Dermoscope - Stethoscope of Dermatologist

1. Dr.Yogesh Kalyanpad
Mumbai

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. 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. Traditional Dermoscope
 Hand-held device
 Light source
 Contact plate
 Linkage fluid

5. Light source
 White light
 Halogen lamp
 White light multiple LEDs
 Polarizing LEDs

10. 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

14. Handheld videodermoscope
 Handy
 Gets used more frequently
 Looks attractive
 User friendly
 Good magnification
 Low resolution
 No polarized light

15. Hand-held Dermatoscope
Hiene Delta 10 (Magnification 10X
(can be variable)
Dermaphot imaging system

16. Video Dermatoscope

17. Hiene Delta 20
Contact plates
Better illumination and resolution

19. 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

28.  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

29. NORMAL PIGMENT
NETWORK
PSEUDO NETWORK ON
FACE

30. 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

32. 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

33. 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

34. 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.

37. Large patches of melasma >2 cm
- diffuse reticular pigmentation ,
- arcuate, star-like, annular & granular dark brown structures in perifollicular
regions but sparing the follicles

38. Scabies burrow
Linear borrow with scaling under
white light and polarizing light

39. 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