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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 Dr Hayes 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-all

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.

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.

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

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.