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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.

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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.

 

April 4, 2018 / molehunter

International Dermoscopy Refresher and Update, Wednesday 28th November 2018, Fareham, Hampshire. Now booking.

 International Dermoscopy Refresher and Update day conference

Wednesday 28.11.2018, Holiday Inn, Cartwright Drive, Fareham, Hampshire PO15 5RJ
This is a dermoscopy refresher and update course with an international flavour, for dermatologists and all clinicians who regularly use dermoscopy to evaluate suspicious skin lesions in hospital or community. Basic knowledge is assumed-doctors and specialist nurses wishing to make a start with dermoscopy would be better advised to attend an introductory course.
Stephen Hayes, Catriona Henderson and Birgit Pees are keen dermoscopists with over 50 years combined clinical experience, who have taught an annual dermoscopy course in Fareham since 2011. This November, we are delighted to welcome Professor Luc Thomas from the University of Lyons, France, one of the most published and respected authorities in world dermoscopy. He specialises in skin cancer with a particular interest in nail unit disease. He has agreed to present on the dermoscopy of pigmented and non pigmented nail unit and foot lesions, also to briefly discuss the use of dermoscopy in France and teach us on some didactic and challenging cases from his practice in Lyons.
All presentations will be richly illustrated with many dermoscopic cases studies. It is hoped to make PDFs of presentations with images available to delegates for private study, subject to permissions.
Programme

08.00-09.00 registration and coffee
09.00 Introduction and overview Stephen Hayes
09.15 ‘One algorithm to rule them all.’ Chaos and clues in dermoscopy SH
10.00 Hypopigmented and other difficult melanomas Catriona Henderson
10.30 Highlights and insights from the 5th dermoscopy world congress, Thessaloniki, Greece, 14-16 June 2018 (we are all going!)-Birgit Pees
11.00 coffee, biscuits and equipment stand
11.20 Dermoscopy of less common skin lesions including atypical dermatofibromas, Merkel cell cancer, pigmented Bowen’s etc CH
12.00 Dermoscopy of vessels (speaker tbc)

12.15 Interactive dermoscopy case discussions-SH, CH, BP

13.00 Lunch (2 course with vegetarian option, served in seated restaurant)
14.00 Dermoscopic diagnosis of pigmented and non pigmented nail unit tumours Luc Thomas
15.00 Pigmented lesions on the face BP
15.30 coffee, biscuits and equipment stand
16.00 Mole mapping and monitoring SH
16.15 Dermoscopy in France-research and instructive cases LT
17.00 finish

BOOKING FORM (please complete and email to stevehayes272@gmail.com)
Name Address including email Fee (tick one)
£220 early bird if booked before 30.6.18
£250 booked after 30.6.18

Payment by BACS 30-90-85, 21513968
(Lloyds Bank, Bishop’s Waltham)
or cheque payable to South Coast Dermoscopy Associates to
South Coast Dermoscopy
96 Winchester Street
Botley, Hampshire SO30 2AA
Receipts and certificates will be sent out by email.
TERMS AND CONDITIONS No reminders will be sent out unless in case of significant changes to the course due to unforeseen force majeure. Programme subject to adjustments if necessary due to circumstances outside our control. 6 hours CME with RCP will be applied for. Refund minus £30 handling fee payable on request up to 1st November, or subsequently on discretion for ill health etc. Delegate places are transferable, i.e. if you can’t come for any reason, a colleague may come in your place for no extra charge as long as you tell us. We will not pass your details on to any other parties. You must enter your car registration number in the hotel reception.

PS this is going to be BRILLIANT!!! Luc Thomas is an absolutely top man. If as we hope the course is successful, we propose to have regular updates, possibly annual, with a different international professor each time. Britain is a bit behind in dermoscopy and we do rely on overseas experts to envision and encourage us.
All correspondence to stevehayes272@gmail.com.
Dr Stephen Hayes GMC 2482404
Course organiser and lead tutor
UK board member, International Dermoscopy Society
South Coast Dermoscopy
http://www.dermoscopy.wordpress.com

March 24, 2018 / molehunter

A new red lump on the skin

This new, firm, pink lesion appeared over several months on a young-middle aged person’s neck. This is a ‘red flag’ presentation. I used to argue with a very senior skin cancer specialist who shall be nameless about the merits of teaching dermoscopy to GPs. He said I shouldn’t bother, but instead teach them about the danger of the new, growing pink nodule (which can be a deadly non-pigmented melanoma). He said there was no evidence for the benefits of teaching GPs dermoscopy. I then referred to a couple of peer reviewed papers, and he got a bit cross, sort of ‘Young man, when I say there is no evidence, HOW DARE YOU contradict me by producing some evidence!?!’  I told him that I would take half of his advice-carry on teaching dermoscopy, but whenever I did, mention the danger of the new, pink lump-which is sometimes a non pigmented (amelanotic) melanoma. Anyway, back to the case.

case 10 (1)

Can you tell what it is? Yes you can-it’s a dark pink lump. But that’s all you can say. Could it be a haemangioma? not impossible on this view, but it’s a short history. Also, on palpation it was firm, not soft and compressible which haemangiomas are. Time for dermoscopy.

case 10 (2)

The dermoscope immediately rules out haemangioma. Nothing like, no chance.

let’s apply SCOPE (*).

Symmetry? of shape and outline, yes, but for colour and structure (way more important) not at all

Colours-how many? I see red, white, brown and black. No way is that acceptable.

Structures-how many? I see shiny white structures, brown globules (1 o’clock to 3 o’clock border) and featureless brown-black border 10 to 1 o’clock) plus irregular vessels. Too many structures.

Edge. The edge is smooth, but rim of dark featureless + brown globules from 10 to 3 o’clock.

Chaos and Clues would also excise this lesion, as would the the two step algorithm. Step one-melanocytic or non melanocytic? It is judged melanocytic, because of brown globules, and by default as we cannot make it anything else (e.g. BCC, wart, haemangioma, dermatofibroma, etc). Step 2-could it be a melanoma? Yes, as it is chaotic.

The lesion was excised immediately and reported as a MUMP, a melanocytic lesion of unknown malignant potential. In plain English, this is an abnormal proliferation of melanocytes which the histopathologists can’t quite come off the fence over. It’s neither a normal mole nor a definite melanoma. The consensus is that you treat it as if it was a melanoma, which we did.

 

LEARNING POINTS

Beware the new, firm, growing lump.

Look out for pigment at the rim of pink nodules, it may be a clue to hypopigmented melanoma.

Irregular brown globules in a lesion like this are highly suggestive of a hypopigmented melanoma.

If in doubt, refer or excise. This was a ‘MUMP’ but could easily have been a nodular melanoma.

(*) SCOPE is a crude mnemonic invented by Dr Catriona Henderson and myself. Based on a slide Dr Henderson produced, to simplify lesion evaluation. It has not been independently evaluated, but we find it helpful. It overlaps very much with ‘chaos and clues’ given that ‘chaos’ is defined as multiple colours, multiple patterns.

 

look for symmetry

Count colours

Count patterns

look at the edge.

March 14, 2018 / molehunter

The battle continues

Alethea’s last post, just before she died from melanoma. So sad. This is why it is worth working constantly to improve the skin lesion diagnostic skills of all health care practitioners, especially GPs.

Me and Melanoma

So, recently lumps have appeared around my body, one on shoulder , two in right boob, one where my ribs are and one in my upper right bum cheek.  The one above shoulder needed removing as it was growing so I am currently waiting for the results.  They think its metastasis but we aren’t sure.

I’ve also been experiencing the worst stomach/tummy pains ever.  They have made me vomit on occasion too. So Wednesday I was checked in to the local general hospital where they gave me blood tests and a chest and abdomen CT scan and x-rays.  They said it may be crone’s disease, then that its an ulcer, then that its metastasis and that I will be needed intravenous chemo.  Needless to say I was devastated.   Then I checked out of the hospital and went to see my doctor who checked the CT and he said he said…

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March 14, 2018 / molehunter

Feedback from South Coast Dermoscopy course

We haven’t done the full feedback analysis yet, but here was this unsolicited email from a participant (see below). I include this not so much as a ‘boast post’ but to illustrate that our integrated skin lesion recognition and dermoscopy course tries very much to familiarise learners with the appearance of  harmless skin lesions. This is very deliberate, since nearly all the moles people ever ask their GP to look at are going to be harmless. Yet every day in clinic I see patients with (to me) obviously harmless skin lesions who have been needlessly sent on an urgent cancer pathway and are in a panicky state as they are afraid they may have a dangerous tumour. That’s one of the things I love most about dermoscopy-the power to reassure. There is no getting away from the reality of melanoma-which kills 6 or 7 people a day in Britain-a certain amount of fear is appropriate, same as with children and road safety. Good GP dermoscopy skills can relieve fears, which is human and compassionate,  and also more efficient in terms of optimum health care resource management.

I teach that doctors need to get skilled, confident and safe to determine a mole is harmless, then don’t just say so but explain why, and use the consultation to advise about sun protection and the signs of a dangerous mole. At the same time, it’s vital not to miss a melanoma, so we also post LOADS of cases of melanoma. The memory drive and on line case discussions over 12 weeks further reinforce such lessons.

Next year, we are thinking about altering the course, maybe running it as a one day course twice a year, as I had to turn a lot of learners away since they couldn’t make the 2 half days. If any previous learners have any views on this, please comment. The USB stick and 12 week on-line tuition will remain.

PS a prospectus and booking details of our International Dermoscopy Refresher and Update day conference on Wednesday 28th November will appear here soon. It will be at Holiday Inn Fareham as usual and will feature Professor Luc Thomas, acclaimed world expert from Lyons, France presenting on foot tumours and perhaps some of his many international research publications as well as reports from the 5th world dermoscopy congress to be held in Greece this June, plus other goodies. This course will not be for beginners but should delight those with some experience and prior learning in dermoscopy who want to refresh and update.

Hi Stephen

Just a note to express my appreciation of the course on Friday
Well organised and well presented it was all I anticipated. The usb stick is a particularly good resource.
The email cases are also stimulating.
Surprisingly perhaps I found the parts on non malignant lesions most helpful. It’s only natural that as specialists you spend you energies on melanoma but as a gp I see mostly benign lesions with only 2-3 melanomas per year on the practice population so I found the positive identifying features of benign lesions to be helpful rather than my usual practice of simply excluding sinister features.
Best wishes
March 2, 2018 / molehunter

ENTRY CLOSED FOR this year’s Integrated Skin Lesion Recognition and Dermoscopy course

 

I look forward to meeting this years learning group on Friday at Fareham.

Details of further courses will appear here soon, including an international dermoscopy refresher and update conference on Wednesday 28th November 2018. Also, as I am running an on line course over the next 12 weeks, more new cases will be being posted here.

For 2019, I am looking at a reboot of the course, perhaps run it twice as year (spring and autumn) with a one day conference at Fareham instead of the 2 half days, a password protected web site and more on line and directed learning. The views of any past or potential learners would be most welcome. How can we do better?

kind regards

Dr Stephen Hayes, course organiser and lead tutor

South Coast Dermoscopy