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Current status of dermoscopy in the diagnosis of dermatologic disease
AAD 75TH ANNIVERSARY ARTICLE
Current status of dermoscopy in the diagnosis of dermatologic disease Ashfaq A. Marghoob, MD Hauppauge, New York
As part of the celebration of the Academy’s 75th anniversary, this year each monthly issue of JAAD features an expert commentary on a previously published article of particular significance to practicing dermatologists.
The use of dermoscopy in the modern era began in acceptance by U.S. dermatologists. With the vast the late 1980s and, to date, myriad articles, chapters, majority of current U.S. dermatology residents learnand books have been pubing dermoscopy, it is only a lished touting its benefits. matter of time before this In essence, the use of derprocedure will become From Malvehy J, Puig S, Argenziano G, moscopy brought dermapart of the normal clinical Marghoob AA, Soyer HP, International tologists back to the roots diagnostic armamentarium Dermoscopy Society Board Members. of their profession by highfor most dermatologists Dermoscopy report: proposal for standardizalighting the importance of practicing in the United tion. Results of a consensus meeting of the International Dermoscopy Society. J Am Acad primary morphology and States. Dermatol 2007;57:84-95. the importance of the clinThe appeal and diffuicopathologic correlation sion of dermoscopy is not ‘‘., there now exists the need for a stanin rendering an accurate limited to dermatologists dardized method for documenting dermoscopic diagnosis. While dermoalone. An ever-increasing findings. Toward this end, the International scopy was initially used number of general practiDermoscopy Society (IDS) embarked on creating primarily to diagnose cutationers (family physicians), a consensus document for standardization and neous neoplasms, in parplastic surgeons, nurse minimal criteria necessary to be able to effecticular to differentiate nevi practitioners, and physitively convey dermoscopic findings to consulting from melanoma, it has also cian assistants are engagphysicians and colleagues.’’ gained traction in the diaging in the learning and use noses and management of of dermoscopy. In addia myriad of inflammatory and infectious conditions tion, dermoscopy is slowly finding its way into hands ranging from psoriasis to lichen planus and scabies to of lay persons who are using it to help with skin tinea nigra. self examinations. Dermoscopy may in fact be the The ability of dermoscopy to elevate clinicians’ ideal ‘‘looking glass’’ that will permit patients and sensitivity and specificity for diagnosing melanoma physicians to easily engage in teledermatology concannot be refuted. This was the primary impetus that sultations for particular lesions that are of concern to propelled the rapid acceptance of dermoscopy in patients. Europe and Australia. In fact, the official guidelines Although dermoscopic morphology is primarily for melanoma screening in Australia and New used to differentiate benign from malignant skin Zealand now advocate its use for the purpose of lesions, it has and continues to provide researchers melanoma surveillance. While the adoption of derwith insights into the natural biology of certain moscopy in the United States has lagged behind lesions. The in vivo longitudinal follow-up of lesions Europe and Australia, it is clearly gaining wider using dermoscopy, together with the knowledge of From Memorial Sloan Kettering Cancer Center. Funding sources: None. Conflict of interest: None declared. Reprint requests: Ashfaq A. Marghoob, MD, 800 Veterans Memorial Highway, Hauppauge, NY 11788. E-mail: [email protected].
814
J Am Acad Dermatol 2013;69:814-5. 0190-9622/$36.00 Ó 2012 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2012.07.029
J AM ACAD DERMATOL VOLUME 69, NUMBER 5
the pathologic correlations of dermoscopic structures, has confirmed the existence of slow-growing melanomas, brought into serious question Unna’s long-standing hypothesis regarding nevogenesis, disclosed the existence of incipient nevus nests that may be the potential seeds for some ‘‘acquired’’ nevi, revealed the morphology of a subset of growing nevi that manifest peripheral globules or streaks, and has unveiled the existence of multiple modes of nevus/ melanoma involution, just to mention a few. In addition, new morphologic structures continue to be defined that further improve upon our ability to more precisely diagnose skin lesions. For example, the recently described peripheral brown dots/globules arranged in a linear pattern and the presence of
Marghoob 815
white circles have been shown to correlate with squamous cell carcinoma. Advancements in dermoscopic equipment have also had a profound effect on what clinicians are able to visualize. This is highlighted by the discovery of the crystalline structure that is much more conspicuous when viewed with polarized light dermoscopy. This structure cannot only aid in the detection of melanoma, but may have prognostic significance as well. The evolution of dermoscopy has resulted in the development of a new generation of excellent and more confident clinicians. This ultimately advances our most important goal, namely, the provision of the best possible care for our patients!
Current status of dermoscopy in the diagnosis of dermatologic disease Ashfaq A. Marghoob, MD Hauppauge, New York
As part of the celebration of the Academy’s 75th anniversary, this year each monthly issue of JAAD features an expert commentary on a previously published article of particular significance to practicing dermatologists.
The use of dermoscopy in the modern era began in acceptance by U.S. dermatologists. With the vast the late 1980s and, to date, myriad articles, chapters, majority of current U.S. dermatology residents learnand books have been pubing dermoscopy, it is only a lished touting its benefits. matter of time before this In essence, the use of derprocedure will become From Malvehy J, Puig S, Argenziano G, moscopy brought dermapart of the normal clinical Marghoob AA, Soyer HP, International tologists back to the roots diagnostic armamentarium Dermoscopy Society Board Members. of their profession by highfor most dermatologists Dermoscopy report: proposal for standardizalighting the importance of practicing in the United tion. Results of a consensus meeting of the International Dermoscopy Society. J Am Acad primary morphology and States. Dermatol 2007;57:84-95. the importance of the clinThe appeal and diffuicopathologic correlation sion of dermoscopy is not ‘‘., there now exists the need for a stanin rendering an accurate limited to dermatologists dardized method for documenting dermoscopic diagnosis. While dermoalone. An ever-increasing findings. Toward this end, the International scopy was initially used number of general practiDermoscopy Society (IDS) embarked on creating primarily to diagnose cutationers (family physicians), a consensus document for standardization and neous neoplasms, in parplastic surgeons, nurse minimal criteria necessary to be able to effecticular to differentiate nevi practitioners, and physitively convey dermoscopic findings to consulting from melanoma, it has also cian assistants are engagphysicians and colleagues.’’ gained traction in the diaging in the learning and use noses and management of of dermoscopy. In addia myriad of inflammatory and infectious conditions tion, dermoscopy is slowly finding its way into hands ranging from psoriasis to lichen planus and scabies to of lay persons who are using it to help with skin tinea nigra. self examinations. Dermoscopy may in fact be the The ability of dermoscopy to elevate clinicians’ ideal ‘‘looking glass’’ that will permit patients and sensitivity and specificity for diagnosing melanoma physicians to easily engage in teledermatology concannot be refuted. This was the primary impetus that sultations for particular lesions that are of concern to propelled the rapid acceptance of dermoscopy in patients. Europe and Australia. In fact, the official guidelines Although dermoscopic morphology is primarily for melanoma screening in Australia and New used to differentiate benign from malignant skin Zealand now advocate its use for the purpose of lesions, it has and continues to provide researchers melanoma surveillance. While the adoption of derwith insights into the natural biology of certain moscopy in the United States has lagged behind lesions. The in vivo longitudinal follow-up of lesions Europe and Australia, it is clearly gaining wider using dermoscopy, together with the knowledge of From Memorial Sloan Kettering Cancer Center. Funding sources: None. Conflict of interest: None declared. Reprint requests: Ashfaq A. Marghoob, MD, 800 Veterans Memorial Highway, Hauppauge, NY 11788. E-mail: [email protected].
814
J Am Acad Dermatol 2013;69:814-5. 0190-9622/$36.00 Ó 2012 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2012.07.029
J AM ACAD DERMATOL VOLUME 69, NUMBER 5
the pathologic correlations of dermoscopic structures, has confirmed the existence of slow-growing melanomas, brought into serious question Unna’s long-standing hypothesis regarding nevogenesis, disclosed the existence of incipient nevus nests that may be the potential seeds for some ‘‘acquired’’ nevi, revealed the morphology of a subset of growing nevi that manifest peripheral globules or streaks, and has unveiled the existence of multiple modes of nevus/ melanoma involution, just to mention a few. In addition, new morphologic structures continue to be defined that further improve upon our ability to more precisely diagnose skin lesions. For example, the recently described peripheral brown dots/globules arranged in a linear pattern and the presence of
Marghoob 815
white circles have been shown to correlate with squamous cell carcinoma. Advancements in dermoscopic equipment have also had a profound effect on what clinicians are able to visualize. This is highlighted by the discovery of the crystalline structure that is much more conspicuous when viewed with polarized light dermoscopy. This structure cannot only aid in the detection of melanoma, but may have prognostic significance as well. The evolution of dermoscopy has resulted in the development of a new generation of excellent and more confident clinicians. This ultimately advances our most important goal, namely, the provision of the best possible care for our patients!