Saturday, June 15, 2024

Dermoscopy

Overview

The widely used acronym ABCDE (asymmetry, irregular borders, multiple colors, diameter >6 mm, enlarging lesion) contains the primary clinical criteria for diagnosing suspected cutaneous malignant melanoma. The early phase of malignant melanoma is difficult to identify because cutaneous malignant melanoma can share many clinical features with an atypical nevus. Several studies have described diagnostic accuracy rates ranging from 50-75%, indicating a need for additional diagnostic tools. The introduction of dermoscopy, also termed epiluminescence microscopy (ELM), has opened a new dimension in the examination of pigmented skin lesions and, especially, in the identification of the early phase of cutaneous malignant melanoma.

Dermoscopy is a noninvasive method that allows the in vivo evaluation of colors and microstructures of the epidermis, the dermoepidermal junction, and the papillary dermis not visible to the naked eye. These structures are specifically correlated to histologic features. The identification of specific diagnostic patterns related to the distribution of colors and dermoscopy structures can better suggest a malignant or benign pigmented skin lesion. The use of this technique provides a valuable aid in diagnosing pigmented skin lesions. Because of the complexity involved, this methodology is reserved for experienced clinicians.

Vestergaard et al have reported dermoscopy assessment is more accurate than clinical evaluation by naked eye for the diagnosis of cutaneous melanoma (odds ratio = 15.6, P = .016). In this study, the mean sensitivity in the diagnosis of melanoma was 74% for the examination by naked eye and 90% for dermoscopy.

The equipment; technologic methods; diagnostic features; and primary aspects of melanoma, common nevi, atypical nevi, and other nonmelanocytic pigmented skin lesions are discussed in this article. The technique is also commonly used to assist in the evaluation of nail fold capillaries and features of alopecia.

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