1989 is an important milestone in the development of a new diagnostic method for visual assessment of skin lesions - dermatoscopy. It was from this time on he entered the active practice of modern dermatologists.
The main popularizer of dermatoscopy was the International Dermatoscopic Society( IDS), established thirteen years ago with the aim of raising the level of education in this field and promoting clinical trials of the method in all corners of the globe.
The main goal of IDS is the international exchange of experience on early diagnosis and prevention of melanoma formation.
The concept of the
method Dermatoscopy is a minimally invasive examination of skin lesions for their malignancy, performed with a special device - a dermatoscope.
Dermatoscopy also makes it possible to make an accurate diagnosis in the presence of melanocytic skin diseases( here you can include different types of moles) and non-melanocytic etiology( cases of squamous cell carcinoma, basiolioma or seborrheic keratosis).For the unmistakable formulation of these diagnoses, a number of specific dermatoscopic criteria have been developed.
With the development of dermatoscopy, it has been used to diagnose skin diseases of non-tumoral nature( this category includes cases of psoriasis, pink and red flat lichen).
Researchers around the world continue to identify the criteria for all new skin diseases that were not previously the object of dermatoscopy.
Russian dermatologists made a great contribution to the development of dermatoscopy, setting the criteria for the first manifestations of fixed erythema, Kaposi's sarcoma, molluscum contagiosum, black acanthosis and a number of other skin lesions.
Globally, dermatoscopy is practiced by over 15,000 doctors specializing in dermatology, dermatooncology and plastic surgery.
In addition to diagnosing skin diseases, the dermatoscopy method is used for:
- Identifying the effectiveness of the selected tactics for treating skin lesions. Controlling the dynamics of the therapeutic process, dermatoscopy provides a basis for a conclusion about how effective this or that method of treatment is.
- The choice of the method of surgical intervention in the removal of moles and other tumors , based on observations of their condition.
- The choice of method of treatment of moles of different types. Dermatoscopy helps identify neoplasms that present a danger to human health and make a decision about their removal.
- Faultless selection of the desired type of laser, used to remove skin lesions. The basis for this infallibility is the ability to accurately establish the type of skin lesions.
- Differentiation of diseases of the scalp. Before the advent of dermatoscopy, the definition of certain diseases( such as decalvirating folliculitis or lupus erythematosus) was a great challenge for dermatologists.
- Diagnosis of diseases of nail plates of different etiology ( including fungal).
- Dynamic monitoring of the state of nevi. Due to different schemes of modern diascopic system support, specialists have the opportunity to control the process of their malignancy. During the examination, the skin of the patient is photographed, fixing all the moles on it. During the next inspection, the diagnostic device automatically notes all changes concerning the state of the nevi, as well as the appearance of new moles. Comparing the new data with the previous result saved in the system, the specialist makes a decision either about the need for further observation or about their immediate removal. The same system is used to determine the degree of alopecia or photo-aging of the skin in patients.
Advantages of
The method of dermatoscopy has a number of advantages over other types of diagnostic studies, because it:
- is devoid of any contraindications to the use;
- is extremely simple and accessible;
- is absolutely non-traumatic and painless;
- does not cause complications;
- allows you to get an almost instantaneous result( the diagnosis takes only a few minutes);
- makes it possible to trace the dynamics of development of cutaneous neoplasms( the data of the previous study are automatically saved by the program).
Dermatoscopy can diagnose various skin diseases, but in cases of early detection of oncological skin lesions this technique is unmatched.
Indications
Indication for the procedure of dermatoscopy is:
- The presence of very light skin and light hair.
- The appearance of new moles( nevi).In some cases, they can be manifestations of metastases, so in case of detection of suspicious neoplasms, it is necessary to show their doctor to the dermatologist as soon as possible. Timely dermatoscopy will reveal cancer on the earliest stages of development, thereby increasing the chance for a complete recovery of the patient.
- The degeneration of old moles( manifested in a change in their structure, color or shape) or a rapid increase in their size.
- Appearance of pain, cracks, inflammation or constant itching and tingling in the area of the nevus.
- Injury of a birthmark. Sometimes a traumatized nevus can start the process of producing a large number of abnormal cells, so the procedure of dermatoscopy is better to be done immediately after getting an injury.
- Continuous appearance of all new birthmarks.
- The presence of birthmarks, whose diameter exceeds ten centimeters.
- Intention to remove an unattractive birthmark. Removal of a nevus can trigger the onset of a malignant tumor process. Passage of dermatoscopy can prevent such a danger.
- The presence of weighed heredity( melanoma cases in a family history).
- Age is more than sixty years old.
Types of dermatoscopy
As a hardware diagnostic test method, dermatoscopy allows a specialist to perform a visual inspection of suspicious lesions subjected to multiple enlargements.
The enlarged images clearly show the structure and color of their epidermal layers, the network of vessels, the connection of the dermal layer with papillary and epidermis, the principle of distribution of the dark natural pigment - melanin.
Depending on what kind of dermatoscope is used for the procedure, dermatoscopy can be manual or electronic( digital).
Digital
Electronic dermatoscope, software, computer and video camera are used for computer dermatoscopy.
During the procedure of electronic diagnostics, the evaluation of the parameters( size, structure, nature of the edges) of the alarming tumors is automatically performed by the apparatus itself.
For clarity, the conclusion is provided with a color scale having zones corresponding to the indicated hazard level, measured in percent.
- The white color of the scale indicates complete safety of the lesion.
- The yellow color indicates its relative safety.
- The red sector is a confirmation that the neoplasm is a serious threat to the health of the patient.
The multiplicity of the increase in the tissues of the structures under investigation in different digital systems can be from twenty to seventy( or more) times.
The undoubted advantages of digital dermatoscopy are: the speed and accuracy of the results, as well as complete independence from the subjective evaluation of the examiner.
Having received the conclusion of the system, the dermatologist can immediately decide on the choice of treatment tactics. As a rule, in case of detection of dangerous neoplasms, a specialist can go on one of three paths:
- prefer tactics of dynamic observation;
- resort to surgical removal of neoplasm with obligatory histological examination of the removed tissues;
- , if there is a suspicion of the presence of metastases, determine the tactics of further treatment.
Digital equipment allows you to document and save images of the morphological structure of anxious tumors with a view to their subsequent comparison and evaluation of dynamic development.
If you need to get advice from a more experienced and qualified specialist, all these data can be transmitted anywhere in the world.
Hand-held
This kind of dermatoscopy is performed using a hand-held device that has the ability of a tenfold increase in the image, which, undoubtedly, allows you to consider deeper layers of the skin than with a simple visual inspection.
This type of device is characterized by its simplicity of construction and convenience of everyday practical application. Some models of handheld devices are equipped with a camera.
In this case, the image can be displayed on the monitor, which gives the doctor the opportunity to slowly study and document the photographs obtained in order to subsequently monitor the nature of the changes occurring.
Using a device deprived of a camera requires a specialist to have considerable knowledge and extensive professional experience, since it must render its conclusion within ten seconds. The use of hand dermatoscopes is gradually entering into the practice of many modern beauticians.
Preparation of
One of the advantages of the method of dermatoscopy is the complete absence of any preparatory measures for its conduct.
The results of the examination will not be affected even by cosmetic products applied to the skin on the eve or on the day of the procedure.
How is skin dermatoscopy performed?
The procedure for dermatoscopy is performed according to the following scenario:
- A special gel is applied to the examined tumor, which is usually used during ultrasound procedure. Using the gel helps not only to increase the transparency of the skin, but also does not allow the appearance of glare in the image.
- The light of the halogen lamp is directed to the skin of the problem area( it should fall at an angle of 20 degrees).
- Neoplasm is pressed with a slide( if the mole is convex or too painful, the slide does not use).
- Having guided the optical dermatoscope to the examined birthmark, a macro survey of its surface is performed. Due to a special scale applied to the contact surface of the dermatoscope, the specialist determines the size of the lesion.
- Having studied the resulting picture, which is a multiple increase in the tissues of the birthmark, the dermatologist makes his diagnosis.
- If the examination was performed on a modern apparatus connected to a computer, the risk of neoplasm is automatically evaluated by a special program, but most often it is the prerogative of the doctor making a conclusion on the basis of the analysis of the photographs taken.
- In the case of detection of tumors that are dangerous to the health of the patient, the doctor makes a special card and stores the data to be able to conduct a dynamic observation of their development. Having photographed suspicious birthmarks, a specialist launches a computer program that allows you to project this image onto a model of the whole organism. During the next visit, the old map is compared with the new images.
If the study is carried out using a hand dermatoscope, the doctor uses a checklist that includes three main criteria when evaluating neoplasms.
Neoplasm, which is in the initial stage of malignancy, must possess:
- Asymmetry of color and structural characteristics with respect to two mutually perpendicular axes.
- Atypical pigmentation characterized by the presence of uneven cells and wide lines.
- Areas that are bluish or white in color, characterized by a bluish-white veil and tumor cells in a regressive stage.
Patient feedback
Denis:
Being the owner of a large number of all kinds of moles, I am forced to undergo a procedure of dermatoscopy twice a year. The examination does not take much time and does not cause any inconvenience and pain. After receiving the recommendation of a specialist, twice removed suspicious moles. Both operations were successful, leaving no visible traces on the body.
Natalia:
Six months ago, I underwent a course of hormonal treatment in connection with the ovarian cyst. Shortly after completing the therapeutic course, I noticed that several moles, which were initially completely flat, acquired a noticeable swelling. After a while, a strong itch appeared in the area of one of these moles, and it itself increased in size.
I was frightened and turned to the nearest clinic where I was advised to do dermatoscopy. The examination took only a few minutes. The doctor who carried out the procedure calmed me, saying that there is no need for immediate removal of the birthmark and that it is advisable to observe its further development.
I received a recommendation to avoid prolonged exposure to the sun and in the summer to use sunscreen. In a year the procedure of dermatoscopy will have to be repeated.
Price
The cost of dermatoscopy in clinics in Moscow differs significantly depending on the class of the clinic and the qualifications of the specialists who conduct the procedure.
- The price of dermatoscopic examination of the skin varies from 350 to 2300 rubles.
- Dermatoscopy of the generalized process will cost the patient 1200 rubles.
- Dermatoscopy with photo fixation can be made for 1300 rubles.
- The procedure on which the photopsy of birthmarks will be made( up to ten neoplasms) costs 2800 rubles.
Where can I go through the procedure?
You can go through the procedure of dermatoscopy in any medical center that has specialized equipment. Information on the list of provided services can be found on the corresponding Internet resources.
The role of dermatoscopy in the diagnosis of skin melanoma: