Abstract
Dermatoscopy, also known as dermoscopy, is a noninvasive, in vivo technique for the diagnosis of pigmented skin lesions. It improves the diagnostic accuracy for melanoma compared with examination with the unaided eye but only for experienced observers who have been specifically trained. In November 2007, for the first time, a dermatoscopy course took place in Sarajevo, Bosnia & Herzegovina. The interactive course covered all aspects of modern dermatoscopy and was well received by the participants.
On 17–18 November 2007, a dermatoscopy course chaired by Harald Kittler (University of Vienna, Austria) and Faruk Alendar (University of Sarajevo, Bosnia and Herzegovina) was held in Sarajevo, Bosnia and Herzegovina. The course was organized by the Department of Dermatology, Clinical Center of the University of Sarajevo, by the Medical University of Sarajevo and by the Institute for Medical Investigations Sarajevo. In total, 70 doctors from Croatia and Bosnia & Herzegovina attended. The official language of the course was English.
The course updated participants with regard to recent advances in dermatoscopy. At the beginning, Faruk Alendar demonstrated the technical equipment that is needed for dermatoscopy and digital dermatoscopy. Harald Kittler then introduced a comprehensive analytical method for dermatoscopy, based on pattern analysis. This method enabled the participants to diagnose various pigmented and nonpigmented skin lesions with specificity. During the course, the participants had the opportunity to discuss cases interactively and to make their own diagnosis.
Meeting highlights: what is dermatoscopy?
Faruk Alendar gave an overview on the basics of the technique and demonstrated conventional and digital dermatoscopes. He explained how dermatoscopy, a noninvasive, in vivo technique, makes the skin surface translucent by using the optical phenomenon of oil immersion. By using this optical trick, dermatoscopy permits the visualization of features that are not visible with the unaided eye and enhances the diagnostic accuracy for nearly all types of pigmented skin lesions. In recent years, dermatoscopy was a highly active field of research. Alendar summarized the most important recent advances in research, focusing on terminology, site-specific dermatoscopy, and diagnostic algorithms. He emphasized that practicing dermatologists should be trained in dermatoscopy until they achieve sufficient expertise Citation[1–5]. Finally, he discussed recent developments with regard to digital dermatoscopy and mole monitoring Citation[6–8].
No need for metaphoric language
The current language of dermatoscopy consists mainly of metaphoric terms that are badly defined. This language is extremely confusing and discourages students to learn the technique profoundly. This is the view of Kittler, who uses simple language with well-defined terms. He developed a method based on pattern analysis that is accessible to everyone. In his system, every dermatoscopic pattern is composed of one or more of five, well-defined basic element: lines, pseudopods, circles, clods and dots. If no basic elements are present, the lesion is structureless. Pigmented skin lesions may exhibit one or more than one pattern. If multiple patterns are present, they can be combined symmetrically or asymmetrically. Similarly, pigmented lesions may consist of a single color or multiple colors. In addition to patterns and colors, every type of pigmented skin lesion may show specific clues that enable the viewer to make a specific diagnosis. There are specific clues to melanoma, basal cell carcinoma, seborrheic keratosis, angiomas and all kinds of melanocytic nevi. According to Kittler, combining patterns, colors and clues is the best way to reach a diagnosis with confidence. He also demonstrated that all metaphoric terms, such as radial streaming, spoke wheel areas, blue ovoid nests and blue-whitish veil, can be translated easily into simple and comprehensible terms.
Digital dermatoscopy
Only advanced melanomas that have been present for years can be diagnosed easily with the unaided eye by employing the clinical ABCD criteria Citation[9]. Incipient melanomas are much more difficult to diagnose, especially when they measure less than 6 mm in diameter Citation[10,11]. This is why the clinical ABCD rule is not a tool for early diagnosis. A melanoma starts as an inconspicuous, uniformly pigmented, small macule. After a while, it develops criteria that can be seen by dermatoscopy and later (usually after years) it will develop criteria that are visible with the unaided eye. There is only one criterion that is always present, regardless of stage: change. The only disadvantage is that change cannot be viewed at a given moment in time, it takes at least two observations to recognize it. Digital dermatoscopy combines dermatoscopy with computer technology, thereby facilitating storage, administration and retrieval of data and images, which makes this technique suitable for monitoring melanocytic skin lesions. Sequential images can be compared directly on the computer screen and changes can be recognized easily. Incipient melanomas lacking specific dermatoscopy features will be detected by demonstrating the presence of change. According to Kittler, this technique is especially useful for patients with multiple nevi. These patients have an increased risk of developing melanomas and, given the high number of lesions, they represent a diagnostic challenge that cannot be solved by simply removing all lesions.
Summary
Regardless of the method used, dermatoscopy improves the diagnosis of pigmented skin lesion, but only for experienced examiners. Therefore, it is of the utmost importance to receive adequate training. The dermatoscopy course held in Sarajevo in November 2007 was an opportunity to get acquainted with this promising technique. The method developed by Kittler simplifies dermatoscopy by using comprehensible terminology and clear definitions. According to Kittler, everybody who wants to become an expert in dermatoscopy should create his own algorithm. Digital dermatoscopy has changed our understanding of melanoma development and facilitates early recognition of this potentially fatal disease.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
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