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March 19, 2014 / molehunter

History and inspection precede dermoscopy in skin lesion recognition

Hi, I’m posting again after a long break due to other stuff. The 2014 course is about to begin and will link with this blog, although to those dropping in here from overseas, welcome! For the next 3 months a lot of what is here will be largely aimed at the 84 learners on the South Coast Dermoscopy Integrated skin lesion recognition and dermoscopy course, but anyone is free to drop in.

This lesion had been present on a limb of an older white person for about 6 months. It continued to grow and scabbed. On presentation it looked like this.

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Applying the dermoscope, we are really no wiser.

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The dermoscopic view is really just the naked eye view amplified. It adds nothing.

DISCUSSION this is a new, growing, bleeding solid lesion on elderly white skin. That is all we need to know. This lesion has to, as we say in the trade ‘go for a swim’ (i.e. be removed without delay and plopped into a pot of formalin to go for histopathological examination.) It could in theory be a traumatised benign skin lesion, but its very dark and covered with blood clot and is getting worse, not better. Dermoscopy is irrelevant, the management decision is made on history and examination alone.

Some old timer dermatologists still say that dermoscopy is a bit of a waste of time because its usually possible to make a diagnosis, or at least a safe management decision, on the history and examination. That is true as far as it goes, and certainly true for this lesion. That is why I like to talk about ‘integrated skin lesion recognition with dermoscopy’ rather than dermoscopy alone. As Professor Giuseppe Argenziano, arguably the top man in Europe, says, dermoscopy will change your mind in perhaps 20% of cases. It is not a substitute for a holistic approach to skin lesion diagnosis, which begins with an appreciation of the natural history of common and important skin lesions.

LEARNING POINT  a new, growing solid skin lesion in elderly white skin (let alone one that is scabbing/bleeding) requires urgent evaluation, and unless a consciously competent suitably skilled person is certain on positive grounds that it is benign, it ‘goes for a swim’ and FAST.

This lesion was a nodular melanoma.

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