Importance of dermoscopy and histopathology correlates

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Main PageDermoscopic structures and thir histopathological correlationImportance of dermoscopy and histopathology correlates
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 Editor: Oriol Yélamos

 Author(s): Oriol Yélamos     ·  Ralph P. Braun     ·  Daniel Morgado     ·  Constanza Riquelme-Mc Loughlin
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Description This chapter covers the importanceThis glossary term has not yet been described. of dermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. and histopathologyThis glossary term has not yet been described. correlates
Author(s) Oriol Yélamos · Ralph P. Braun · Daniel Morgado · Constanza Riquelme-Mc Loughlin
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Status update December 9, 2019
Status by Ralph P. Braun


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Improve the diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions

DermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. evaluates the lesion in all its extension on a horizontal plane. This can allow the selection of the best area to biopsy in large lesions, as well as giving information to the pathologist of the most representative area to section (Bauer et al., 2001; Soyer et al., 2005). Improvement in sampling can occur either using dermoscopy in the clinical setting (Bauer et al., 2001) or by using dermoscopy directly in the excised specimen in the laboratory (ex vivo dermoscopy) (Marc Haspeslagh et al., 2016; Scope et al., 2007). Ex vivo dermoscopy (EVD) is a valuable tool since most dermoscopic features are visible even after formalin fixation (Marc Haspeslagh et al., 2016). It can be extremely helpful when scarce or no clinical information is available, in this setting EVD can improve the diagnosis of challenging melanocyticThis glossary term has not yet been described. lesions (Amin and Fraga, 2012; Cabete et al., 2016). EVD is very useful when evaluating large and complex pigmented lesions since clinicians or pathologists can mark the areas of interest using “derm dotting” in order to analyze them properly under the microscope (Haspeslagh et al., 2013). EVD can identify melanomas missed with conventional step sectioning, improves the staging of melanomas (Cabete et al., 2016), increase the detection of positive margins in keracinocyte carcinomas (Marc Haspeslagh et al., 2016), decreases the diagnostic turnaround time (Marc Haspeslagh et al., 2016) and potentially reduces the costs of histologic processing. Dermoscopy of the hair and scalpThis glossary term has not yet been described. can be a valuable tool in the diagnosis and follow-up of these disorders (Richarz et al., 2018; Tosti, 2007), It can also guide the biopsy procedure, allowing identification of even individually affected follicles in early or focal cicatricial alopeciaThis glossary term has not yet been described.. The trichoscopyThis glossary term has not yet been described. guided biopsies can reach a definitive pathological diagnosis in 95% of the cases (Miteva and Tosti, 2013).

Provide prognostic information

Dermoscopic structuresThis glossary term has not yet been described. observed in melanocytic neoplasms are not only important for diagnosis, but can also provide valuable prognostic information such as mitotic activity (Deinlein et al., 2017; Ribero et al., 2017), Breslow >0.75mm (Argenziano et al., 1997a; Silva et al., 2013), dermal invasion (Balagula et al., 2012) or presence of lymph node metastases (table 1) (González-Álvarez et al., 2015).

Predict the histologic subtypes and guide treatment

Dermoscopy can helpRefers to giving assistance or support to others for mutual benefit identify different subtypes of skin cancers, which can have important therapeutic implications. For example, dermoscopic structuresThis glossary term has not yet been described. more frequently associated with non-superficialThis glossary term has not yet been described., mostly nodular BCCAbbreviation for Basal Cell Carcinoma, are blue-ovoid nestsThis glossary term has not yet been described., arborizing vesselsanalytic term is branched vessels; Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels; BCC and ulcerationThis glossary term has not yet been described., and warrant surgical excision. On the other hand, the presence of serpentine vesselslinear irregular vessels with multiple bends. Seen with flat BCC and melanoma, leaflike areas or multiple small erosions in a flat lesion are associated with superficial BCC (table 2) and can be treated non-surgically (Aimilios Lallas et al., 2014) (Ahnlide et al., 2016). Dermoscopy may also help predict the response to treatment: the presence of ulceration in a non-treated BCC has been associated with a good response to imiquimod (Urech et al., 2017). In squamous cell carcinomaThis glossary term has not yet been described. (SCCSquamous cell carcinoma), dermoscopy can help differentiate between actinic keratosisActinic keratosis (also called solar keratosis and senile keratosis; abbreviated as AK) is a pre-cancerous patch of thick, scaly, or crusty skin. and Bowen's diseaseThis glossary term has not yet been described. (Cameron et al., 2010; Zalaudek et al., 2012), and to predict the degree of differentiation of infiltrating SCCs (A. Lallas et al., 2015; Zalaudek et al., 2012). In melanomaThis glossary term has not yet been described., dermoscopy can predict genetic mutations associated with this tumorThis glossary term has not yet been described. which may have relevant therapeutic implications with the advent of the new targeted drugs (table 1) (Bombonato et al., 2017; Pozzobon et al., 2014; Sanchez et al., 2014). Dermoscopy of skin infections and infestations can help to guide the treatment and to monitor the clinical response in different pathologies such as scabiesThis glossary term has not yet been described., vulgar wartsThis glossary term has not yet been described., molluscum contagiosumThis glossary term has not yet been described., pediculosisThis glossary term has not yet been described., tinea nigraThis glossary term has not yet been described., among othersThis glossary term has not yet been described.This glossary term has not yet been described. (Zalaudek et al., 2008).