clear definitions, simple terminology, no metaphoric terms
TRANSCRIPT
Meeting Report
10.1586/17469872.3.1.27 © 2008 Future Drugs Ltd ISSN 1746-9872 27www.future-drugs.com
Clear definitions, simple terminology, no metaphoric termsExpert Rev Dermatol. 3(1), 27–29 (2008)
Faruk Alendar, Harald Kittler†, Hana Helppikangas and Temeida Alendar†Author for correspondenceDepartment of Dermatology, University of Vienna Medical School, Waehringerguertel 18–20, A-1090 Vienna, Austria [email protected]
Clear definitions, simple terminology, no metaphoric terms17–18 November 2007, Dermatoscopy School, Sarajevo, Bosnia and Herzegovina
Dermatoscopy, also known as dermoscopy, is a noninvasive, in vivo technique for the diagnosisof pigmented skin lesions. It improves the diagnostic accuracy for melanoma compared withexamination with the unaided eye but only for experienced observers who have beenspecifically trained. In November 2007, for the first time, a dermatoscopy course took place inSarajevo, Bosnia & Herzegovina. The interactive course covered all aspects of moderndermatoscopy and was well received by the participants.
On 17–18 November 2007, a dermatoscopycourse chaired by Harald Kittler (University ofVienna, Austria) and Faruk Alendar (Univer-sity of Sarajevo, Bosnia and Herzegovina) washeld in Sarajevo, Bosnia and Herzegovina. Thecourse was organized by the Department ofDermatology, Clinical Center of the Univer-sity of Sarajevo, by the Medical University ofSarajevo and by the Institute for MedicalInvestigations Sarajevo. In total, 70 doctorsfrom Croatia and Bosnia & Herzegovinaattended. The official language of the coursewas English.
The course updated participants with regard torecent advances in dermatoscopy. At the begin-ning, Faruk Alendar demonstrated the technicalequipment that is needed for dermatoscopy anddigital dermatoscopy. Harald Kittler then intro-duced a comprehensive analytical method fordermatoscopy, based on pattern analysis. Thismethod enabled the participants to diagnose var-ious pigmented and nonpigmented skin lesionswith specificity. During the course, the partici-pants had the opportunity to discuss casesinteractively and to make their own diagnosis.
Meeting highlights: what is dermatoscopy?
Faruk Alendar gave an overview on the basics ofthe technique and demonstrated conventional
and digital dermatoscopes. He explained howdermatoscopy, a noninvasive, in vivo tech-nique, makes the skin surface translucent byusing the optical phenomenon of oil immer-sion. By using this optical trick, dermatoscopypermits the visualization of features that arenot visible with the unaided eye and enhancesthe diagnostic accuracy for nearly all types ofpigmented skin lesions. In recent years, der-matoscopy was a highly active field ofresearch. Alendar summarized the mostimportant recent advances in research, focus-ing on terminology, site-specific dermatos-copy, and diagnostic algorithms. He empha-sized that practicing dermatologists should betrained in dermatoscopy until they achievesufficient expertise [1–5]. Finally, he discussedrecent developments with regard to digitaldermatoscopy and mole monitoring [6–8].
No need for metaphoric language
The current language of dermatoscopy con-sists mainly of metaphoric terms that arebadly defined. This language is extremely con-fusing and discourages students to learn thetechnique profoundly. This is the view ofKittler, who uses simple language with well-defined terms. He developed a method basedon pattern analysis that is accessible toeveryone. In his system, every dermatoscopic
28 Expert Rev. Dermatol. 3(1), (2008)
Meeting report Alendar, Kittler, Helppikangas & Alendar
pattern is composed of one or more of five, well-definedbasic element: lines, pseudopods, circles, clods and dots. Ifno basic elements are present, the lesion is structureless. Pig-mented skin lesions may exhibit one or more than one pat-tern. If multiple patterns are present, they can be combinedsymmetrically or asymmetrically. Similarly, pigmentedlesions may consist of a single color or multiple colors. Inaddition to patterns and colors, every type of pigmented skinlesion may show specific clues that enable the viewer to makea specific diagnosis. There are specific clues to melanoma,basal cell carcinoma, seborrheic keratosis, angiomas and allkinds of melanocytic nevi. According to Kittler, combiningpatterns, colors and clues is the best way to reach a diagnosiswith confidence. He also demonstrated that all metaphoricterms, such as radial streaming, spoke wheel areas, blue ovoidnests and blue-whitish veil, can be translated easily intosimple and comprehensible terms.
Digital dermatoscopy
Only advanced melanomas that have been present for yearscan be diagnosed easily with the unaided eye by employingthe clinical ABCD criteria [9]. Incipient melanomas aremuch more difficult to diagnose, especially when they meas-ure less than 6 mm in diameter [10,11]. This is why the clini-cal ABCD rule is not a tool for early diagnosis. A melanomastarts as an inconspicuous, uniformly pigmented, small mac-ule. After a while, it develops criteria that can be seen by der-matoscopy and later (usually after years) it will develop crite-ria that are visible with the unaided eye. There is only onecriterion that is always present, regardless of stage: change.The only disadvantage is that change cannot be viewed at agiven moment in time, it takes at least two observations torecognize it. Digital dermatoscopy combines dermatoscopywith computer technology, thereby facilitating storage,
administration and retrieval of data and images, whichmakes this technique suitable for monitoring melanocyticskin lesions. Sequential images can be compared directly onthe computer screen and changes can be recognized easily.Incipient melanomas lacking specific dermatoscopy featureswill be detected by demonstrating the presence of change.According to Kittler, this technique is especially useful forpatients with multiple nevi. These patients have an increasedrisk of developing melanomas and, given the high number oflesions, they represent a diagnostic challenge that cannot besolved by simply removing all lesions.
Summary
Regardless of the method used, dermatoscopy improves thediagnosis of pigmented skin lesion, but only for experiencedexaminers. Therefore, it is of the utmost importance to receiveadequate training. The dermatoscopy course held in Sarajevo inNovember 2007 was an opportunity to get acquainted with thispromising technique. The method developed by Kittler simpli-fies dermatoscopy by using comprehensible terminology andclear definitions. According to Kittler, everybody who wants tobecome an expert in dermatoscopy should create his own algo-rithm. Digital dermatoscopy has changed our understanding ofmelanoma development and facilitates early recognition of thispotentially fatal disease.
Financial & competing interests disclosureThe authors have no relevant affiliations or financial involvement withany organization or entity with a financial interest in or financial conflictwith the subject matter or materials discussed in the manuscript. Thisincludes 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.
References
1 Goldman L. Some investigative studies of pigmented nevi with cutaneous microscopy. J. Invest. Dermatol. 16, 407–426 (1951).
2 Steiner A, Pehamberger H, Wolff K. In vivo epiluminescence of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J. Am. Acad. Dermatol. 17, 584–591 (1987).
3 Pehamberger H, Binder M, Steiner A et al. In vivo epiluminescence microscopy: improvement of early diagnosis of melanoma. J. Invest. Dermatol. 100, S356–S362 (1993).
4 Soyer HP, Smolle J, Hoedl S et al. A new approach to the diagnosis of cutaneous pigmented tumors. Am. J. Dermatopathol. 11, 1–10 (1989).
5 Carli P, De Giorgi V, Soyer HP, Stante M, Mannone F, Giannotti B. Dermatoscopy in the diagnosis of pigmented skin lesions: a new semiology for the dermatologist. J. Eur. Acad. Dermatol Venereol. 14, 353–369 (2000).
6 Kenet RO, Kang S, Kenet BJ et al. Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy. Grading protocol and atlas. Arch. Dermatol. 129, 157–174 (1993).
7 Sober AJ. Digital epiluminescence microscopy in the evaluation of pigmented lesions: a brief review. Semin. Surg. Oncol. 9, 198–201 (1993)
8 Kopf AW, Elbaum M, Provost N. The use of dermoscopy and digital imaging in the diagnosis of cutaneous malignant melanoma. Skin Res. Technol. 3, 1–7 (1997).
9 Nachbar F, Stolz W, Merkle T et al. The ABCD rule of dermatoscopy: high prospective value in the diagnosis of doubtful melanocytic skin lesions. J. Am. Acad. Dermatol. 30, 551–559 (1994).
10 Lucas CR, Sanders LL, Murray JC, Myers SA, Hall RP, Grichnik JM. Early melanoma detection: nonuniform dermoscopic features and growth. J. Am. Acad. Dermatol. 48, 663–671 (2003).
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11 Kittler H. Use of digital dermoscopy to monitor melanocytic lesions: risks and benefits. J. Drugs Dermatol. 2(3), 309–311 (2003).
Affiliations
• Faruk AlendarDermatovenerology Department, Clinical Centre University of Sarajevo, Bosnia & [email protected]
• Harald Kittler, Professor, MDDepartment of Dermatology, University of Vienna Medical School, Waehringerguertel 18–20, A-1090 Vienna, Austria [email protected])
• Hana Helppikangas, MD, Dermatovenerology Department, Clinical Centre University of Sarajevo, Bosnia & [email protected]
• Temeida AlendarDermatovenerology Department, Clinical Centre University of Sarajevo, Bosnia & [email protected]