Dermatoscopy

All the images presented below have been taken in my consulting room, using the equipment described in the article. All author rights reserved.

DERMATOSCOPICAL EXAMINATION:

Dermatoscopy is used to examine skin lesions, particularly pigmented naevuses, to assess the threat of dangerous neoplasms. Dermatoscopy has already been used in dermatology for quite a long time, but the possibility to store the results of the examination has only been made possible with the development of digital image technology. Storing the examination results is crucial as it allows for the comparison of the changes that the lesion undergoes with a time. A written description will never be as precise as the image. The additional adventage of storing the dermatoscopical images is the elimination of possible mistakes as a result of subjective assessments by subsequent specialists examining the images. From this point of view it is commonly understood that the usefulness of the dermatoscopy without archiving of the digital images is very much limited in XXI century. High resolution images of skin lesions, give much information about the lesion character. The information might be however inprecise due to the partial light reflection from the skin surface. Dermatoscopy is a skin examination with a 10-20 times magnification. The skin is covered by a thin liquid film and must be exposed to a strong light beam. Only then is the reflection of the skins surface made insignificant and structures located up to several milimeters below the surface are visible. An image of the same lesion taken from a distance of a couple of millimeters with a high quality camera will show completely different lesion structures than a image taken with a dermatoscopical camera, which is shown on image 1.

In our consulting room we offer a comprehensive skin lesion examination, which consists of the skin surface image and dermatoscopical examination. To have it performed a patient is required to visit the consulting room twice:

  • 1. On the first visit a doctor (Dr. Wasyłyszyn) examines the lesions and performes a palpable assessment, checking their convexity, and compactness etc. Afterwards digital images of the skin surface are made. Only the entire procedure is valuable to the doctor and for this reason the remote treatment of patients is not possible, by the provision of an image alone.
  • 2. Dermatoscopical examination is performed by the medical personnel on the second visit. The examination results are stored as digital images. The best available dermatoscopic equipment by Heine (Delta 20) with the peryferials for digital photography is used.(image 2).

The images are then assessed by the doctor. Three aspects are considered: naked-eye examination, skin surface image and dermatoscopy result. Having all three types of data to hand, the doctor is able to give a diagnosis upon his experience together with the schemes from the dermatoscopical reference guide available in the consulting room. For the material assessement a special computer programmes can be used, (provided by the dermatoscopical equiment manufacturer), however its usefulness should not be over estimated. It is possible, if the need arises for further specialist assessment of the images to be made. Our consulting room cooperates with the proffessors from the Clinique of Dermathology or Oncological Institute (available for additional charge).

WHAT DOES THE EXAMINATION RESULT LOOK LIKE ?

It is a soft copy (pdf file) which containes the decription and all the high resolution images. The file is sent via e-mail. Upon request the file can be printed out in the external photographical laboratory, however it is not advisable due to high costs of the large format printouts.

DO WE STORE ALL THE EXAMINATION RESULTS ?

Yes we are obliged to archive the tests results for 3 years. After this period of time further archiving can be provided upon request. This would enable it to be checked again even after several decades.

EXAMINATION EXAMPLE

How to interpret the TDS result (total dermatoscopic score):

  • Below 4.75 – benign lesion
  • 4.75-5.45 lesion suspected to be malignant
  • above 5.25 malignant lesion

Sensitivity of the TDS method in melanocyte lesions diagnostics is assessed for 97% ( Stolz. W et al – Color Atlas of Dermatoscopy, Berlin, Blackwell Publishing 2002)

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