Orit Markowitz - A Practical Guide to Dermoscopy

Orit Markowitz, MD, FAAD

Director of Pigmented Lesions and Skin Cancer
Assistant Professor of Dermatology
Mount Sinai Medical Center
New York, New York
Director of Pigmented Lesions Clinic
Brooklyn VA
Brooklyn, New York
Adjunct Professor, Dermatology
SUNY Downstate Medical Center
Brooklyn, New York
Chief of Dermatology
Queens General Hospital
Jamaica, New York

Executive Editor: Rebecca Gaertner

Senior Development Editor: Kristina Oberle

Senior Production Project Manager: Alicia Jackson

Design Coordinator: Teresa Mallon

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Copyright 2017 by Wolters Kluwer

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Library of Congress Cataloging-in-Publication Data

Names: Markowitz, Orit, author.
Title: A practical guide to dermoscopy / Orit Markowitz.Description: Philadelphia : Wolters Kluwer, [2017] | Includes bibliographical references.
Identifiers: LCCN 2017003523 | ISBN 9781451192636
Subjects: | MESH: Dermoscopy | Skin Neoplasmsdiagnosis | Melanomadiagnosis | Nevusdiagnosis | Pigmentation Disorderspathology | Skin Pigmentation
Classification: LCC RC280.S5 | NLM WR 141 | DDC 616.99/477075dc23 LC record available at https://lccn.loc.gov/2017003523

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LWW.com

This book is for my father, Michael Markowitz.
As an electronic engineer and inventor, his passion for science
and discovery was truly infectious. His loss fueled my own passion for
research and innovation at an early age and continues
to drive me all of these years later.
Thank you Dad.

Sarah Utz, BA

MD Candidate 2017
Icahn School of Medicine at Mount Sinai
New York, New York

Dermoscopy has changed the landscape of how we manage pigmented lesions. While the technology is not new, it continues to evolve, and the ways in which residents and physicians learn how to best use this modality is likewise evolving. Well-established methods for learning dermoscopy have focused primarily on pattern recognition, and while this method is a crucial piece toward mastering dermoscopy, this method alone may not work for everyone or for every lesion. During my own training, I was struck by how identifying the pattern algorithm of certain lesions was not possible, specifically for early lesions and particularly for early amelanotic melanomas. I was intrigued by how to diagnose these more effectively, especially given that amelanotic melanoma, while being the most rare, is the most deadly when picked up. As my career evolved and I began teaching students, residents, and fellows, I was pushed to strengthen and actualize the connection between the clinical and dermoscopic exams. I found the most apparent link to be color. Over time, I began to recognize that different colors and color combinations clinically, and then dermoscopically, would correlate with my diagnoses, in some instances bypassing pattern altogether. So I set out to develop my own method of color recognition to complement and streamline the traditional pattern recognition method. At first, I simply began using the Color Wheel in my own practice, but quickly incorporated it into my teaching roles. Now as the Director of Pigmented Lesions of the Department of Dermatology at the Icahn School of Medicine at Mount Sinai and Director of the Pigmented Lesions Clinic at the Brooklyn Veterans Hospital of Downstate University Medical Center, I teach it to the students, residents, and fellows, in addition to directing the Greater New York Dermoscopy course annually for residents in New York. Further, I have lectured nationally and internationally on the Color Wheels utility in the diagnosis of early malignancies.

This book is truly a labor of love many years in the making. It is my immense pleasure to present my method in a user-friendly manual that can be used by newcomers and experts in the field alike. The majority of pictures and examples are ones that I have collected over the years from my own patients. The figures have been developed in collaboration with a phenomenal graphic designer, Rene Moreno, in order to visually lead us through the book. We begin by presenting and reviewing the traditional methods of dermoscopy, as well as briefly introducing the concepts behind dermoscopy for our newcomers. For our seasoned veterans of dermoscopy, we hope that this guide will be a welcome complement to your already vast knowledge and that you may pick up some new pearls along the way.

I owe a great deal of debt to my mentors of dermoscopy, Dr. Alfred Kopf, Dr. Harold S. Rabinowitz, and Margaret Oliviero, FNP, BC, for their continual support and guidance. And to my mentors of dermatology, Dr. Daniel Siegel and Dr. Mark Lebwohl, who support my research and are fierce advocates for the noninvasive imaging work I do, which all begins with dermoscopy.

Many thanks are due to Sarah Utz, my wonderful medical student at the Icahn School of Medicine, for helping to make this book a reality. She started on this journey with me 3 years ago as a newly minted medical student and is now a budding dermatologist. She was truly instrumental throughout this entire process.