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Dermoscopy of Early Stage Melanoma
Melanoma develops from melanocytes, which are located in the epidermis of the skin. Melanoma can be display as changes of existing mole or a new spot on the skin. If not identified and treated early, melanoma is more likely to spread to other parts of the body. Melanoma can become life-threatening even in 6 weeks…
Early Stage Melanoma Dermoscopy | A Visual Guide for Diagnosis | IBOOLO
IBOOLO presents a comprehensive guide to early stage melanoma dermoscopy, the non-invasive technology revolutionising dermatology. Discover how to correctly identify subtle signs of melanoma, alopecia, Bowen's disease, and other conditions, helping you gain confidence and provide more precise care.
Early Stage Melanoma Dermoscopy: A Visual Guide for Diagnosis
Early detection is the most powerful tool against melanoma. This visual guide focuses on early stage melanoma dermoscopy, providing an in-depth look at the key features and patterns that distinguish early malignant lesions from benign moles. Learn how to spot the subtle clues that can save a life.
Early Melanoma Dermoscopy: What to Look For
The saying “a picture is worth a thousand words” is especially true in dermatology. Dermoscopy of early stage melanoma isn't about looking for a single red flag, but rather a combination of subtle, atypical features. Think of yourself as a detective looking for clues. Here are the most critical visual signs to look for:
1. The Atypical Pigment Network
The pigment network is the most important feature. In a benign mole, the network is symmetrical and fades at the periphery. In early melanoma, this network becomes abnormal. Look for:
- Irregularity: The lines of the network vary in thickness and spacing. Some parts may be thick and dark, while others are thin and faint.
- Abrupt Termination: Instead of gradually fading, the network stops suddenly at the edge of the lesion. This “cut-off” appearance is a major red flag.
- Atypical Pigmentation: The network shows multiple shades of brown or black, not a single uniform color.
2. The Presence of Atypical Vessels
While vascular patterns are more common in amelanotic melanoma, they can also appear in early pigmented lesions. Early stage melanoma dermoscopy often reveals blood vessels that are:
- Dotted: Tiny red or black dots appear chaotically distributed throughout the lesion. They are often of different sizes.
- Linear-Irregular: The vessels are squiggly or serpentine, and their arrangement is random, not organized.
The combination of these vessel types with an atypical pigment network is a highly suspicious finding.
3. The Clues of Regression and Atypia
As melanoma evolves, the body's immune system may try to fight it off, leading to subtle changes visible with dermoscopy. These clues are critical for diagnosis:
- Dots and Globules: In a benign mole, these are typically uniform in color and size, and evenly distributed. In early melanoma, they are irregularly distributed, vary in size, and have multiple colors.
- Blue-White Veil: This is a hazy, gray-blue or whitish area within the lesion. It can be an early sign of tumor regression or deep pigment, both of which are highly concerning.
- Irregular Streaks: Look for short, finger-like projections or streaks at the periphery that are irregular in shape and asymmetric in their distribution.
Systematic Approach to Dermoscopic Diagnosis
To ensure accuracy, it's best to use a systematic algorithm when performing dermoscopy of early melanoma.
The ABCD Rule of Dermoscopy
This method scores four key features:
- A for Asymmetry: Evaluate the lesion in two axes (horizontal and vertical). A score of 0 is for perfect symmetry, while a score of 1-2 points indicates asymmetry.
- B for Border: The border of the lesion is divided into eight segments. A sharp, well-defined border gets 0 points, while an ill-defined border gets 1 point. The total score can be up to 8.
- C for Color: Identify the number of colors present (e.g., black, brown, red, blue, gray, white). Each color adds a point to the score.
- D for Dermoscopic Structures: Identify and count the different types of structures present, such as network patterns, dots, globules, streaks, or a homogeneous area.
A higher total score indicates a higher likelihood of melanoma, prompting a biopsy.
Beyond the Basics: Location-Specific Considerations
The dermoscopic appearance of early melanoma can vary significantly depending on its location. Recognizing these patterns is key to avoiding misdiagnosis.
1. Facial Melanoma
On the face, melanoma often presents with an annular-granular pattern, which looks like tiny, asymmetrically distributed gray-brown rings or granules around hair follicles. The classic pigment network is often absent, making diagnosis challenging without this specific knowledge.
2. Acral Melanoma (Palms and Soles)
Acral melanoma is one of the most dangerous subtypes. In this location, look for a parallel ridge pattern. This is where pigment is concentrated on the ridges of the skin, not in the furrows. This pattern is almost always associated with malignancy.
The Role of Digital Dermoscopy and Follow-up
Technology has revolutionized our ability to detect early melanoma. Digital dermoscopy allows clinicians to capture and store high-resolution images of a mole over time. This Sequential Digital Dermoscopy Imaging (SDDI) is a powerful tool for monitoring a suspicious lesion for subtle changes. Any change in size, shape, color, or structure over a 3-6 month period is a strong indication for biopsy.
Dermoscopy of early stage melanoma is not a simple check, but a sophisticated process of pattern recognition. By carefully looking for a combination of atypical pigment networks, irregular vessels, and structural clues, clinicians can dramatically improve their diagnostic accuracy. When in doubt, a biopsy remains the gold standard. But with the right knowledge and tools, we can catch melanoma in its most treatable stage.
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Melanoma develops from melanocytes, which are located in the epidermis of the skin. Melanoma can be display as changes of existing mole or a new spot on the skin. If not identified and treated early, melanoma is more likely to spread to other parts of the body. Melanoma can become life-threatening even in 6 weeks due to its aggressive speed of growth.
Hence, there is very crucial to inspect melanoma in its early stage. Dermoscopy is a very reliable and valuable aiding tool to identify and diagnose early melanoma. Dermoscopy enhances the confidence of dermatologists and patients, and also reduces the unnecessary biopsy and surgery.
What is melanoma?
Melanoma is a type of potential dangerous skin cancer that originates from melanocytes. Melanocytes are cells that are responsible for producing pigment melanin and give color to the skin. When melanocytes start to grow out of control, then melanoma arises. As a potential invasive skin cancer, melanoma can spread very quickly to other tissues of the body if left untreated.
What is early melanoma?
Early melanoma means it is on the early stage, has not spread. Stage of 0 and 1 are the early stage of melanoma
Stage 0: Stage 0 is the most noninvasive stage of melanoma, also called melanoma in situ. Such melanoma is located in the outermost layer of the skin and has not developed deeper.
Stage 1: Early melanoma, although also localized, becomes aggressive when it has penetrated the surface layer into the next layer of skin. At this point, the invasive tumor is less than 1 mm in size and may or may not ulcerate. When it is not ulcerated and is less than 0.8 mm in size, it is considered early and thin, also known as stage 1.
Epidemiology of melanoma
In the world, incidence rates of melanoma has been rising, especially like Australia and New Zealand reported as the highest rate of c
ountries. Western European and North America are following. Meanwhile, Asia and Africa have lower incidence rate of melanoma. As reported, melanoma is the third most common cancer in Australia and New Zealand. Melanoma is the fifth most common cancer in America.
Fair-skinned populations are the higher risk of groups than dark-skinned people in general.
High risk of melanoma
The main high risk factor for developing melanoma is over UV exposure, otherwise, there are some other high risk factors for producing melanoma as below:
Over UV exposure/history of sunburn
Fair-Skinned /white-skinned population
Family history
Existing moles
Increasing age
Weakened immune system
Clinical signs of early melanoma
The first clinical signs and symptoms of melanoma commonly are:
A change in an existing mole or freckle
The appearance of a new spot or atypical looking growth on the skin
For early melanoma, there are famous “ABCDE” rules of the signs include: A: A is for Asymmetry. Melanoma often has irregular shapes and its two half are asymmetric. It means one half can not match the other. B: B is for Border. Border are irregular, blurred or ragged.
C: C is for Color. Colour is fulled with variation, or unusual colors, mixed colors and may change over the time.
D: D is for Diameter. Diameter of the spot is larger than 1/4inch (about 6millimeters)
E: E is for Evolving. Melanoma is change in its size, shape or color over time.
Stages of early melanoma
Stages of early melanoma can be complex, in summary, the stages are:
Dermoscopy of early stage melanoma
In clinical, some melanomas are extremely complex and difficult to identify. Especially in early stage of melanoma, its appearance in small size hard to detected. Dermoscopy plays a very important role to identify and diagnose the melanoma by combining a powerful lighting system and great magnification.
There are some certain features of early melanoma under dermoscopy including:
Asymmetrically distributed
Unusual pigment network
Irregular brown-black or multiple dots/globules
Blue-white veil
atypical vascular pattern or radial streaming
Scar-like depigmentation
What is the technique of dermoscopy?
Dermoscopy, also known as dermatoscopy or epiluminescence microscopy, is a dependable and useful medical device of helping skin doctors to diagnose various of skin lesions or skin diseases. Here’s the technique of dermoscopy as below:
Instrument: Dermoscopy is commonly display as a handheld tool. This tool combines magnifying lens with a powerful lighting system to allow enhanced visualization with more details that are invisible by naked eyes. In addition, some dermoscopes is designed attached on a camera or a phone to directly observe or capture images of skin lesions.
Skin Preparation: Before the examination of dermoscopy, the patient’s skin should be keep clean. In some cases, if necessary, hair should be removed.
Application of Gel or Fluid: A gel or liquid (often alcohol or oil) may be applied to the skin lesion to reduce surface reflections and allows better visualization of deeper skin. But with the innovation and development of dermoscopy, there might no need any gel or liquid during the process of dermoscopy examination.
Observation of Structures: Dermoscopy reveals details of specific structures of the lesion to supply more valuable and key information for diagnosis.Such details include pigment networks, dots, globules, vessels, and other patterns.
Digital Imaging: Some dermoscopes are connected with a computer or a phone to capture digital images of the skin lesion. These images can be stored for later analysis and comparison.
Training and Expertise: It requires specialized and trained medical workers to interpret dermoscopic findings. Various patterns of dermatoscopic features of the lesion should be correlated with clinical context to get accurate and precise diagnosis.
How accurate is dermoscopy for melanoma?
Inspection by dermoscopy is more accurate than visual inspection alone in the diagnosis of melanoma.The accuracy of dermoscopy has been reported to range from 60% to 100%. But generally, Dermoscopy improved the accuracy of clinical diagnosis up to 35%.
A 2018 Cochrane meta-analysis evaluated the diagnostic accuracy of dermoscopy in melanoma.
Advantages and disadvantages of dermoscopy for melanoma
As we can see, dermoscopy indeed can increase the sensitivity of diagnosis for melanoma.There are some advantages and disadvantages of for comparison dermoscopy with clinical examination(visual inspection):
Compared with clinical examination, dermoscopy allows a brightening detail structures of skin lesion which are invisible by naked eyes. It is no doubt that dermoscopy can greatly increase the accuracy of diagnosis. In addition, dermatologist can store the images captured by dermoscope connected with phone or computer for later analysis and comparison. Dermoscopy plays a very significant role in the detection and diagnosis of skin lesion. People also need to learn how to use a dermoscopy to do self-examination in daily life . Any suspicious findings, have the skin checked by the professionals as soon as possible.
