useful dermoscopy videos on YouTube. Excellent resource, and free. Share and enjoy.

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>>Many of the world’s top dermoscopy teachers have taken the trouble to post presentations and lectures on YouTube. I strongly recommend these ones linked below, you will find others. I have put links to a few of the best here, please have a look and if you can, mark the video up and leave a positive comment.

I have mostly put up simpler videos for beginners, some of them are more challenging. If anything is difficult, do the easier ones first and then return to the more difficult ones later.

PLEASE NOTE there is inevitably a subjective element in dermoscopy/dermatoscopy and different teachers have different styles and emphases, and there is some conflict of terminology still. Do not worry. As you learn from many teachers, it will all come together and make sense.

benign naevi reticular pattern Iris Zalaudek Iris’s short videos are particularly ideal introductions to the basics. Watch them all twice.

blue naevi Iris Zalaudek

globular naevi Iris Zalaudek

naevi in the elderly

starburst pattern Iris Zalaudek

Giuseppe Argenziano of Naples has published about a quarter of the world literature on dermoscopy, he is a very able speaker, anything of his is worth viewing.

blue lesions , benign and malignant

3 point check list for melanoma

dermoscopy of melanoma incognito

the ten second rule for melanoma

classification of multiple naevi (1st of 3 videos)

Harald Kittler of Vienna has advanced a new descriptive terminology which rationalises the terms we use to describe dermoscopic features. This descriptive terminology is slowly replacing the older metaphoric set of terms. He also pioneered the ‘chaos and clues’ pattern analysis approach.

easy cases with pattern analysis (chaos and clues)

pattern analysis in dermatoscopy

radial lines and pseudopods

dermatoscopy of structureless lesions

vascular patterns in dermatoscopy

Vienna experience of monitoring moles (3 videos, somewhat advanced but important)

The myth of dysplastic naevi-as above, you may prefer to leave this until later . But it is important-Professor Kittler presents strong evidence that the term ‘dysplastic naevus’ is misleading and should be abandoned.

Ian McColl, a Scots dermatologist now working in Australia, has made a number of 10-15 minute videos where he talks though cases in detail, mainly using the Kittlerian descriptive terminology. Rewarding. I have put links to a few, more will suggest themselves as you watch. Enjoy.

dermoscopy made simple-structureless

dermoscopy made simple-vessels

dermoscopy made simple-seborrhoiec keratoses

dermoscopy made simple-benign naevi

dermoscopy made simple-clues to melanoma

Other recognised world experts include Ashfaq Marghoob from New York

specific dermoscopic features of melanoma-streaks

dots and globules

Ralph Braun from Zurich, Switzerland has also put up some very good videos,

dermoscopic-histopathological correlations

the revised 2 step algorithm

Luc Thomas of Lyon, France is a particular expert on the dermoscopy of acral lesions

5 basic nail dermoscopy cases

pigmentation of the nail unit

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Please dermoscopy learners, watch these videos and click ‘like’ if you do. These videos get a shamefully small number of likes-these are top world experts, all of them better than me, and they deserve credit.

April 9, 2018 / molehunter

Item on dermoscopy in PMFA magazine

Click the link to view a PDF of an article on dermoscopy PMFAAM18 Dermoscopy V4I wrote that will  be out out soon on the PMFA magazine. I’m quite pleased with it.