Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis.
ABSTRACT Intraepidermal carcinoma (IEC), superficial basal cell carcinoma (sBCC), and psoriasis are common entities that may all present as well-defined, brightly erythematous plaques. Currently, there are limited data on the dermatoscopic features that differentiate these diagnoses.
We sought to describe the most significant morphologic findings seen on dermatoscopy of IEC, sBCC, and psoriasis, and formulate a diagnostic model based on these features.
We conducted a retrospective observational study using macrophotography and dermatoscopy to evaluate the presence or absence of dermatoscopic features and formulated diagnostic models for each diagnosis. A convenient sample of 300 lesions was collected from 255 patients from two hospital dermatology clinics and 4 private dermatology practices. These comprised 150 cases of sBCC, 100 cases of psoriasis, and 50 cases of IEC.
The most significant dermatoscopic features of IEC were a clustered vascular pattern, glomerular vessels, and hyperkeratosis. When all 3 features were observed together, the diagnostic probability for IEC was 98%. sBCCs were characterized by a scattered vascular pattern, arborizing microvessels, telangiectatic or atypical vessels, milky-pink background, and brown dots/globules; the diagnostic probability was 99% if 4 of these 6 features were identified. For psoriasis, the significant features identified were a homogenous vascular pattern, red dots, and light-red background, yielding a diagnostic probability of 99% if all 3 features were present.
Lack of evaluation of interobserver/intraobserver reproducibility is a limitation.
Dermatoscopy is valuable in the diagnosis and differentiation of IEC, sBCC, and psoriasis because of consistent dermatoscopic morphology.
- SourceAvailable from: Cliff Rosendahl[Show abstract] [Hide abstract]
ABSTRACT: Skin cancer and melanoma in particular cause substantial mortality and morbidity in Australia1. This carries both a personal and economic cost. Melanoma is the most common cancer in the 15-45 year old age group1. Projected incidence and mortality from melanoma in Australia in 2010 were 11,500 and 1500 respectively1. Non-melanoma skin cancer (NMSC) is the costliest malignancy treated in Australia2. Apart from primary prevention the only way to prevent death from melanoma is to diagnose and treat it before it metastasises and early diagnosis can reasonably also be expected to reduce morbidity and mortality of, and costs associated with, NMSC. The high incidence of melanoma and non-melanoma skin cancer in Australia makes Australia an ideal place for research into these conditions and it is the opportunities provided by this situation that are being harnessed by the related projects in this endeavour. There is a relative deficiency of dermatologists in Australia3 and this, compounded with the high rate of skin cancer has created an ‘evolutionary niche’ that has of necessity been filled by primary care doctors who are sub-specialising in skin cancer management4. The role of these doctors is not defined and previously there are have been no studies to assess the effectiveness of these doctors, relative to either main-stream general practitioners or dermatologists3. SCARD was conceived to allow those doctors who treat skin cancer to measure their performance and compare it to that of their peers. It harvests data, which subject to meeting ethics requirements, is available for research5. As the second stream of this endeavour, innovative diagnostic techniques have been developed and tested. They were designed for application in routine practice without the obstacles of mathematical calculations or confusing metaphorical terminology. Not only have we studied the Chaos and Clues algorithm and shown it to be efficacious for the detection of all pigmented malignancies whether melanocytic or not6, but we have included case studies showing that it can diagnose the smallest published melanoma (1.6mm diameter) 7, the rarest non-melanocytic pigmented skin malignancy, pigmented invasive squamous cell carcinoma8 and one of the rarest melanomas, nail matrix melanoma9. This project focuses mainly on the diagnostic component of “improving the management of skin cancer in Australia” but also includes some work on treatment aspects with respect to the design of SCARD although there is no analysis of that in this study. A stated mandate of this PhD project is “Improving the management of skin cancer in Australia…”, therefore efforts at dissemination in Australia, of discoveries made, are an integral part of the thesis. A solicited educational paper on ‘Chaos and Clues’ is presented, published as a peer-reviewed article in the Australian Family Physician10. This has been a challenging project but it has been made possible by collaboration with people of outstanding commitment and creative ability. It has also been made possible by the enthusiastic participation of the people being studied – the primary care skin cancer practitioners of Australia. It is to them and their patients that this work is dedicated. References 1. Australian Institute of Health and Welfare 2010. Cancer in Australia 2010: An overview. Cancer Series No. 60. Cat. no. CAN 56. Canberra: AIHW. Retrieved from http://www.aihw.gov.au/publication-detail/?id=6442472459 on October 1, 2011 2. Australian Institute of Health and Welfare. Health system expenditures on cancer and other neoplasms in Australia 2000-2001. Health and Welfare Expenditure Series Number 22. Canberra: AIHW 2005 3. Commens CA. Skin cancer: changing paradigms of practice and medical education. Med. J. Aust 2007;187:207–8. 4. Wilkinson D, Bourne P, Dixon A, Kitchener S. Skin cancer medicine in primary care: towards an agenda for quality health outcomes. Med. J. Aust 2006;184:11-12 5. Rosendahl C, Hansen C, Cameron A, Bourne P, Wilson T, Cook B, et al. Measuring performance in skin cancer practice: the SCARD initiative. Int. J. Dermatol. 2011 Jan;50(1):44–51. 6. Rosendahl C, Tschandl P, Cameron A, Kittler H. Diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions. J. Am. Acad. Dermatol. 2011 Jun;64(6):1068–73. 7. Rosendahl C, Cameron A, Bulinska A, Williamson R, Kittler H. Dermatoscopy of a minute melanoma. Australas. J. Dermatol. 2011 Feb;52(1):76–8. 8. Rosendahl C, Cameron A, Bulinska A, Weedon D. Cutaneous pigmented invasive squamous cell carcinoma: a case report with dermatoscopy and histology. Dermatol Pract Concept 2011;1(1):14. doi: 10.5826/dpc.0101a14 9. Rosendahl C, Cameron A, Wilkinson D, et al. Nail matrix melanoma: consecutive cases in a general practice. Dermatopathol Pract Concept (in press). 10. Rosendahl C, Cameron A, McColl I, Wilkinson D. Dermatoscopy in routine practice: Chaos and Clues. Australian family Physician – in press12/2012, Supervisor: Professor David Wilkinson, Professor H Peter Soyer
Article: Pink Lesions[Show abstract] [Hide abstract]
ABSTRACT: Dermoscopy (dermatoscopy or surface microscopy) is an ancillary dermatologic tool that in experienced hands can improve the accuracy of diagnosis of a variety of benign and malignant pigmented skin tumors. The early and more accurate diagnosis of nonpigmented, or pink, tumors can also be assisted by dermoscopy. This review focuses on the dermoscopic diagnosis of pink lesions, with emphasis on blood vessel morphology and pattern. A 3-step algorithm is presented, which facilitates the timely and more accurate diagnosis of pink tumors and subsequently guides the management for such lesions.Dermatologic clinics 10/2013; 31(4):649-78. DOI:10.1016/j.det.2013.06.005 · 1.43 Impact Factor
Article: Vascularización en dermatoscopia[Show abstract] [Hide abstract]
ABSTRACT: Under the right conditions, dermoscopy allows us to observe the vascular features of many different types of skin lesions. The visualization and identification of vessels with a characteristic morphology can be the key to diagnosis, especially in hypopigmented lesions in which the typical pigmented structures are not visible.Some of the more characteristic associations are the presence of crown vessels in sebaceous hyperplasia, arborizing telangiectasias in basal cell carcinoma, comma-shaped vessels in intradermal and compound nevi, dotted vessels in Spitz nevi and melanoma, and hairpin vessels in seborrheic keratoses.The recognition of distinctive vascular features can be of great help in the diagnosis of many types of skin lesions, and very often such patterns are the only key to the diagnosis of melanoma.Actas Dermo-Sifiliográficas 06/2012; 103(5):357–375. DOI:10.1016/j.ad.2011.11.005