The term dermoscopy derives from two basic Greek words: dermà, meaning “skin,” and skopéō, meaning “to look or see.” As you are likely already aware, however, the science and practice of dermoscopy involve so much more than simply “looking at skin.” Indeed dermoscopy, which is also called dermatoscopy, has evolved a sort of language all its own. As you will soon learn in the coming chapters, there is a wealth of terms, each important to the practice of dermoscopy, with their own specific meanings and even subtle connotations depending on a given lesion. As with any language, a fluent understanding of the meaning of these terms is essential to becoming a proper speaker. To this end, Chapter 1, “Dermoscopy from A to Z,” will be your starting point for a comprehensive overview of the basic terminology and concepts of dermoscopy. For example, it is here where you will be introduced to the essential principles of pattern analysis and the “two-step algorithm.” This will serve as your basic approach when analyzing a lesion, such as differentiating melanocytic from nonmelanocytic. Next, and arguably the most critical part of the book, is Chapter 2, “Comprehensive Dermoscopy Criteria Review.” In this chapter, representative images and detailed explanations will guide you as you learn the language of dermoscopy. Although the task may be initially daunting, through study, practice, and dedication you will overcome a steep learning curve to master the techniques and language of dermoscopy.
Our goal in writing this book has been to teach you the language and key principles of dermoscopy. Through the use of extensive clinical and dermoscopic images along with detailed explanations and diagnostic clues, you will have the opportunity to self-assess your knowledge and skills as you study. In our era of information overload, we have endeavored to design this book to be short, sweet, and to the point. We hope that you will find it to be an easy, enjoyable, and practical read. Important principles are often repeated in an effort to make them familiar and more easily remembered.
We have included 105 cases that are likely to be seen on a regular basis in a general dermatology practice. For each case, you will find a short history along with a clinical image and an unmarked dermoscopic image. Study the unmarked image and attempt to identify the global and local dermoscopic features. Next, make your diagnosis after identifying as much detail as you can. Then, turn the page and the dermoscopic image will be presented again, this time marked with circles, boxes, arrows, and/or stars to highlight the important dermoscopic features of each case. On the same page you will find the diagnosis along with a detailed discussion and a few pearls, or key take-away points, for your review. Our goal is to fully demonstrate the global features and local criteria of each lesion. The concept of dermoscopic differential diagnosis is critical and is emphasized throughout the book.
Each case has a discussion of all of its salient features. We achieve this not in long, verbose paragraphs, but rather in outline form to make the information easier to digest. We realize that your time is valuable and want to make the learning and recall process as easy and effective as possible.
Case series are organized into groups, depending on particular common dermoscopic features. For example, there are lesions in which the major feature may be pigment network; dots and globules; regression; pink, blue or black color; or vascular structures. There are similar clinical and/or dermoscopic images grouped together in specific body locations, such as brownish spots on the face or black lesions on the trunk. We have done this to better simulate real-life clinical encounters. One case often flows into the next, and concepts learned in a previous case may inform the analysis of a subsequent case. Finally, each case ends with a series of dermoscopic and/or clinical pearls based on our combined years of experience treating patients in outpatient clinical settings.
We present the many faces of melanoma from head to toe, whether easily diagnosed with well-developed criteria or challenging to the most astute dermoscopist. We include more than 100 clinical and dermoscopic images of melanoma to help you improve your diagnostic skills. In addition, we are especially delighted to include subspecialty expertise in the fields of hair and nail dermoscopy. You will find nail cases as well as chapters on trichoscopy and on dermoscopy in general dermatology. At the end of the book, you will also find a succinct glossary of specific terms and general principles to review at a glance.
In conclusion, we strongly believe in the importance of using dermoscopy routinely in the practice of dermatology. As a cutting-edge, noninvasive technique, dermoscopy uniquely allows us insights into the diagnosis of numerous dermatologic conditions and indeed may be a potentially lifesaving tool to care for our patients. Our book is sprinkled with general principles and specific points that may at times be controversial but are strongly embedded in our core beliefs. Each of us has a profound responsibility for the well-being of every patient who walks through the door. We applaud you as you embark on your journey to learn the techniques and language of dermoscopy!
Dr. Robert H. Johr
Chapel Hill, North Carolina
Dr. Wilhelm Stolz