The SDPA Annual Summer Conference kicked off the morning pre-conference track with in an-depth look at dermoscopy. Dr. Jennie Clarke provided a quick overview of the history of dermoscopy while emphasizing that dermoscopy is not used for diagnosis but for guidance to determine the need to biopsy suspicious lesions. She highlighted that dermoscopy can be used as an adjunct to the history and clinical exam to help improve diagnostic accuracy and significantly decrease the number of unnecessary biopsies.
Dr. Joslyn Kirby then went on to review the merits of dermoscopy and explained the 2-step algorithm to evaluate a lesion. Dr. Kirby emphasized that the vocabulary of dermoscopy is not as important as being able to “see” and understand patterns.
For the second part of the dermoscopy course, Dr. Clarke reviewed the typical patterns of pigmented lesions including those on acral surfaces. She reviewed dermoscopic images of benign lesions and the 10 features of melanoma. In addition, Dr. Clarke explained that the “ugly duckling rule” applies to both the clinical and dermoscopic exam of each patient. Dr. Kirby also emphasized when examining a patient with numerous nevi, a provider should be “looking for the match clinically and dermatoscopically” in the context of that individual’s nevi.
Dr. Kirby went on to state that “dermatology makes me humble”. She explained that constantly questioning one’s clinical impression in conjunction with dermatoscopic findings can help fine tune one’s diagnostic accuracy. She reiterated that if a lesion doesn’t fit into an expected category or pattern, this lesion needs a biopsy or “if it doesn’t fit, it needs to split”. She illustrated this with a case of Merkel cell carcinoma.
The final portion of the dermoscopy track began with unique dermatoscopic findings that can help in the evaluation of hair, aka trichoscopy. Understanding these dermatoscopic findings may decrease the need for biopsy in patients with hair loss. Finally, Dr. Clarke reviewed the anatomy of the nail before reviewing benign and atypical nail presentations with dermoscopy, or onychoscopy. While onychoscopy can give a provider more information, biopsying “a new pigmented linear band in a single digit in an adult patient” is always good practice.