1. Dermoscopy Workshop An Introduction to Dermoscopy
Dr Nicky Jackson
GPwSI Dermatology

2. Aims To understand the role of a dermatoscope in clinical practice.
To gain more confidence in using a dermatoscope to help diagnose skin lesions.

3. Objectives To review the role of the dermatoscope
To look at the common features of lesions
1. Dermatofibroma
2. Haemangioma
3. Seborrhoeic Wart
4. Naevus
5. Melanoma
To review with a quiz!

4. Dermatoscopes

5. Dermatoscopes

6. The Role of the Dermatoscope?

7. Dermoscopy
Magnify & Illuminate skin lesions to assess structures more easily
To show patients images of their lesions
A diagnostic aid
Benign vs malignant
To add to clinical records to keep lesions under review
To aid referral/ triage

8. Dermatofibroma
Dermatofibromas most often occur on the legs and arms, but may also arise on trunk or any site of the body
People may have 1 or up to 15 lesions.
Size varies from 0.5–1.5 cm diameter; most lesions are 7–10 mm diameter.
They are firm nodules tethered to the skin surface and mobile over subcutaneous tissue.
The skin dimples on pinching the lesion.
Colour may be pink to light brown in white skin, and dark brown to black in dark skin; some appear paler in the centre.
They do not usually cause symptoms, but they are sometimes painful or itchy.

9. Dermatofibroma

10. Dermatofibroma

11. Dermatobibroma

12. Dermatofibroma under Dermatoscope

13. Dermatofibroma under Dermatoscope

14. Angioma
Angioma or haemangioma describes a benign overgrowth of blood vessels in the skin. 
Angiomas are due to proliferating endothelial cells; these are the cells that line blood vessels.
Acquired angiomas include:
Cherry angioma
Spider angioma (spider naevus)
Venous lake

15. Haemangiomas

16. Haemangiomas

17. Haemangiomas under Dermatoscope
Red/ Purple Lacunars easily seen.
Spider naevi blanche under pressure

18. Haemangiomas Under Dermatoscope

19. Diagnosis?

20. Haemangioma

21. Seborrhoeic Wart Seborrhoeic Keratoses, Basal Cell Paplillomas
Estimated 90% people aged over 60 have them. Uncommon <20yrs old
Can arise on any part of skin except palms, soles and mucous membranes
Often Multiple
Classic stuck on warty appearance

22. Seborrhoeic Wart

23. Seborrhoeic Wart

24. Seborrhoeic Wart Milia-like cysts – there are two types:
Tiny white starry
Larger yellowish cloudy
Irregular crypts/ fissures/ ridges
Comedo like openings
Light brown fingerprint-like parallel structures
Ceribriform Surface
Hairpin vessels

25. Starry & cloudy milia like cysts

26. Milia Like cysts

27. Comedo like openings, Milia, Irregular fissures

28. Seborrhoeic Wart Under Dermatoscope
Cerebriform Surface

29. Fingerprint & Fat Fingers Pattern

30. Hairpin vessels

31. Naevi Very common, can be multiple Acquired/ Congenital
Colour van range pink to black
Multiple types
Intradermal
Junctional
Compound
Blue naevi

32. Naevus Pigment Network

33. Naevi

34. Naevi

35. Naevus - Wobble sign

36. Globular & Homogenous

37. Blue Naevi

38. Melanoma
ABCDE Rule?

39. Melanoma ABCDE Rule A Asymmetry B Border - irregular C Colour
D Diameter >7mm
E Elevation/ Evolution

40. 3 Point Dermoscopy Checklist
Asymmetry: asymmetry of colour and structure in one or two perpendicular axes
Atypical network: pigment network with irregular holes and thick lines
Blue-white structures: any type of blue and/or white colour, i.e. combination of blue- white veil and regression structures

41. Melanoma
Macroscopic
Under dermatoscope

42. Melanoma

43. Melanoma

44. Melanoma

45. Benign vs Malignant

46. Benign vs Malignant

47. Benign vs Malignant

48. Benign vs Malignant

49. Quiz! 10 Images Choice of 5 following:- Dermatofibroma Haemangioma
Seborrhoeic Wart
Naevus
Melanoma

50. 1.

51. 2.

52. 3.

53. 4.

54. 5.

55. 6.

56. 7.

57. 8.

58. 9.

59. 10.

60. 11. Bonus Slide!

61. Answers

62. 1.

63. 2.

64. 3.

65. 4.

66. 5.

67. 6.

68. 7.

69. 8.

70. 9.

71. 10.

72. 11. Bonus Slide!

73. 3 Point Dermoscopy Checklist
Asymmetry: asymmetry of colour and structure in one or two perpendicular axes
Atypical network: pigment network with irregular holes and thick lines
Blue-white structures: any type of blue and/or white colour, i.e. combination of blue- white veil and regression structures
Practice!

74. Dermatology Resources
RSS Website- Dermatology Guidelines
BAD British Association of Dermatology
Dermnet NZ – Good images
Primary Care Dermatology Society
International Dermoscopy Society