Dermatology Online Journal

Dermatoscopy. A Practical Guide
Authors: Rabinowitz, Kopf, and Katz.
Publisher: MMA Worldwide Grlup, Inc
Cost: $190 personal
$299 institutional

Review by Martin Weinstock, M.D.
Dermatology Online Journal 5(2): 12

Review

Dermatology requires a combination of skills, many of which are also required of physicians in other specialties. One of the skills unique to dermatology is the visual ability to notice and recognize patterns of skin lesions, and hence to formulate diagnoses and differential diagnoses rapidly upon visual inspection of our patients. Each year we see this skill develop over time in our trainees, with a combination of personal study, formal instruction, and experience under expert supervision.

Epiluminescence microscopy (ELM), also known by several other names including dermoscopy, is a tool for dermatologists to increase their accuracy in diagnosing melanoma. This tool also requires pattern recognition skills that must be developed for it to increase the accuracy of melanoma diagnosis. For this reason, it is not surprising that formally trained dermatologists increase their diagnostic ability with this technique, but dermatologists without the training do not.

The recognition of dysplastic nevi and increased publicity about melanoma have augmented the importance of a dermatologist's skills in the diagnosis of pigmented lesions. This has focused increasing attention on the techniques, such as ELM, available to aid the dermatologist in this task. A dermatologist who wishes to improve his/her ELM skills can attend a course, study a book, or find information on the internet. Rabinowitz, Kopf, and Katz have produced a CD-ROM to add to these resources available to us.

Their CD-ROM is basically an atlas in electronic format, primarily consisting of pictures of lesions with minimal text and a number of arrows. It is organized into groups of images. The first group illustrates the terms used in describing pigmentation, structures seen in ELM, and borders of lesions. Subsequent groups of images are organized into melanocytic and nonmelanocytic lesions, and melanoma, followed by nevi simulating melanoma and lesions with indeterminate patterns. Alternative methods of diagnosing melanoma using ELM are then described and illustrated. The final portion of the CD-ROM, the "interactive" tutorial, is a series of images presented as clinical image, ELM image, and histopathology. The Stolz and Menzies systems scores and the final diagnoses are then given.

To learn the visual skill of ELM, first and foremost you need lots of images. This CD-ROM contains lots of images to develop or sharpen your skills. It can be quite helpful in training, but in my opinion should supplement rather than substitute for sessions with a live instructor skilled in this form of diagnosis. The images are of excellent quality; the limited commentary is clear; and it is easy to skip to another part of the CD-ROM with a single click of the mouse once you are into the images. Some may prefer more complete labeling of images with more arrows, and more identification of features. Some images are not labeled with diagnosis when used to exhibit certain diagnostic points, i.e., identification of a structure. Some may quibble with the absence of documentation of the diagnosis for many of the images, a perpetual issue in pigmented lesions, although I would certainly trust the authors on this score.

Those who are or will be learning ELM will find this a very useful image set for their electronic bookshelf. More experienced users may also benefit from reviewing these images. There are many approaches to ELM; the approach of this CD-ROM may differ slightly from others in which you have been trained, and may therefore offer helpful insights. I therefore recommend it to all those who use this technique, or who are interested in doing so. ELM is appropriately becoming more widely used, and this CD-ROM promotes its skillful use.

© 1999 Dermatology Online Journal

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