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May 8, 2019 / molehunter

Funny looking mole on the chest

This lesion appeared on a holiday photo from 2 years ago. It had got a bit bigger since then. It wasn’t itching or bleeding, and as you can see does not look very dramatic to the naked eye.

case for IDS (1)

When the dermatoscope is applied, the appearance changes radically.

case for IDS (2)

Using the ‘chaos and clues’ algorithm this is clearly chaotic. As I often say to learners in my clinic, even if you cannot put a name to the structures seen through the dermatoscope, you can count the number of structures and clearly there are many structures here. Chaos on dermoscopy is defined as multiple colours, multiple structures, and lack of symmetry.

I can see 4 four colours (brown, blue, red, black) arranged asymmetrically, plus irregular dots and clods, featureless blue and red areas, and angulated lines (slightly easier to see if you squint at the picture). Too many colours, too many structures.

The lesion was removed immediately and proved to be a melanoma, 0.35mm thick, so a 99% or better chance of a cure.

 

October 16, 2019 / molehunter

International dermoscopy course, pre-course work

Next Friday 12th and Saturday 13th June, in Winchester (ancient capital of England) a most excellent team of presenters will be delivering a 2 day course in skin lesions diagnostics, principally dermatoscopy/dermoscopy.

faculty winchester 2020

I am deeply honoured that such very highly regarded scientists and clinicians are coming to the UK to teach. The theme of the conference is ‘teach the teachers’ and delegates will receive a memory drive containing PDFs of the presentations (there will be NO photography of the screen during lectures!) plus a large annotated collection of my own copyrighted lesion images which can be used to reinforce learning and to teach, without further permissions.

For details and to book, click on top right of this screen.

The reason for this post is that I am getting enquiries from beginners in dermoscopy/skin lesion recognition asking about the next course I am running. Currently, this is the only course I am developing for 2020. So if you would like to come, but are a beginner, I suggest a few choices.

  1. Go on a less advanced course first (or instead, if that meets your needs best). The PCDS run courses on ‘dermoscopy for absolute beginners’ around the UK, see their web site. http://www.pcds.org.uk/events/educational-eventshttp://www.pcds.org.uk/events/educational-events There may be other courses around if you look for them
  2. Do some pre-course study and come for just the first day of the Winchester conference. I will be structuring the conference so that if folks only want to come for one day, Friday will be more basic and Saturday more advanced. Days can be booked separately.

What do I suggest for pre-course study? For a start,  you could scroll back through this blog, where I have been posting cases and links since 2011. Then you can click on the links on the right of this page. I particularly recommend YouTube, where many of the top teachers of the International Dermoscopy Society have posted videos. These are free to view and can be watched repeatedly.

Also, get a book. The one I most recommend at present is Cliff Rosendahl’s new book Cliff Rosendahl’s new book. I must declare an interest since Professor Rosendahl showed me generous hospitality when I stayed with him in Brisbane and studied in his clinic, and also I wrote the foreword, but it is still a very good book indeed.

More later.

September 12, 2019 / molehunter

New mole on the arm

A sixty something person presented with a new mole on the upper arm. It looked different and wasn’t there a year ago.

a case (1)

Don’t much like the story, and the mole does look to be of mixed colour. Let’s look closer.

a case (2)

Even in this poorly focused picture we can see that the colour, shape and edge are quite variable. Significantly, there is an asymmetrical mix of pink and brown. Not liking it. What does the dermatoscope show?

a case (3)The dermatoscope accentuates the asymmetry of colour we already saw, and adds another dimension-the dermatoscopic structures which are not visible to the unaided eye. We see irregular clods (little globules or lumps of pigment), angulated lines and polygonal shapes,  abnormal vessels and overall chaos.

Excision confirmed a melanoma. Beware of new, changing moles on the sun-exposed skin of an older white person. This was hopefully caught in time, but it could have been caught earlier.

 

August 21, 2019 / molehunter

New colour skin cancer leaflet

This leaflet is free to download and distribute, as long as it is not altered or sold at a profit.

The images are all my copyright and are of real skin cancers, selected to give a fair representation of this very variable disease.

If you are worried about a mole that is new, changing or  just looks wrong, seek professional advice.

 

Skin cancer advice leaflet Molehunter Diagnostics

 

 

 

 

 

June 17, 2019 / molehunter

Odd looking mole picked up on skin check was an early melanoma

A middle aged man was referred on an urgent skin cancer pathway regarding a lesion on the head. On examination, it was a straightforward seborrhoiec keratosis. A panic over nothing?

While the patient was in clinic, a full skin examination was carried out. 2 minutes into the examination, the observer (SH) noticed a lesion on the abdomen, of which the man was unaware.

suspected MiS lines angulated 1087058(3)

Not very impressive? But it looked different from all other moles on careful examination, so the dermatoscope was applied.

suspected MiS lines angulated 1087058(4) - Copy

(please note, the grey blob at 6 o’clock was an artefact and can be ignored)

The appearance is chaotic, i.e. there are multiple colours, multiple structures, and a lack of symmetry. In particular, we can see angulated lines and polygons. You can see the angulated lines better if you squint (half close your eyes) while looking at the picture. These structures have been identified and recognised as an important clue to very early melanomas.

The lesion was excised and proved to be a melanoma in situ. I had the pleasure of telling the person that, although this might have developed into a life threatening melanoma cancer given a year or three (*), since it was caught and excised at the in situ stage, a 100% guarantee of cure could be given.

(*) There is some controversy as to whether ‘melanoma in situ’ always develops into invasive (and so potentially lethal) melanoma over time. Science can never answer this question by direct observation, for 2 reasons,. one technical and the other ethical. Firstly, we cannot know that a lesion is in situ melanoma until it is cut out and put under a microscope. Once we do that, it stops growing so we can’t study it. Secondly, it would be unethical to conduct such a study even if it was technically possible, since we know that melanoma does develop in at least some in situ melanomas from direct observation and histology.

Dr Jeff Keir, who kindly taught me in his clinic in Ballina, New South Wales,  in January 2019, has official government figures to show that where he practices, there is a very high incidence of melanoma, but most are caught at the in situ stage, by meticulous screening, and the rate of fatality is extremely low. This seems to be evidence that catching in situ melanomas stops them developing and saves lives a few years down the line.

June 12, 2019 / molehunter

Pigmented lesion on face, recent change

Pigmented lesions on the face are common over the age of 70, especially in white sun damaged skin. most will be harmless freckles or lentigos, some will be seborrhoiec keratoses, others pigmented actinic keratosis (potentially pre-cancerous sun damage) but occasionally lentigo maligna. By the way, ‘sunbathing’ is not necessary to get sun damaged facial skin, just being outdoors without a suitable hat in any weather conditions. gardeners, farmers and all outdoor work or recreation builds up the sun damage one photon at a time. Just like putting 5 pence coins into a Piggy Bank, eventually you will have £1,000.

Anyway, this person presented with a history of recent change of colour in a long standing facial pigmented lesion.

SH case (2)

The lesion is a bit over 1 cm diameter and looks pinky grey. Very nondescript. Can dermatoscopy give us any clues?

SH case (1)

This image shows chaos, which is defined in dermatoscopy as multiple colours and/or structures, arranged in an asymmetric manner. So we look for clues.

Colours red and brown are seen, and also grey in the form of aggregations of fine dots, some of which surround pale circles (which represent the openings of sweat and sebaceous glands and hair follicles). At the top right of this picture we can see some fine parallel lines-this could represent solar lentigo, which could be part of the lesion or just adjacent sun damaged skin. The nearly round light brown area near the middle could be the remains of a seborrhoiec keratosis, but again that could be co-incidence/collision lesion (2 overlapping lesions of different kinds) and that doesn’t help us very much either.

There are a few scattered grey circles. Grey circles in a facial pigmented lesion are a clue to lentigo maligna. However they are not a very prominent feature here.

The history of recent change and the overall impression of a pink and grey lesion made me think of a lichenoid keratosis. However, I couldn’t be sure so went for a biopsy. To excise the whole lesion would have required a fairly big operation on the face, necessary for lentigo maligna but not for lichenoid keratosis (which is self resolving) or pigmented solar keratosis (which can be treated by non surgical methods sch as cryotherapy, Efudix cream or photodynamic therapy) so an ellipse biopsy was removed from the most suspicious looking part of the lesion.

The report came back confirming lichenoid keratosis as I had thought.

Lichenoid keratosis is an oddity, typically presenting on elderly sun damaged skin (face, upper trunk or back of forearm-all sun exposed sites) as a recent change of colour, thickness and sensation in a long standing pigmented lesion,. What happens is that for unknown reasons, an immunological reaction kicks off in a solar lentigo or seborrhoeic keratosis, which becomes inflamed (hence the pink or red colour, irritation an thickening) and then self-destructs (undergoes a process called regression, which is signified by the grey dots). I find that I can often reliably distinguish these lesions from Lentigo maligna, especially where there is a very even pattern of fine grey dots through the whole lesion, or where there are clear-cut remnants of seborrhoiec keratosis, and of course in the absence of known clues to lentigo maligna.

I was interested to note that when this case was posted on the Facebook page of the International Dermoscopy Society (the Facebook page is for doctors only but there is a lot of freely available information on the IDS web site) a majority of posters assumed it was a lentigo maligna. I had thought about 70-30 lichenoid keratosis versus lentigo maligna, hence the biopsy. Grey dots can be seen in both types of lesion.

I will post a few more cases of both kinds of lesion over the summer. As an aside, I have just seen the programme for the dermoscopy sub-specialist day for the European Academy of Dermato-Venereology conference in Madrid this October and there is a presentation on lichenoid keratosis versus lentigo maligna. I look forward to this very much, all the more as I have been kindly asked to play the role of an ‘expert’ in a lesion quiz.

June 10, 2019 / molehunter

ABCD rule for diagnosing melanoma skin cancer

ABCD rule for diagnosing melanoma from Stephen Hayes on Vimeo.

This video is aimed at the general public. If you are worried about a skin lesion that is new, changing, irregular or otherwise worrying, seek advice from a suitably skilled health care professional.

June 1, 2019 / molehunter

International Dermoscopy Conference Winchester Guildhall 12/13 June 2020-speakers announced-THE WORLD’S BEST!

International Dermoscopy Conference 12/13 June 2020, Winchester.

I am delighted to announce that, in my role as a UK board member of the International Dermoscopy Society, and with the collaboration of colleagues, I have organised a 2 day skin cancer diagnostics training conference in the heart of southern England with 6 of the world’s top dermatoscopy/dermoscopy teachers. To the best of my knowledge, this is the first 2 day conference of this kind held in Britain with 6 top international speakers.

This conference will be suitable for qualified or trainee dermatologists, plastic surgeons, GPSIs, GPs, specialist and practice nurses, occupational health and elderly care doctors, general physicians, oncologists and any health care professional whose work involves seeing patients who are concerned about skin lesions.

Our world-class faculty will include Professor Giuseppe Argenziano of Naples, Italy, Professor Harald Kittler of Vienna, Austria, Professor Luc Thomas of Lyon, France, Professor Bengu Nisa Akay of Ankara, Turkey, Professor Cliff Rosendahl of Brisbane, Australia, and Associate Lecturer Dr Agata Bulinska from Poland. All of these dear friends are distinguished researchers and teachers who have between them published hundreds of papers in peer review journals and travel the world teaching skin lesion diagnostics. All are inspiring teachers and I am incredibly honoured that they have agreed to teach in Winchester, England.

Geppi photo new (1)harald kittler faceLT couleurbengu nisa akayCliff-Profile-imgagata bulinska

The venue is the impressive Winchester Guildhall, at the centre of the picturesque old city near the famous cathedral and 2 or 3 minutes walk from many excellent restaurants and hotels. 15 minutes by direct train from Southampton airport (flights from many UK and Irish destinations and continental airports such as Paris, Amsterdam, Dusseldorf, Geneva, Bordeaux, Verona and others.) Also 1 hour by frequent train from London Waterloo, 90 minutes by coach from Heathrow and 1 hour 40 minutes by train from Gatwick.

The 2 day conference programme (in final preparation) is designed to give a good grounding from beginner to expert level in skin lesion recognition with an emphasis on the well proven technique of dermatoscopy/dermoscopy, in which our presenters are recognised world experts. Ideally delegates will attend both days (highly recommended), but we know how busy people are and so the Friday will be set at a more intermediate level to meet the needs of beginners and those who can only find one day to attend, while the Saturday will be aimed more at an expert level and would suit experienced users more.

Delegates will receive a memory drive with as many PDFs as possible of the presentation plus other learning and teaching material including at least 200 high quality images that can be used for teaching. In view of the skin cancer epidemic, more teachers of skin lesion recognition skills are required and while your own images will always carry more weight, this should act as a library resource for those beginning to teach this vital skill to colleagues .

cost will include refreshments and lunch.

EARLY BIRD £250 for both days or £150 for one day if payment received by 31st November 2019

REGULAR PRICE from 1st December 2019 £300 for both days or £165 for either day.

NB as a goodwill gesture in view of Brexit, all delegates who normally live in mainland Europe, including the whole island of Ireland, Turkey, will pay in Euros, e.g. E250 instead of £250, which is about a 15% discount. Please come, we love you!

It is hoped to put on a social event/drinks and entertainment on Friday evening if a minimum number of delegates indicate on booking that they would like this, a modest additional cost will be involved.

for booking details please email stevehayes272@gmail.com

conference organiser

Dr Stephen Hayes GMC 2482404

Associate Specialist in Dermatology, University Hospital Southampton

UK board member International Dermoscopy Society

Chair, British and Irish Dermoscopy Group

Director Molehunter Diagnostics Ltd

96 Winchester Street,  Botley, Hampshire SO30 2AA