Dermoscopy can assist clinicians in the evaluation and diagnosis of skin tumors. Since dermoscopy is becoming widely accepted and used in the medical community, there is now the need for a standardized method for documenting dermoscopic findings so as to be able to effectively communicate such information among colleagues.
Toward this end, the International Dermoscopy Society embarked on creating a consensus document for the standardization and recommended criteria necessary to be able to effectively convey dermoscopic findings to consulting physicians and colleagues.
The Dermoscopy Report Steering Committee created an extensive list of dermoscopic criteria obtained from an exhaustive search of the literature. A preliminary document listing all the dermoscopic criteria that could potentially be included in a standardized dermoscopy report was elaborated and presented to the members of the International Dermoscopy Society Board in two meetings of the Society and subsequently discussed via Internet communications between members and the Steering Committee.
A consensus document including 10 points categorized as either recommended or optional and a template of the dermoscopy report were obtained. The final items included in the document are as follows: (1) patient's age, relevant history pertaining to the lesion, pertinent personal and family history (recommended); (2) clinical description of the lesion (recommended); (3) the two-step method of dermoscopy differentiating melanocytic from nonmelanocytic tumors (recommended); (4) the use of standardized terms to describe structures as defined by the Dermoscopy Consensus Report published in 2003. For new terms it would be helpful to provide a working definition (recommended); (5) the dermoscopic algorithm used should be mentioned (optional); (6) information on the imaging equipment and magnification (recommended); (7) clinical and dermoscopic images of the tumor (recommended); (8) a diagnosis or differential diagnosis (recommended); (9) decision concerning the management (recommended); (10) specific comments for the pathologist when excision and histopathologic examination are recommended (optional).
The limitations of this study are those that are intrinsic of a consensus document obtained from critical review of the literature and discussion by opinion leaders in the field.
Although it may be acceptable for a consulting physician to only state the dermoscopic diagnosis, the proposed standardized reporting system, if accepted and utilized, will make it easier for consultants to communicate with each other more effectively.
"Two examples representing this structure can be seen in Fig. 1. There are two types of pigment network: the typical one, with a light-to dark-brown net with small, uniformly spaced holes and thin lines distributed more or less regularly, and the atypical one, which is a black, brown or gray net with irregular holes and thick lines, frequently being an indicator of melanoma . "
[Show abstract][Hide abstract] ABSTRACT: By means of this study, a detection algorithm for the "pigment network" in dermoscopic images is presented, one of the most relevant indicators in the diagnosis of melanoma. The design of the algorithm consists of two blocks. In the first one, a machine learning process is carried out, allowing the generation of a set of rules which, when applied over the image, permit the construction of a mask with the pixels candidates to be part of the pigment network. In the second block, an analysis of the structures over this mask is carried out, searching for those corresponding to the pigment network and making the diagnosis, whether it has pigment network or not, and also generating the mask corresponding to this pattern, if any. The method was tested against a database of 220 images, obtaining 86% sensitivity and 81.67% specificity, which proves the reliability of the algorithm.
Computers in Biology and Medicine 11/2013; 44(1). DOI:10.1016/j.compbiomed.2013.11.002 · 1.24 Impact Factor
"The interpretation of dermatoscopic images, in order to give out a presumably diagnostic based on this investigation, was performed on ‘Pattern Analysis‘, ‘ABCD Rule’ and ‘7–Point Checklist’ diagnosis algorithms . "
[Show abstract][Hide abstract] ABSTRACT: Reflectance-mode confocal microscopy (RCM) is a new in vivo skin imaging technique. We present our one-year experience in RCM examinations in skin tumors and the retrospective analysis of patients enrolled in the Dermatological Department of 'N. Paulescu' Institute using the Fotofinder Dermoscope IIŴ for the dermatoscopy analysis and VivaScope 1500Ŵ for in vivo RCM. We established the rank of RCM in the complex algorithm of skin cancer diagnose, showing that the presented experience can open new possibilities to implement this automated image analyzing system in the routine practice. Our analyzed cases clearly showed that confocal microscopy, therefore, optical biopsy, could guide the clinician towards an accurate diagnosis before surgical removal. Moreover, we emphasized that the development of this technique increases the potential of future teledermatologic applications.
[Show abstract][Hide abstract] ABSTRACT: REsUMEN Antecedentes: el liquen plano es una enfermedad idiopática de la piel y las mucosas. Se caracteriza por pápulas violáceas pruriginosas, localizadas con mayor frecuencia en las extremidades. En la superficie de las pápulas pueden apreciarse las estrías de Wickham, que desde el punto de vista histológico se correlacionan con las zonas de ortoqueratosis. Objetivo: investigar las variantes clínicas dermoscópicas del liquen plano. Pacientes y método: estudio descriptivo en cinco pacientes con diagnóstico clínico e histopatológico de liquen plano. Cada uno se revisó con el dermoscopio Dermlite PRO HR, se fotografió con una cámara Sony DSC-W55 y se describieron las características observadas. Se realizó el estudio histopatológico para corroborar los hallazgos clínico-dermoscópicos. Resultados: en todos los casos se identificaron las estrías de Wickham, en su variable reticular. Además, se encontró una nueva variante en el centro o periferia de las lesiones, la cual adoptaba la forma de "trébol de cuatro hojas". Conclusión: la identificación dermoscópica de las estrías de Wickham podría ayudar el diagnóstico del liquen plano en etapa activa, principalmente en los casos para los que la clínica puede no ser característica. Palabras clave: liquen plano, estrías de Wickham, dermoscopia. ABsTRACT Background: Lichen planus is an idiopathic disease of skin and mucosa. The clinical forms are purple itching papules, most of the cases located in extremities. In the papules surface we can observed the Wickham striae, this projection varying sizes, form thin spikes. The histology correlate with Wickham striae seems to be a compact orthokeratosis. Objective: To find the clinical dermoscopic pattern of lichen planus. Patients and method: We conducted a descriptive study on five patients who had a clinical and histopathology diagnosis of lichen planus. To each one we perform a dermoscopic study with Dermlite PRO HR; we took pictures with a Sony DSC-W55 camera, and describe the observed characteristics. A histopathologic study to verify the findings was performed. Results: In all cases we identified the Wickham striae, in their reticular morphologic variant. Also, we identified a new variant at the edge and center of lesion, which has the image of a "four-leaf clover". Conclusion: The dermoscopic identification of Wickham striae could allows to do a diagnosis in the active stage of lichen planus, especially in those cases where the clinical appearance could be not characteristic.
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