Skip to content
March 16, 2019 / molehunter

redacted PDF of inflammoscopy presentation PCDS spring conference 16th March 2019

This is for delegates who attended my presentation at Stratford on Avon on 16/3/19 but other learners can study it, even though it won’t make so much sense if you weren’t there today. I have removed copyrighted material but in most cases left the URL so you can see it for yourself on line.

redacted FINAL inflammoscopy PCDS March 2019




December 24, 2018 / molehunter

Pink and brown mole on leg-beware

This mole had been changing for a while. Always beware of ONE mole that is new or changing and/or looks different to anything else on the skin. The leg is a particular site of concern.


melanoma leg (2)

There are three distinct colours to the mole, pink (most prominent) then blue/black, then brown, like an asymmetrical tricolour. Three colours is NEVER acceptable. The combination of pink, blue or black and brown will almost always be a melanoma.

The dermoscopy makes things even more obvious.

melanoma leg (1)

We see chaos (asymmetrical arrangement of various patterns and colours) and clues to melanoma. The blue-white featureless area (called blue-white veil’ in older textbooks) is a clue to melanoma, as are the blue and brown clods (also called ‘globules’) but above all the overall complete lack of order and symmetry.

Note carefully: the bit that is featureless pink is 100% melanoma. Some melanomas are pink or red.


The lesion was confirmed as a melanoma. We really need to be picking lesions up at a much earlier stage than this in order to improve survival. I am currently in Queensland, Australia studying with some experts to try to learn just how to do that,

NB All patients have given permission for their non-identifiable images to be used anonymously for the public good to improve skin cancer diagnosis education. This blog is offered as a free educational resource for health care professionals but in order to achieve maximum impact it is not password protected and the general public can see it too. I therefore try to pitch the level of difficulty correctly, with a mixture of easy, moderate and difficult cases. Doctors and nurses who work in diagnosis need to train on more difficult cases in order to achieve earlier diagnosis, but as we are still seeing advanced melanomas presenting later than they should, obvious cases like this are posted as a public service.

September 1, 2018 / molehunter

Dermoscopy day course 3rd April 2019, Solent University, Southampton

Integrated skin lesion recognition and dermoscopy course

Wednesday 3rd April 2019, Solent University, East Park Terrace,

Southampton SO14 0YN

Skin cancer cases continue to increase, and every GP and many other health care practitioners are daily approached by patients who are anxious about moles. Abundant international evidence has established dermoscopy (hand held skin microscopy) as the triage tool of choice. Training is required.

This day course is taught by South Coast Dermoscopy Associates, with guest presenter Dr Finbar McGrady from Belfast. It will benefit any doctor, nurse or other health care professional who se work involved evaluating skin lesions about which patients have concerns. Drs Stephen Hayes, Catriona Henderson and Birgit Pees are all experienced dermoscopist who have been teaching this course together successfully since 2011. We are delighted to welcome Dr Finbar McGrady from Belfast, who teaches dermoscopy and runs a Northern Ireland dermoscopy Facebook page with 200 GP followers and won the poster award at the 5th world dermoscopy congress in June 2018, Thessaloniki, for a presentation about his work in GP dermoscopy education.

A memory drive will be provided with the presentations plus abundant additional learning material.

Cost including refreshments and lunch £150. This is a substantial reduction on the 2018 price, as we have moved from 2 half days with 12 weeks on line case discussions to a one day course. The International Dermoscopy Society now runs such a good continuing case discussion on Facebook for registered doctors that learners are directed there instead.


For a full prospectus and to book your place, email secretary Caron Andrews at 

08.00-09.00 registration and coffee

0900 introduction-the skin cancer epidemic, morbidity and mortality, overview of skin cancer biology and basic diagnosis for the clinician SH

09.30 dermoscopy, what it is, why it works, how to get started CH

10.05 dermoscopy of benign naevi BP                                                 

10.40 dermoscopy of seborrhoeic keratoses, haemangiomas, dermatofibroma and other benign skin lesions FMcG

11.15 coffee and dermoscope stand

11.45 dermoscopy of basal and squamous cell cancers (including actinic keratosis and Bowen’s disease) BP

12.15 dermoscopy of melanomas CH

12.45 lunch

13.45 dermoscopic pattern analysis with chaos and clues FMcG

14.30 pigmented lesions of the face BP

15.00 dermoscopy of foot lesions CH

15.30 tea break and dermoscope stand

15.45 putting it all together-interactive case discussions-SH

17.00 close

Venue: Solent University, East Park Terrace, Southampton SO14 0YN

course organiser and lead tutor

Dr Stephen Hayes GMC 2482404

Associate Specialist in Dermatology

University Hospital Southampton


The venue is 12 minutes walk from Southampton Central station, and 15 minutes by taxi from Southampton airport.


August 20, 2018 / molehunter

Chaos and Clues for skin lesion recognition with dermoscopy

Here’s a link to a paper by a master of dermoscopy, Associate Professor Cliff Rosendahl of Brisbane, Australia. Definitely worth studying. I’m studying it and making notes for my CME today.

Chaos and clues is increasingly being recognised as the simplest way to teach dermoscopy to complete beginners. As I have been teaching dermoscopy for about 10 years, and have only another 40 months until final retirement, I am trying to simplify things so as to teach other teachers before I disappear into the beautiful new log cabin at my orchard to write novels, play guitar and daydream, so chaos and clues seems to me the way to go. Endorsed by Viennese and world dermatoscopy hero Professor Harald Kittler who worked on this algorithm with Cliff, so what could go wrong?

cliff rosendahlharald

Chaos and clues is IMHO the ‘one algorithm to rule them all’ although it does no harm to learn all the other algorithms too As Harald says, the expert dermoscopist learns all the algorithms and then develops their own. But if the work has already been done, and it has, why not take advantage of it?

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

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.