Enzo Berardesca (editor) - Non Invasive Diagnostic Techniques in Clinical Dermatology

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Part 1
Imaging Techniques

Enzo Berardesca , Howard I. Maibach and Klaus-Peter Wilhelm (eds.) Non Invasive Diagnostic Techniques in Clinical Dermatology 2014 10.1007/978-3-642-32109-2_1

Springer Berlin Heidelberg 2014

1. Use of Videodermatoscopy in Dermatology

Francesco Lacarrubba 1, Franco Dinotta 1, Cecilia Santagati 1 and Giuseppe Micali 2

(1)

Dermatology Clinic, University of Catania, Catania, Italy

(2)

Dermatology Clinic, University of Catania, A.O.U. Policlinico Vittorio Emanuele, Via Santa Sofia, 78 95123 Catania, Italy

Giuseppe Micali

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Abstract

Videodermatoscopy (VD) is a noninvasive technique that allows a rapid and magnified (10 to 1,000) in vivo observation of the skin surface with the visualization of morphologic structures invisible to the naked eye. It represents the evolution of dermatoscopy (also called dermoscopy), performed with manual devices, which do not require any computer assistance and generally employs 10 magnifications. VD is widely used in the diagnosis of pigmented skin lesions, as well as in a wide variety of dermatologic conditions (non-pigmented skin lesions, ectoparasitoses, cutaneous/mucosal infections, inflammatory disorders, scalp disorders, nail disorders, vascular disorders). It may also be useful for prognostic evaluation and monitoring of response to treatment, representing an important and relatively simple aid in daily clinical practice.

1.1 Introduction

Videodermatoscopy (VD) is a noninvasive technique that allows a rapid and magnified in vivo observation of the skin surface with the visualization of morphologic structures invisible to the naked eye [].

VD is widely used in the diagnosis of pigmented skin lesions, as well as in a wide variety of dermatologic conditions (Table ). It may also be useful for prognostic evaluation and monitoring of response to treatment, representing an important and relatively simple aid in daily clinical practice.

Table 1.1

VD applications in dermatology

Pigmented skin lesions

Melanocytic (nevi, melanoma)

Non-melanocytic (solar lentigo, seborrheic keratosis, dermatofibroma, basal cell carcinoma)

Nonpigmented skin lesions

Sebaceous hyperplasia

Pyogenic granuloma

Clear cell acanthoma

Xanthomatous neoplasms

Mastocytosis

Sarcoidosis

Median raphe cysts

Eccrine poroma

Keratoacanthoma

Actinic porokeratosis

Nonpigmented facial actinic keratosis

Bowens disease

Invasive squamous cell carcinoma

Kaposis sarcoma

Ectoparasitoses

Scabies

Head and pubic lice

Tungiasis

Cutaneous leishmaniasis

Furuncular myiasis

Demodicosis

Cutaneous / mucosal infections

Molluscum contagiosum

Cutaneous warts

Genital warts

Tinea nigra

Lupus vulgaris

Inflammatory disorders

Psoriasis

Lichen planus

Urticaria and urticarial vasculitis

Rosacea

Pityriasis lichenoides et varioliformis acuta

Scalp disorders (see )

Hair loss

Parasitoses

Psoriasis

Hair shaft disorders

Nail disorders

Psoriasis

Onychomycosis

Onychomatricoma

Glomus tumor

Vascular disorders

Port-wine stains

Infantile hemangioma

Pigmented purpuric dermatoses (PPD)

In this chapter we will use the term VD, even for those cases in which studies have been performed using manual low-magnification devices.

1.2 Pigmented Skin Lesions

VD allows the identification of different skin structures localized from the epidermis to the superficial/medium dermis usually undetectable by simple clinical observation. Several studies correlated the VD features (retrieved by horizontal observation) and the correspondent histopathologic findings (observed in vertical extension). The introduction of VD has forwarded a great impact in the management of pigmented skin lesions, significantly improving the early detection of melanoma and increasing diagnostic accuracy from 5 to 40 % over clinical visual inspection, depending on lesion type and physician experience [].

The classic approach to a pigmented lesion by VD is based on a two-step procedure (Fig. ).

Fig. 1.1

Two-step approach for the diagnosis of pigmented skin lesions

The observer should first distinguish melanocytic lesions from non-melanocytic ones. In Tables ].

Table 1.2

Common VD features of melanocytic lesions

VD features	Description	Histopathologic correlation
Pigment network	Grid of brownish lines over a tan background.	The lines correspond to melanin pigment contained in keratinocytes or in melanocytes outlining the pattern of the epidermal rete ridges, while the tan areas among them correspond to the dermal papillae tips
It can be typical (regular, thin, narrow) or atypical (irregular, thick, wide) in benign and malignant melanocytic lesions, respectively
Diffuse pigmentation	According to the localization of the melanin pigment within the skin, different colors can be seen.	Melanin pigment localized within the epidermal stratum corneum appears black; in the lower epidermal layers light to dark brown; in the papillary dermis gray; pigmentation of the reticular dermis is steel blue
Even and uneven pigmentation is usually found in benign and malignant lesions
Hypopigmentation	Diffuse or localized areas of decreased pigmentation, commonly observed in benign melanocytic lesions	Decreased melanin pigment

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