Article
Dermoscopy of Dermal Nevi
Dermal nevi may be present at birth or develop throughout life. These lesions are very common and can present in any individual. Dermal nevi appear in approximately 1% of newborns. Dermoscopy plays an important role as a common observation tool in dermatology that helps doctors observe the deep structure of dermal pigmented nevi. Overview of…
Dermal nevi may be present at birth or develop throughout life. These lesions are very common and can present in any individual. Dermal nevi appear in approximately 1% of newborns. Dermoscopy plays an important role as a common observation tool in dermatology that helps doctors observe the deep structure of dermal pigmented nevi.
Overview of Dermal Nevi
A dermal nevus is a benign, well-defined, raised, colored, papule that appears on the surface of the skin. Dermal nevi can be brown, tan, black, reddish-brown, purple, or skin-colored, and are generally round or ovoid . They may be sessile, raised, and have hair growing from them.
Moreover, dermal nevi are usually benign skin lesions formed by melanocytes in the skin that accumulate in the dermis. Most dermal nevi are stable and do not undergo malignant changes. So, most people don’t need to be alarmed if they find a dermal pigmented nevus on their body.
Principles of Dermoscopy Examination
A dermatoscope is a handheld device, equipped with a magnification lens and a light source. It enables the visualization of the subsurface morphology of cutaneous lesions, down to the depth of the superficial dermis. It reveals colors and structures that are normally not visible to the unaided eye and improves the diagnostic accuracy.
Preparation before Digital Dermoscopy Examination
Before the start of dermoscopy, the patient needs to clean the skin surface to be examined in advance, and inform the doctor if there is any local inflammation or breakage, so that the doctor can assess the suitability of dermoscopy. During the examination, the doctor will put the probe of the dermatoscope on the surface of the skin lesion that needs to be observed, keeping a good distance between the probe and the skin. Adjust the light source and magnification of the device until the picture is clear. The doctor will select representative areas of dermal nevus for examination, including the edges and centre of the lesion as well as the surrounding normal skin areas for comparative analysis.
Steps in Dermoscopy
When performing a dermoscopy, first the doctor will select a typical area of dermal nevus skin. Next, gently place the probe of the dermatoscope on the skin surface to be observed, rotate and adjust the focus until the image is clear. Observe the structure and colour changes of the lesions through dermoscopy, and determine the type and degree of progression of the lesions based on the observations. If you want to save the image, you can point the mobile phone clip to the main camera of the mobile phone, then connect the magnetic ring option to the mobile phone clip, and finally connect the dermatoscope magnetically. Switch on the camera function of the mobile phone to save the image. Failure to acquire a dermatoscope image may result if you make a mistake during the operation.
Digital Dermoscopy of Dermal Nevi
The pigment cells of dermal pigmented nevi are mainly distributed in the dermis, usually located in the upper or middle part of the dermis. These pigment cells can be seen dermoscopically usually arranged in clusters, forming islands, curved or scattered within the dermis and even sometimes deep into the subcutaneous tissue. There are several different types of dermal pigmented nevi, including but not limited to:
Flat dermal pigmented nevi:
These nevi are usually smaller, more regular in shape, and commonly found in adult skin.
Nodular dermal nevus:
Nodular dermal naevi are usually larger and often form elevations on the surface of the skin, and can even be felt as hard nodules.
Mixed dermal pigmented nevus:
This type of nevus has mixed features of epidermis and dermis, and pigment cells can be observed under dermoscopy to exist between epidermis and dermis at the same time.
How to Analyse Colours, Patterns, Boundaries and Structures in Digital Dermoscopic Images
Colour:
In dermatology microscopy images, the density and distribution of pigmentation often determines the colour of its appearance. Typically, dermal nevi appear dark brown to black, or lighter if the pigment cells are more dispersed.
Pattern:
Observe the pattern of pigment cell arrangement in the image; normal dermal pigmented nevi appear as regular clusters and may have a more uniform distribution of structures.
Border:
Dermal pigmented nevi usually have clear borders and do not easily penetrate into the surrounding tissues. On the other hand, malignant melanoma, for example, may show irregular, fuzzy borders and may show signs of infiltration or expansion into other layers of the skin.
Structure:
Normal dermal pigmented nevus cells are relatively neatly arranged and the stroma appears normal, whereas abnormal hyperplasia or stromal changes may suggest pathological changes.
Diagnosis and Management of Dermal Nevi
Dermal nevi are benign. Even though benign nevi do not pose health risks such as melanomas, many people opt to have them removed. Most people who seek to have nevi removed do so for cosmetic reasons, for instance, if one is embarrassed about how a particular mole or moles look.
Common methods of removing nevi include: the nevus can be cut off the skin. Some nevi may have subcutaneous cells, which reside underneath the skin, so the doctor might need to make a deeper cut to remove the entire mole to prevent it from growing back. The cut may require stitches.
Differentiation of Dermal Nevi from Other Skin Lesions
Dermal nevi with this clinical morphology will usually reveal one or more of the following dermoscopic features: comma vessels, brown halo, globules, small foci of tan structureless pigmentation, hypopigmented areas. They can also reveal arborizing vessels making it difficult to differentiate them from BCC. The clues to the diagnosis of dermal nevi include the presence of the aforementioned features and lack of other BCC-specific features. In addition, the arborizing vessels in dermal nevi are often a tad out of focus and have a bluish hue. In contrast, in BCC the arborizing vessels are usually sharply in focus and bright red in color.
Application of New Techniques in Digital Dermoscopy
Artificial intelligence (AI) can be defined as the branch of computer science dealing with the simulation of intelligent human behavior in computers. Dermatology has taken the leading position for the implementation of AI in the medical field because of its large clinical, dermoscopical, and dermatopathological image database.
In 2017, Stanford university published a study on deep learning of skin tumors. They trained CNN, using more than 1 lakh images of around 2000 different diseases and tested its performance against that of 21 board-certified dermatologists on biopsy-proven clinical images. It was found that machine had a competence, comparable to that of board-certified dermatologists in identifying and classifying skin cancers.
Conclusion
Dermoscopy contributes to a better visualisation of the deeper components of the skin and assists in the accurate diagnosis of dermal Nevi, including its type, size and distribution, in order to establish more targeted treatment. Doctors can differentiate dermal nevi with other pigmented skin diseases using dermoscopic image analysis and can avoid misdiagnosis after that. Dermoscopy is a promising approach to improving the diagnostic accuracy and efficiency of dermal nevi and other skin diseases with continuous education and technological innovation as important drivers for the continuous development of dermoscopy.
Dermal Nevi Dermoscopy: Essential Tools for Skin Cancer Detection - IBOOLO
IBOOLO reveals how dermal nevi dermoscopy revolutionises skin lesion diagnosis. This technology exposes hidden structures, enhancing melanoma detection while reducing biopsies.
Mastering Dermoscopy for Dermal Nevi: Benefits and Techniques
Dermoscopy has become an essential tool for dermatologists in diagnosing dermal nevi and skin cancer. Through high-magnification and specialised lighting techniques, dermoscopy reveals skin features invisible to the naked eye, such as pigment distribution, vascular patterns, and follicular structures. This non-invasive technology not only improves diagnostic accuracy but also reduces unnecessary biopsies, providing patients with safer and more effective examination options. This article explores in depth the advantages, latest developments, and importance of dermal nevi dermoscopy in skin health management.
What is Dermoscopy of Dermal Nevi?
Dermoscopy of dermal nevi is a non-invasive diagnostic technique that observes the surface and superficial structures of skin moles through high-magnification and specialised lighting. Dermoscopy penetrates the stratum corneum, allowing physicians to see features imperceptible to the naked eye, such as pigment distribution, vascular morphology, and follicular structures. This examination method is simple to perform, non-invasive, and safe, with high patient acceptance. In recent years, it has emerged as a cutting-edge technology in dermatology, playing an increasingly important role in the diagnosis of skin diseases.
How Does Dermoscopy Work for Dermal Nevi?
The working principle of dermal nevi dermoscopy is based on optical magnification and specialised lighting techniques. Dermoscopy magnifies the skin surface tens or even hundreds of times, allowing observation of minute structures in the lower epidermis, dermoepidermal junction, and papillary dermis. Its functionality is mainly reflected in two aspects:
1. Magnification: Currently, clinical magnifications commonly used range from 6x to 100x.
2. Elimination of reflected light: Non-polarised or cross-polarised light principles are used to eliminate surface reflection, selectively collecting transmitted light to enhance changes in the skin surface and superficial dermis. This technology enables physicians to observe the size and morphology of pigmented structures and superficial vascular plexus vessels within the epidermis, dermoepidermal junction, and superficial dermis, revealing morphological features invisible to the naked eye.
How to Use Dermoscopy for Dermal Nevi?
The specific use of dermoscopy for dermal nevi includes the following steps:
Step 1: Preparation: Clean the skin surface to remove oils, cosmetics, or scales.
Step 2: Apply contact medium: Apply transparent gel or liquid to the skin to reduce light reflection.
Step 3: Observation and recording: Gently place the dermoscope probe on the skin surface, adjust the focus, observe and record structural and colour changes of the nevus.
Step 4: Feature analysis: Through dermoscopic observation of structural, colour, and vascular distribution features of the nevus, identify key characteristics such as pigment distribution and vascular patterns.
What Are the Applications of Dermoscopy for Dermal Nevi?
Dermal nevi dermoscopy has a wide range of applications in diagnosis, including:
1. Early diagnosis: Helps identify early malignant melanoma, improving diagnostic accuracy.
2. Differentiation between benign and malignant nevi: Distinguishes benign nevi from potentially malignant lesions by observing structural and colour characteristics.
3. Dynamic monitoring: Provides long-term monitoring of suspicious nevi to observe changes.
4. Auxiliary diagnosis: Assists in diagnosing other skin lesions, such as basal cell carcinoma and squamous cell carcinoma.
5. Hair and scalp condition assessment: Used to examine causes of hair loss, assess follicular health, and guide treatment plan selection.
6. Inflammatory skin disease diagnosis: For conditions such as psoriasis and eczema.
7. Other applications: Diagnosis of vascular skin diseases, nail disorders, viral warts, etc.
What Are the Features and Advantages of Dermoscopy Devices?
Dermoscopy equipment for examining dermal nevi has the following features and advantages:
1. High magnification: Ability to magnify the skin surface tens or even hundreds of times, observing minute structures imperceptible to the naked eye.
2. Elimination of reflected light: Reduces surface reflection through special techniques, making deeper structures more visible.
3. Image recording: Equipped with image acquisition systems for convenient recording and follow-up.
4. Non-invasiveness: Painless and non-invasive examination process with high patient acceptance.
5. Improved diagnostic accuracy: Significantly improves diagnostic accuracy for malignant melanoma and other skin lesions.
6. Painless operation: Simple operation with a wide range of applications.
7. High reproducibility: Convenient for multiple observations at the same location to monitor disease changes, aiding in long-term management of chronic skin conditions.
As a non-invasive diagnostic tool, dermoscopy plays an increasingly important role in diagnosing skin diseases. It provides physicians with a deeper, more detailed perspective to observe the skin surface and underlying structures, thereby increasing the possibility of early detection and correct diagnosis of various skin lesions.
What Is the Structure and Workflow of Dermoscopy Devices?
Dermoscopy devices used for dermal nevi examination are non-invasive tools designed to provide high-resolution skin images to help physicians more accurately identify lesion characteristics. The following are the main components and workflow of dermoscopy devices:
Device Structure
1. Optical magnification system: The core component is its optical magnification system, typically equipped with high-magnification achromatic lenses, with magnifications ranging from 10× to 200× or even higher. This high magnification ability allows physicians to observe the skin's surface and superficial structures, including pigment distribution, vascular morphology, and follicular structures.
2. Built-in lighting system: To provide clear images, dermoscopes are equipped with efficient built-in lighting systems. Halogen lamps or other light sources are typically used to provide uniform illumination, ensuring image clarity and contrast.
3. Polarised light system: Modern dermoscopes often feature polarised light filters that reduce skin surface reflection and scattered light, thereby improving image quality. Polarised light technology is particularly suitable for observing deeper skin structures, such as blood vessels and pigment distribution.
4. Image recording system: Some dermoscopes have built-in photography systems that can capture and store high-resolution images. These images can be used for subsequent analysis, follow-up monitoring, and sharing with other physicians for consultation and research.
5. Portable design: Many dermoscopy devices are designed to be portable, convenient for physicians to use in different settings. Portable design not only improves the flexibility of the equipment but also makes it suitable for various clinical environments, including outpatient clinics, operating rooms, and mobile medical scenarios.
Workflow
The workflow of dermal nevi dermoscopy is relatively simple but requires strict adherence to steps to ensure the accuracy of examination results. The detailed steps are as follows:
1. Preparation:
- Clean the skin: Before examination, the skin surface must be thoroughly cleaned to remove oils, cosmetics, or scales. These impurities may affect the imaging quality of the dermoscope, resulting in blurry images or excessive reflected light.
- Select contact medium: Apply transparent gel or liquid (such as alcohol or water) to the skin to reduce light reflection and enhance imaging effects. The contact medium helps the dermoscope better adhere to the skin surface, improving image clarity.
2. Apply contact medium:
Even application: Apply the transparent gel or liquid evenly on the skin surface, ensuring coverage of the entire examination area. The role of the contact medium is to reduce surface reflection, allowing the dermoscope to more clearly observe deeper skin structures.
3. Observation and recording:
- Adjust focus: Gently place the dermoscope probe on the skin surface, adjust the focus until the image is clear. Physicians need to carefully observe the structure, colour, and vascular distribution of dermal nevi.
- Capture images: Use the dermoscope's image recording system to capture high-resolution images. These images can be used for subsequent analysis and follow-up, helping physicians monitor changes in lesions.
4. Analysis and diagnosis:
- Identify key features: Physicians analyse the characteristics of nevi based on dermoscopic images, such as pigment distribution, vascular patterns, and structural symmetry. These features are crucial for distinguishing benign nevi from potentially malignant lesions.
- Comprehensive judgment: Combining the patient's medical history, symptoms, and dermoscopic images, physicians can more accurately determine the nature of nevi and decide whether further biopsy or other treatment measures are needed.
Why Is Dermoscopy Beneficial for Skin Health?
Dermal nevi dermoscopy offers multiple benefits for skin health. Here are some key points:
Improved Diagnostic Accuracy
Dermoscopy significantly improves diagnostic accuracy for skin lesions, especially early identification of malignant lesions such as melanoma. Through high magnification and specialised lighting, dermoscopy reveals minute structures and pigment distributions imperceptible to the naked eye, helping physicians more accurately determine the nature of lesions. For example, dermoscopy can identify irregular vascular patterns, pigment networks, and structural asymmetry, features crucial for early detection of malignant melanoma.
Non-invasive Examination
Dermal nevi dermoscopy is completely non-invasive, requiring no surgery or biopsy, avoiding patient discomfort and risk. This non-invasiveness makes dermoscopy an ideal screening tool, particularly suitable for regular examinations of high-risk populations (such as those with long-term UV exposure or a family history of skin cancer). Non-invasive examination not only reduces patient discomfort but also lowers medical costs and potential complication risks.
Dynamic Monitoring
Dermoscopy allows for long-term monitoring of skin lesions, observing changes in lesions. By regularly capturing high-resolution images, physicians can compare images from different periods, promptly detecting potential malignant changes. This dynamic monitoring is significant for early detection and intervention of malignant lesions such as skin cancer, significantly improving cure rates and survival rates.
Reduction of Unnecessary Biopsies
Through precise image analysis, dermal nevi dermoscopy can reduce unnecessary biopsies of benign lesions. Biopsy is an invasive procedure that may cause pain, scarring, and an increased risk for patients. Dermoscopy helps physicians more accurately judge the nature of lesions through high-resolution images, thus avoiding unnecessary biopsies and reducing patient burden.
What Are the Precautions for Using Dermoscopy?
When using dermoscopy for dermal nevi examination, the following points should be noted to ensure the accuracy of results and patient comfort:
Clean Skin
Before examination, the skin surface must be thoroughly cleaned to remove oils, cosmetics, or scales. These impurities may affect the imaging quality of the dermoscope, resulting in blurry images or excessive reflected light. When cleaning the skin, mild cleansers and clean water can be used, avoiding irritating chemicals.
Avoid Excessive Pressure
During examination, avoid applying excessive pressure to the skin. Excessive pressure may cause skin deformation, affecting image quality and observation of lesion characteristics. Physicians should gently place the dermoscope probe on the skin surface, ensuring good contact without applying too much force.
Choose an Appropriate Contact Medium
When using transparent gel or liquid, ensure it is evenly applied to the skin surface to reduce light reflection. The role of the contact medium is to help the dermoscope better adhere to the skin surface, improving image clarity. Common contact media include transparent gel, alcohol, or water; physicians should choose the appropriate medium based on specific circumstances.
Comfortable Patient Position
Ensure patients maintain a comfortable position during examination for ease of physician's operation. A comfortable position can reduce patient discomfort and improve examination compliance. Physicians can adjust patient position as needed to ensure examination areas are easily observable.
Equipment Maintenance
Regularly maintain dermoscopy equipment to ensure stable performance. Clean lenses and light sources, check contact medium supply to ensure equipment is in optimal working condition. Regularly calibrate equipment to ensure image accuracy and consistency.
How to Choose the Right Dermoscopy Device?
When choosing appropriate dermoscopy equipment for dermal nevi examination, multiple factors should be comprehensively considered to ensure the equipment meets clinical needs and provides high-quality images. The following are key factors to consider when selecting dermoscopy equipment:
Magnification
Choose appropriate magnification based on needs. Dermoscope magnifications typically range from 10× to 200×, with different magnifications suitable for different clinical scenarios. For example, low magnification (10×-20×) is suitable for observing large-area skin lesions, while high magnification (100×-200×) provides more detailed microstructural information, helping identify minute lesion features.
Polarised Light Function
Modern dermoscopes typically feature polarised light systems that reduce skin surface reflection and scattered light, improving image quality. Polarised light technology is particularly suitable for observing deeper skin structures, such as blood vessels and pigment distribution. Polarised light functions can significantly improve image clarity and contrast, helping physicians more accurately identify lesion characteristics.
Image Recording Function
Choose dermoscopes with image recording systems for subsequent analysis and follow-up. Image recording systems can capture and store high-resolution images, which can be used for subsequent analysis, follow-up monitoring, and sharing with other physicians for consultation and research. Image recording functions not only improve diagnostic accuracy but also provide convenience for long-term patient management.
Portability
Choose portable or fixed dermoscopes based on usage scenarios. Portable dermoscopes are compact, easy to carry and operate, and suitable for various clinical environments including outpatient clinics, operating rooms, and mobile medical scenarios. Fixed dermoscopes typically offer higher performance and stability, suitable for occasions requiring high-precision diagnosis.
Price and Brand
Consider the equipment price and brand reputation, choosing cost-effective products. Dermoscopy equipment prices vary widely, from hundreds to tens of thousands of dollars. When selecting equipment, choose appropriate products based on budget and actual needs. Meanwhile, choosing products from reputable brands can ensure equipment quality and after-sales service.
Why Is Dermoscopy Important in Clinical Practice?
Dermal nevi dermoscopy has significant clinical importance. Here are some key points:
Early Diagnosis
Dermoscopy can detect malignant lesions such as skin cancer early, improving cure rates. Through high magnification and specialised lighting, dermoscopy reveals minute structures and pigment distributions imperceptible to the naked eye, helping physicians more accurately determine the nature of lesions. For example, dermoscopy can identify irregular vascular patterns, pigment networks, and structural asymmetry, features crucial for early detection of malignant melanoma.
Auxiliary Diagnosis
Dermoscopy helps physicians make more accurate diagnoses and differential diagnoses of various skin lesions. Besides melanoma, dermoscopy can also be used to diagnose other skin lesions such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
How Does Dermoscopy Compare to Traditional Methods for Dermal Nevi?
As a non-invasive diagnostic technique, dermal nevi dermoscopy has significant advantages compared to traditional naked-eye observation and biopsy methods:
1. Improved diagnostic accuracy: Dermoscopy significantly improves diagnostic accuracy for skin lesions, especially early identification of malignant lesions such as melanoma. Studies show dermoscopy can improve melanoma diagnostic accuracy by 10-27%.
2. Reduction of unnecessary biopsies: Through high magnification and specialised lighting, dermoscopy can reduce unnecessary biopsies of benign lesions, lowering patient discomfort and medical costs.
3. Dynamic monitoring: Dermoscopy allows for long-term monitoring of skin lesions, observing changes in lesions, and helping early detection of potential malignant changes.
4. Non-invasiveness: Dermoscopy is completely non-invasive, requiring no surgery or biopsy, avoiding patient discomfort and risk.
In contrast, traditional naked-eye observation methods are easily influenced by subjective factors, with lower diagnostic accuracy. While biopsy is the gold standard for diagnosis, it is an invasive procedure that may cause pain, scarring, and an increased risk for patients.
What Is the Role of Dermoscopy in Skin Cancer Screening?
Dermal nevi dermoscopy has important application value in skin cancer screening:
1. Early diagnosis: Dermoscopy can detect malignant lesions such as skin cancer early, improving cure rates. Through high magnification and specialised lighting, dermoscopy reveals minute structures and pigment distributions imperceptible to the naked eye, helping physicians more accurately determine the nature of lesions.
2. Auxiliary diagnosis: Dermoscopy helps physicians make more accurate diagnoses and differential diagnoses of various skin lesions. Besides melanoma, dermoscopy can also be used to diagnose other skin lesions such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
3. Monitoring lesion changes: Dermoscopy allows for long-term monitoring of skin lesions, observing changes in lesions, and promptly detecting potential malignant changes.
4. Reduction of misdiagnosis: Through precise image analysis, dermoscopy can reduce misdiagnosis of benign lesions and unnecessary biopsies.
What Are the Latest Developments and Future Trends in Dermoscopy?
Dermal nevi dermoscopy technology has made significant progress in recent years, with future development trends including:
1. Polarised light technology: Modern dermoscopes often feature polarised light filters that reduce skin surface reflection and scattered light, improving image quality.
2. Digital image recording: Some dermoscopes have built-in photography systems that can capture and store high-resolution images for subsequent analysis and follow-up.
3. Computer-aided diagnosis: Computer image analysis systems (such as SolarScan, MoleMax III, Fotofinder) provide digital dermoscopy, macro imaging, data storage and retrieval, monitoring, and diagnostic support.
4. Multimodal imaging: Combining technologies such as optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) provides a more comprehensive assessment of skin lesions.
How to Interpret Dermoscopy Results Correctly?
Correctly interpreting dermal nevi dermoscopy results requires physicians to possess certain professional knowledge and experience. Here are some key points:
1. Identify key features: Dermoscopy reveals minute structures and pigment distributions of skin lesions, such as pigment networks, vascular patterns, and structural symmetry. These features are crucial for distinguishing benign nevi from potentially malignant lesions.
2. Use diagnostic algorithms: Various diagnostic algorithms (such as the ABCD method, pattern analysis, and 7-point checklist) can help physicians more systematically analyse dermoscopic images.
3. Combine with clinical background: Physicians should combine patient medical history, symptoms, and clinical manifestations to comprehensively judge the nature of lesions.
4. Regular training: Physicians need to regularly participate in dermoscopic diagnosis training to master the latest diagnostic standards and techniques.
Why Is Dermoscopy Important for Skin Health Management?
Dermal nevi dermoscopy has significant importance for skin health management:
1. Early detection of lesions: Dermoscopy can detect malignant lesions such as skin cancer early, improving cure rates.
2. Reduction of unnecessary biopsies: Through precise image analysis, dermoscopy can reduce unnecessary biopsies of benign lesions, reducing patient burden.
3. Dynamic monitoring: Dermoscopy allows for long-term monitoring of skin lesions, observing changes in lesions, and promptly detecting potential malignant changes.
4. Improved diagnostic accuracy: Dermoscopy significantly improves diagnostic accuracy for skin lesions, especially early identification of malignant lesions such as melanoma.
5. Non-invasiveness: Dermoscopy is completely non-invasive, requiring no surgery or biopsy, avoiding patient discomfort and risk.
Dermoscopy plays an increasingly important role in diagnosing dermal nevi and skin cancer. Through high magnification and specialised lighting techniques, dermoscopy reveals minute structures and pigment distributions of skin lesions, significantly improving diagnostic accuracy. Compared to traditional methods, dermal nevi dermoscopy is non-invasive, fast, and efficient, reducing patient discomfort and medical costs. With continuous technological advancement, dermoscopy is developing in more intelligent and precise directions, providing stronger support for skin health management.
