Differences between polarized and non polarized dermoscopy

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Description Describes the differences between polarized and non polarized dermoscopy
Author(s) Ofer Reiter · Florentia Dimitriou · Alon Scope · Ashfaq A. Marghoob · Ralph P. Braun
Responsible author Alon Scope→ send e-mail
Status released
Status update April 2, 2019
Status by Ralph P. Braun


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The main difference between non-polarized dermoscopy (NPD) and polarized dermoscopy (PD) is the depth of visualized structures. While NPD is better for inspecting structures in the superficial skin layers (e.g., superficial epidermis down to the dermo-epidermal junction [DEJ]), PD is better for evaluating the deeper skin layers (e.g., DEJ and superficial dermis).

For example, both Milia-like cysts and blue-white veil are caused by superficial changes in the epidermis and are therefore better visualized with NPD. On the other hand, Shiny white structures (chrysalis/crystalline, blotches and strands, rosettes) are better visualized with PD since they are associated with increased collagen at the superficial dermis. In addition, polarized light rapidly randomizes its polarization when it encounters a birefringent structure, such as collagen.

An example of Milia-like cysts,better visualized under NPD:

Npd vs pd milia1.JPG


An example of a blue-white veil, also much better visualized with NPD:

Npd vs pd blue veils.JPG



And finally an example of Shiny white lines/streaks, which are much better visualized with PD:

Npd vs pd shiny lines.JPG



Additional difference between NPD and PD[edit]

  • Since PD does not require direct skin contact, blood vessels and pink color (vascular blush) are more evident under PD (due to lack of pressure effect). In addition, blood vessels are located in the dermis that is better visualized with PD.
  • In pigmented lesions with melanin at the DEJ (e.g.. junctional nevi) or superficial dermis (e.g. blue nevi), PD will show slightly darker shades of brown and blue, and sometimes more variability in pigmentation, compared with NPD.


Diagnostic accuracy[edit]

The differences between PD and NPD may impact the diagnostic accuracy and diagnostic confidence level. For example, PD can increase sensitivity for detecting amelanotic melanomas or structure-poor melanomas and basal cell carcinomas, because PD highlights the presence of blood vessels, vascular blush, and/or white shiny lines (chrysalis/crystalline). In contrast, NPD can increase specificity by allowing to correctly identify Milia-like cysts and comedo like openings in seborrheic keratoses.


”Hybrid” dermoscopes toggle between PD and NPD modes. These hybrid devices can enhance dermoscopic diagnosis because PD and NPD provide complementary information. These devices should always be in direct contact with the skin and used with a liquid interface, otherwise, dermoscopic structures will only be visualized in PD mode.
Toggling between polarized light and non-polarized light will reveal the differences between both even better. This has been described as the blink sign because while toggling the structures will blink at you.

Differences between polarized and non polarized light as seen in dermoscopy[edit]

Colors and structures NPD PD
Melanin + ++
Red/pink + +++
Blue-white due to orthokeratosis +++ +
Blue-white due to regression +++ ++
Peppering +++ ++
Chrysalis or white scar +/− +++
Vessels + +++
Milia-like cyst +++ +/−





References

  1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.
  2. Agero, A.L., Taliercio, S., Dusza, S.W., Salaro, C., Chu, P. & Marghoob, A.A., 2006, Conventional and polarized dermoscopy features of dermatofibroma. Arch Dermatol, 142, 1431–7.
  3. Anderson, R.R. & Parrish, J.A., 1981, The optics of human skin. J Invest Dermatol, 77, 13–19.
  4. Benvenuto-Andrade, C., Dusza, S.W., Agero, A.L., Scope, A., Rajadhyaksha, M., Halpern, A.C. & Marghoob, A.A., 2007, Differences between polarized light der- moscopy and immersion contact dermoscopy for the evaluation of skin lesions. Arch Dermatol, 143, 329–38.
  5. Benvenuto-Andrade, C., Dusza, S.W., Hay, J.L., Agero, A.L., Halpern, A.C., Kopf, A.W. & Marghoob, A.A., 2006, Level of confidence in diagnosis: clinical examination versus dermoscopy examination. Dermatol Surg, 32, 738–44.
  6. Pan, Y., Gareau, D.S., Scope, A., Rajadhyaksha, M., Mullani, N.A. & Marghoob, A.A., 2008, Polarized and nonpolarized dermoscopy: the explanation for the observed differences. Arch Dermatol, 144, 828–9.
  7. Ronger, S., Touzet, S., Ligeron, C., Balme, B., Viallard, A.M., Barrut, D., Colin, C. & Thomas, L., 2002, Dermoscopic examination of nail pigmentation. Arch Derma- tol, 138, 1327–33.
  8. Stauffer, F., Kittler, H., Forstinger, C. & Binder, M., 2001, The dermatoscope: a potential source of nosocomial infection? Melanoma Res, 11, 153–6.
  9. Wang, S.Q., Dusza, S.W., Scope, A., Braun, R.P., Kopf, A.W. & Marghoob, A.A., 2008, Differences in dermoscopic images from nonpolarized dermoscope and polarized dermoscope influence the diagnostic accuracy and confidence level: a pilot study. Dermatol Surg, 34, 1389–95.



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