1_Dermoscopy Pt 2

Question 1

what is dermoscopy?

Answer 1

• A non-invasive technique using a device that applies polarized light** and/or fluid that **eliminates the reflection of light from the surface of the skin
• allowing visualization of color and structure in the epidermis, DEJ, and papillary dermis
• generally a 10x fold magnification

Question 2

what is the most common PRIMARY TUMOR of the foot?

Answer 2

MELANOMA,

specifically the superficial spreading type; ACRAL MELANOMA (incl nail)

Question 3

why use dermoscopy in podiatry?

Answer 3

often diagnosis is delayed or misdiagnosed;

(melanoma has a 5 yr survival rate of 77% on foot vs. elsewhere on body)

Question 4

we have been taught the ABCDs of melanoma, but what are the other tests to perform?

Answer 4

BIOPSY is the gold standard, but DERMOSCOPY can possibly prevent the need for a biopsy

Question 5

why are acral melanomas difficult to monitor/diagnose?

Answer 5

ACRAL MELANOMAS don’t often look like the melanomas elsewhere;

recall: Acral lentiginous melanoma (ALM) is a form of skin cancer that appears on the palms of the hands, the soles of the feet, or under the nails

Question 6

when is a dermatoscope used?

what can it distinguish?

Answer 6

• Suspicious lesion examine with dermatoscope
• Differentiates:
  
  • melanocytic vs nonmelanocytic
  • benign vs malignant)
• Determine if biopsy is needed for definitive diagnosis;
  
  • IF no need to biopsy, continue to monitor or observe

Question 7

what are the characteristics of MELANOMA w/ the dermatoscope?

(when NOT on palm or sole?)

Answer 7

• Asymmetrical, areas of regression, gray veil** (**shadowy-like feature)

Question 8

how does melanoma present on the FOOT?

Answer 8

• Plantar vs dorsal skin –
  
  • nevi vs melanoma,
  • blue-white veil rarely seen plantarly, thickened skin makes pigmentation look skewed
• Nails – subungual hemorrhage, nevus, fungus, melanoma

Question 9

when assessing ACRAL LESIONS on palms and soles, what presentation is benign?

Answer 9

• “furrows are fine, ridges are risky”
  
  • Furrow – depression in skin
  • Ridge – elevation in skin

Question 10

what is the “parallel pattern” with regard to dermoscopy of acral nevi

Answer 10

• ‘Parallel pattern’ refers to network seen within most melanocytic nevi on palmar and plantar surfaces

Question 11

What are the 3 benign patterns for acral nevi?

Answer 11

• parallel furrow: pigmented furrows
• lattice-like: pigmented furrows and lines crossing these
• fibrillary: delicate pigmentation crossing skin markins

Question 12

what pattern of acral nevi is MALIGNANT?

Answer 12

PARALLEL RIDGE is malignant (ridges are risky)

pigmented ridges (white dots represent sweat duct openings), highly specific for melanoma in volar sites

Question 13

is there a distinct pattern in homogenous-type nevi on volar sites?

Answer 13

No obvious parallel pattern in homogenous-type nevi on volar sites

Question 14

which skin presentation is described as “PEAS IN A POD”?

Answer 14

BENIGN ACRAL NEVUS;

globules are on ridges, and nevi cells surrounding eccrine ducts

Question 15

when does a congenital benign acral nevus present?

Answer 15

Congenital - in terms of dermatology; means “up to one year of age”;

Question 16

if pigmentation is in the furrows, it is likely …

Answer 16

BENIGN

(furrows are fine, ridges are risky)

Question 17

what are some other uses of dermatoscopy other than melanoma?

Answer 17

• inflammation
• monitoring wart treatment
• distinguishing warts from calluses
• melanonychia (of nails)
• nail pigmentation, fungal infxn, hypertropy

Question 18

dermatoscopy and inflammation:

differences b/w PSORIASIS and LICHEN PLANUS

Answer 18

Question 19

how is dermatoscopy used for monitoring wart treatment?

Answer 19

• can also use the dermatoscope for warts; because it may look like the wart is gone but it may recur in 3 weeks
• As tx continues to progress, the skin lines start to reform; they are developing but “PUFFY”/papilloform;
  
  • you want to confirm the skin lines have returned and are well-defined

Question 20

dermatoscopy and distinguishing WART VS/ CALLUS:

skin lines

Answer 20

• Callus: SKIN LINES INTACT; pain straight on,
• Wart: INTERRUPTION OF SKIN LINES; pain on squeezing the sides

(BUT not 100%)

Question 21

what are some of the causes of LONGITUDINAL MELANONYCHIA (LM)?

Answer 21

Question 22

what can dermatoscopy identify about MELANIN INCLUSIONS?

Answer 22

• color: gray or brown;
• melanocytic activation
• no hyperplasia or hyperplasia

Question 23

what is this dermatoscopic finding?

Answer 23

SUBUNGUAL HEMATOMA

Question 24

what is the following dermatoscopic finding?

Answer 24

FUNGAL MELANONYCHIA

Question 25

what are A-F in the following image?

Answer 25

• A = superficial stain,
• B = melanocytic activation,
• C = GRF from faulty biomechanics can lead to thickened nail,
• D = benign/gray,
• E = benign.
• F = malignant

Question 26

are nails inert tissue?

Answer 26

NOPE;

Nails are not inert pieces of tissue, they are a water-based membrane

Question 27

how does onychomycosis appear on dermatoscopy?

Answer 27

• spiked pattern, longitudinal striae, linear edge, distal irregular termination

Question 28

what biomechanical change might be mistaken for toenail fungus?

Answer 28

With hammertoes, the patient is essentially, “walking on the nail” –>

causes the nail to hypertrophy; it is NOT a fungus

Question 29

when assessing nails with dermoscopy, what step requires more evaluation?

Answer 29

Nails: Grey—is usually melanin activation, if brown determine further