Dermoscopy: An Illustrated Self-Assessment Guide

441 Pages·2010·23.5 MB·English

by  Robert Johr

Dermoscopy
An Illustrated Self-Assessment Guide
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Dermoscopy
An Illustrated Self-Assessment Guide
Robert H.Johr,MD
Clinical Professor of Dermatology and
Associate Clinical Professor of Pediatrics
Pigmented Lesion Clinic
University of Miami School of Medicine
Miami,Florida
Prof.Wilhelm Stolz,MD
Director Clinic of Dermatology,Allergology and Environmental Medicine
Hospital München Schwabing,and
Professor of Dermatology,Faculty of Medicine
Ludwig-Maximilians-Universität Munich
Germany
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Contents
Foreword vii
Preface ix
Acknowledgments xi
Chapter 1 Dermoscopy from A to Z 01
Chapter 2 Scalp,Face,Nose,and Ears 27
Chapter 3 Trunk and Extremities 95
Chapter 4 Palms,Soles,Nails 325
Chapter 5 Genitalia 389
Index 419
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Foreword
The new textbook, “Dermoscopy: An Illustrated Self- lesions dermoscopically, helping to separate those lesions
Assessment Guide”by Dr.Robert H.Johr and Prof.Wilhelm which deserved follow-up from those which deserved biopsy.
Stolz,is a welcome addition to the evolving world of dermo- To this day,I continue to use dermoscopy not only to evalu-
scopic knowledge.I have reviewed all of the images and the ate pigmented lesions in children, but I also use it as an
text and feel that the contributions are indeed unique.First of advanced “pocket magnifier”. Specifically, hair shaft disor-
all,the exquisite nature ofthe photographic images deserves a ders,scabies,questionable molluscum lesions,etc.,are read-
comment.Also,the clarity oflabeling for each image separates ily identified when separated out by means of dermoscopy.
this text from all others I have seen.Specifically,all ofthe key When I forget my dermascope or when I find it uncharged,
features are isolated by means of circles,rectangles,asterisks, I actually feel less qualified to evaluate my patients.
etc., and this clear demarcation has succeeded where many I firmly believe that dermoscopy should be taught as an
similar textbooks fail.Secondly,the questions,statements and essential skill in every residency program and that all practition-
the answer format draws the reader into the dialogue. You ers should strive to learn this technique.I certainly learned it
really cannot escape committing yourself to a diagnosis, or when I was in my mid 50s,hence,a mature dog can learn new
differential diagnosis,as you answer the questions and state- tricks.I am still surprised by the fact that virtually all children
ments posed.I think these two unique aspects ofthe textbook referred to me for evaluation of pigmented lesions have not
serve the learning process in a very positive way. been viewed with dermoscopy by their referring dermatologists.
I should also add that I am an unabashed enthusiast of This needs to change.This technique adds a dimension which
dermoscopy.Although I presently confine my clinical prac- clearly makes us better diagnosticians and better dermatolo-
tice to pediatric dermatology,until 7 years ago,I saw adults gists.The book by Drs,Johr and Stolz will help us in this effort.
on a daily basis and evaluated all of their pigmented lesions
with dermoscopy. I have been committed to learning the Ronald C.Hansen,MD
technique for the last 14 years. Most of that learning curve Chief,Pediatric Dermatology
has involved discussions and teaching by Dr. Robert Johr. Phoenix Children’s Hospital,Phoenix,Arizona
Early on,we saw patients with complex pigmentary disorders Professor,Dermatology and Pediatrics
such as xeroderma pigmentosum and evaluated numerous University ofArizona College ofMedicine,Tucson,Arizona
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Preface
Dermoscopy is itselfa language full ofterms that have specific the important features of each case. Our goal is to fully
meanings and even connotations, depending on any given demonstrate the global features and local criteria of each
lesion being examined.As in any language,its vocabulary is a lesion.This is another very important unique teaching point
work in progress based in consensus among its “expert” ofour book.
speakers who are striving to create a system to communicate Each case has a discussion of all of its salient features.
dermoscopic findings based on observational data.In order Not in long drawn out paragraphs,but in outline form.We
for there to be mutual comprehension among users of this realize that your time is valuable and want to make the learn-
powerful technique, the language of dermoscopy must be ing and recall process as easy as possible.
spoken properly.This is not an easy task since there is a signifi- Series of cases are organized into groups. For example,
cant learning curve to master the technique as well as its ter- there are lesions in which the major feature might be pigment
minology.It takes study,practice,and dedication. network, dots and globules, regression, pink, blue or black
Dermoscopy is the standard ofcare around the world and color,or vascular structures.There are similar-looking clini-
is becoming very popular in the United States.Dermatologists cal and/or dermoscopic images grouped together in specific
and other groups of physicians are realizing what a valuable body locations,such as brownish spots on an ear lobe or in
tool it is.The goal ofthis book is to teach what we believe are the genital area.This simulates real-life encounters.One case
the important general principals and specific points of der- often flows into the next and knowledge gained from the pre-
moscopy and to allow for users to “self-assess”their knowledge vious case is needed to solve the next case.Melanocytic,non-
and skills using the techniques taught here. melanocytic,benign,malignant,or inflammatory pathology
In an era ofinformation overload,we designed the book from head to toe with 95 melanomas and their most impor-
to be short,sweet,and to the point.We want it to be an easy, tant simulators.
enjoyable,and practical read.Important principles are often Each case ends with a series of dermoscopic and/or
repeated which is a good way for them to be remembered. clinical pearls based on years of experience treating patients
We “keep it real”with 191 cases that any busy clinician with skin cancer. The patients’ well-being trumps political
may have the opportunity to see in general dermatology clinic correctness. The book is sprinkled with general principles
on a daily basis.Great clinical and dermoscopic images with and specific points that are controversial but strongly embed-
short histories are followed by five “true or false”statements. ded in our core beliefs.
As in real life,then comes the decision making in check box This book was a coproduction between United States
form: what is the potential risk and what is the diagnosis? and Germany.The text was developed in Florida and most of
Finally,the disposition ofthe case;whether to effect no inter- the cases were seen in Munich.
vention, follow-up, or to make a histopathologic diagnosis? Being a competent diagnostician must include the
The concept of dermoscopic differential diagnosis is found tissue-sparing and potentially life-saving technique called
throughout the book.In most cases,we do not get into the dermoscopy.
controversial issue of the best technique to make a Each of us has a profound responsibility for the well-
histopathologic diagnosis.We leave that up to you. being of every patient that walks through the door. Always
Turn the page, and the answers to the statements are regard each patient as someone’s precious loved one as ifthey
given in a format that separates our book from the others. were your own!
The dermoscopic images are presented again with an exten-
sive description of the criteria in the lesion.It is essential to Robert H.Johr Prof.Wilhelm Stolz
evaluate as much as possible before making a diagnosis. Boca Raton,Florida Munich,Germany
There are many circles,boxes,arrows,and stars to point out