4th World Dermoscopy Congress, Vienna. Initial report
Just back from the 4th World Congress of Dermoscopy (now including ‘skin imaging’) in Vienna which I attended with my Southampton dermatologist colleagues Birgit Pees and Catriona Henderson. Our attendance was enabled by a generous grant from the Donna Annand Melanoma Charity in return for some teaching we did for them on the island of Jersey. I will be writing the experience up and posting here in pieces, but here is a quick overview to get things started, setting aside the astonishing cultural experience of Vienna.
1,300 dermatology doctors from 66 countries attended 3 full days of presentations, workshops and poster displays at the majestic Hofburg Palace, with many 10-15 minute presentations from dozens of different countries, 100 or so poster presentations. Sadly nothing from the British Isles.
Events began at 08.30 on Tursday 16th April with a consensus conference on dermatoscopic terms. The new descriptive dermoscopic terminology which Professor Harald Kittler set out in 2007 (just 5 nouns=clods, dots, lines, circles and pseudopods plus adjectives and spatial descriptions) is coming in although the best of the metaphorical terminology (maple leaf, cerebriform etc) will stay. Redundant metaphorical terms will be discouraged and the invention of new ones banned (which as the ‘inventor’ of the terms charcoal flecks and raspberry and orange trifle I reluctantly accept!). An elite working group of internationally respected dermoscopists will produce a dictionary with a list of approved terms and specific definitions. This will facilitate research and international communications by cleaning up definitions and also greatly assist the translation of dermoscopy books into various languages, a very necessary goal as it is spreading EVERYWHERE. There is now strong agreement on this and it will happen.
Confocal microscopy of the skin is gaining widespread acceptance. It is a non invasive tool that goes very close to a horizontal in vivo microscopic view and can tell between LM and benign lentigo, delineate cancer margins, assist in avoiding excision in questionable cases, and probably far more. Very new, will get bigger. Lots of costly new toys were on display for digital monitoring of suspicious moles and high risk patients.
A speaker from Poland gave a good presentation about their appalling 50% melanoma death rate and of a campaign led by top dermatologists which is reversing this trend. the Polish team also won the dermoscopy championship (we were knocked out in the 2nd round).
A major theme was dermoscopico-pathological correlation, and it seems that there is an emerging standard to photograph all lesions being excised for audit, learning and as a research database.
Dermoscopy can usually differentiate between regular superficial BCCs and those with a nodular component, and this matters as the former respond far better to non surgical methods.
The skin cancer epidemic is truly world wide and cases are predicted to double by 2030, whether they will level off or not then remains to be seen. This makes the widespread adoption of dermoscopy skills and easy acess to evaluation by a trained practitioner all the more important.
Dermoscopy is very handy in the tropics for spotting various parasites not just scabies. Also of growing value in trichoscopy.
The public have swallowed numerous false beliefs about sun protection and use far too little cream. The evidence that SPF creams protect against skin cancer is limited, although it makes sense to act as if it does. If people are determined to sunbathe (and as we know they are) applying SPF probably won’t stop them getting skin cancer even if they use enough, and they don’t use enough. We really need to go back to the drawing board on this one.
An American dermatologist/journal editor spoke about the need to train GPs and nurses to learn dermoscopy to do good triage, obstacles being the willingness of insurers to pay for this and the reluctance of dermatologists to give up the cash cow of seeing worried well elderly for their seborrhoiec keratoses. Also they need to get the lawyers off doctors’ backs if they stop chopping so many benign lesions for histology.
The term ‘dysplastic naevus’ is as near as makes no difference completely useless and should be abandoned, except as a general risk marker in the context of 100+ naevi. Most melanomas don’t arise from pre-existing naevi, of those that do, most arise from benign banal naevi, not ‘dysplastic’ ones. So there is no evidence to consider ‘dysplastic’ naevi as premalignant.
Les Globulos Marrones (see dermatologist rock and roll on YouTube) played a great gig at a local jazz club Friday night with Geppi Argenziano on Drums, Harald Kittler and Luc Thomas (and others) on guitar. Luc Thomas from Lyon, France gave a fantastic presentation on dermoscopy of acral lesions and another great presentation on something else (made notes, head still in a whirr). I asked him if he would come to UK, he said yes, but he also asked delegates to consider coming to Lyon, which could be a venue, especially if we were minded to link up with other European based Primary Care organisations. Excellent speaker, good guitarist too.
Holland has a well organised GP dermoscopy training scheme run by a Dr N Kukitch, with whom I spoke. Over 1,000 Dutch GPs have done it. I have her contact details, she has mine. I think we should talk.
Much more detail later, the above is just a taster. The overall impression was of dermoscopy world wide getting bigger and better and new skin scanning techniques moving on, with the UK regrettably behind the curve due to a lack of leadership from the top-so what we have been doing in the PCDS seems all the more important and I resolve to put what effort I can into driving education forward. But I’m getting on-we need more, young, energetic educators who can train others in dertmoscopy skills.
On a personal level I was overwhelmed both by Vienna and by spending 3 days with people of 66 nations from Thailand to Finland to Bosnia-Herzegovina united by a common desire to fight melanoma by earlier detection (etc).
The next world congress is in Thessaloniki, Greece, 14-16th June 2018. I plan to be there and hope to present some work on GP dermoscopy education from the United Kingdom of Great Britain (if it still exists!)