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Looking through a Dermoscope

Dermoscope - Stethoscope of Dermatologist

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Looking through a Dermoscope

  1. 1. Dr.Yogesh Kalyanpad Mumbai
  2. 2. Dermatoscopy  Synonyms: Surface microscopy, epiluminescent microscopy, capillary microscopy  To magnify the surface features of the skin  Being non-invasive can be repeated  Images can be stored and studied later  Used for decades for early diagnosis of melanoma  Can be used for diagnosis of other disorders
  3. 3. Introduction  The term ‘dermatoscopy’ was coined by Saphier in 1920  Pioneered in USA by Goldman in 1950s for diagnosis and follow up of melanocytic nevi and cutaneous melanomas  Terminology defined by Bahmer in 1990 with Delta 10  Enhances the most basic of fundamentals in clinical dermatology – the visual inspection  Non-invasive and repeatable  Recordable in standardized conditions for monitoring
  4. 4. Traditional Dermoscope  Hand-held device  Light source  Contact plate  Linkage fluid
  5. 5. Light source  White light  Halogen lamp  White light multiple LEDs  Polarizing LEDs
  6. 6. Comparison of dermoscopesVideodermoscope Handheld dermocsope  Computer connection needed  Viewing easy as image is enlarged  Capture device not needed  Video real time easy  Storage, cataloguing and analysis easy  Check resolution  Check light source  Computer not needed  Viewing not easy  Capture device needed  Contact plate and linkage fluid needed
  7. 7. Handheld videodermoscope  Handy  Gets used more frequently  Looks attractive  User friendly  Good magnification  Low resolution  No polarized light
  8. 8. Hand-held Dermatoscope Hiene Delta 10 (Magnification 10X (can be variable) Dermaphot imaging system
  9. 9. Video Dermatoscope
  10. 10. Hiene Delta 20 Contact plates Better illumination and resolution
  11. 11. What do I expect?  Not what you see through a magnifying lens  Magnification is much more than a lens  Unexpected morphologic features  Just like you go directly to high power of microscope
  12. 12.  Pigment network  Trunk & extremities  Represent melanin pigment in keratinocytes, or in melanocytes along the DE junction  Reticulation = rete ridge pattern  Hypomelanotic holes= tips of dermal papillae  Pseudonetwork  Face  Due to interruption of lighter uniform pigment by follicular pattern
  14. 14. Dots/ Granules  small round structures (< 0.1mm in dia.)  Black-pigment in str. corneum & upper epidermis  Brown-focal melanin accumulation at DE jn.  Gray blue (peppering)- tiny melanin granules in papillary dermis  Steel blue or blue –melanophages in deep papillary or reticular dermis
  15. 15. Globules  Globules are large dots  Correspond to nests of melanocytes, melanin &/or melanophages on both sides of DEjunction Blotches • A brown-black poorly circumscribed area
  16. 16. Melasma types In individuals with dark-brown skin, examination with a Wood ‘s light does not localize pigment, and these patients are thus classified as indeterminate
  17. 17. Role of Dermoscopy in Melasma  Differentiating from LPP, Nevus of Ota, ochronosis etc.  Identifying early cases (speckled) that look like freckles  Deciding depth of melasma especially in dark skinned individuals where Wood’s lamp is of little help  Monitor efficacy of therapy standardized photos  Pick up complications early e.g. atrophy, depigmentation, telangiectasia, exogenous ochronosis, steroid dermatitis etc.
  18. 18. Large patches of melasma >2 cm - diffuse reticular pigmentation , - arcuate, star-like, annular & granular dark brown structures in perifollicular regions but sparing the follicles
  19. 19. Scabies burrow Linear borrow with scaling under white light and polarizing light
  20. 20. Do I really need to do this?  Doctors are committed to delivering a continually improving standard of care  Standard of care begins with standard of diagnosis  Dermoscope can be a dermatologist’s sthethoscope