Dr. Orit Markowitz, author of A Practical Guide to Dermoscopy , said dermoscopy is the natural evolution beyond the ABCDEs of clinical examination of pigmented lesions. Dermoscopy allows us to become experts in evaluating pigmented lesions which results in saved lives in patients with melanoma. Furthermore, dermoscopy allows providers to feel comfortable reassuring patients and helps them avoid “cutting” on patients if it is not necessary. She did caution that dermoscopy shouldn’t be used without clinical correlation. Dr. Markowitz illustrated the benefits of using polarized and non-polarized light in appreciating specific features in lesions and recommended the use of a dermatoscope with the capability to allow one to toggle between polarized and non-polarized light. She also discussed the different mediums when utilizing a dermatoscope, including alcohol, oil, glycerin and gel.
Coverage: SDPA 20th Annual Fall Dermatology Conference Nov. 17-20, 2022, in Miami
While dermoscopy can help most providers in the evaluation of lesions, Dr. Markowitz reports the exception is with lesions which are elevated and multicolored, when dermoscopy can make evaluating these lesions more challenging. The “wobble” sign is when you use contact dermoscopy on a lesion and it “wobbles” nicely. This is a benign sign. This is common, for example, in intradermal nevi. The benign patterns of pigmented lesions were illustrated through numerous slides of examples by Dr. Markowitz. As seborrheic keratoses tend to be the most frequently referred lesion on patients to dermatologists, she reviewed the dermoscopic characteristics of these lesions including milia like cysts, fissures, ridges, coral pattern, finger like patterns and sharply demarcated borders.
Additionally, Dr. Markowitz revealed the malignant patterns in pigmented lesions including disorganized reticular and disorganized globular patterns. She also reviewed the blue white veil often found in nodular lesions and the radial streaming or focal pseudopods. Polymorphous and dotted vessels in amelanotic malignant melanomas are not to be missed as these melanomas are the most aggressive, most rapidly growing lesions that are also the easiest to miss. Dr. Markowitz highlighted some of the subtle dermoscopic features of lentigo maligna and the importance of discovering these lesions early to help decrease on the morbidity of these lesion removals. Dermoscopy of vascular lacunae in examples of angiokeratomas was also covered. Lastly, Dr. Markowitz answered attendee questions regarding equipment and resources and the approach to the patient with numerous pigmented lesions.
Byline: Sarah B.W. Patton, PA-C
Pictured: Orit Markowitz, MD, Markowitz Medical