The history of skin surface microscopy dates backto the German dermatologist Johann Saphier (1920) who had published a series of communications using a new diagnostic apparatus composed of a binocular microscope with an integrated source of light for the examination of the skin. He had used this apparatus in different indications and presented some very interesting morphological observations concerning the anatomical structures of the skin. Thirty years later, Leon Goldman (1951) published a series of articles on new instruments to be used in so-called “dermoscopy” techniques. Goldman was the first dermatologist who used this technique in the assessment of pigmented lesions.
MacKie et al. (1971) described the use of a dermoscope for the pre-surgical assessment of pigmented lesions. Since then, researchers all over the world started to work in the field of dermoscopy. This new approach in the diagnosis of pigmented lesions identified a great number of structures that are invisible on clinical examination. Today, dermoscopy is a routine technique predominantly used in European countries and recognized by many others.
Dermoscopy is a non-invasive, diagnostic imaging technique which allows the visualization of subtle clinical features of the skin surface and its underlying structures normally not visible to the unaided eye. The technique has also been referred to as epiluminescence microscopy, episcopy or dermatoscopy. The basic principle of dermoscopy is transillumination of the lesion and examining it with adequate magnification to visualize subtle features. The incident light on skin undergoes reflection, refraction, diffraction and absorption.
These phenomena are influenced by the physical properties of the skin. Most of the incident light on the dry and scaly skin is reflected, but the smooth, wellhydrated or oily skin allows most of the light to pass through it, reaching the deeper dermis. This principle has been applied to improve the visibility of subsurface skin structures by employing contact media fluids over the lesions to improve the translucency of the skin. Various contact fluids have been tried such as oils (e.g., olive oil), water, antiseptic solutions, and glycerin. Water or antiseptic solutions can evaporate quickly and hence are less preferred than oils. Frequently, liquid paraffin is used, which is inexpensive, safe and easily available, with good results. Glass has a refractive index very similar to that of skin and hence when placed over oil-applied skin, further enhances transillumination of the lesion. The essential components of a dermoscope are :
- 1) an achromatic lens,
- 2) an integrated illuminating system, and
- 3) a power supply.
The achromatic lenses used for dermoscopy usually provide 10-fold magnification. The halogen lamps oriented at an angle of 20° are placed within the handheld piece of the dermoscope. The color contrasts of lesions are altered by the yellow light of halogen lamps. Some dermoscopes are equipped with light emitting diodes providing high intensity white light and consume 70% less power than halogen lamps. Illumination can be altered by turning off a set of light emitting diodes. They are also designed to emit lights of different colors for better visualization of the skin as penetration of the skin by light is proportional to the wavelength of light.
Handheld instruments are usually powered by batteries housed in the instrument handles such as lithium ion, rechargeable lithium, or AA batteries. Additional facilities in some of the dermoscopes are an inbuilt photography system, either an attachable conventional or digital camera or an inbuilt camera, and supporting software, for the capture, storage, retrieval and even diagnostic software for interpretation the of images.
The main focus of this book is to provide a comprehensive, current, and accurate lexicon to expand and clarify the meaning of surface microscopic and dermoscopic terminology including a broad range of both melanocytic and non-melanocytic skin lesions.
The rapid advance of new technological approaches in dermatologic diagnosis, i.e., computer-aided surface microscopy and teledermoscopy via the Internet, facilitates consultation and exchange of information between physicians of different disciplines. As a result of these advances, surface microscopy and dermoscopy now have a worldwide acceptance as an important in vivo diagnostic step between the macroscopic clinical and the subsequent microscopic–histological evaluation. The anatomical structures seen using this novel technique create a new terminology and a set of dermoscopic criteria.
The contents of this book will help dermatologists, histopathologists and physicians of other medical specialties in determining whether the lesion needs to be biopsied, excised, or can be left along for observation only. The daily challenge physicians face when evaluating skin lesions requires immediate access to the current dermoscopic nomenclature and definition. In the past, many different and sometimes confusing terms have been used in designating the surface microscopic features.
All surface microscopy photographs presented here were achieved using a microDermvideodermatoscopic system and an Olympus macrophotographic unit (OM-4Ti). Red bars integrated in the figures are at intervals of 1 mm. The fine black circle lines are spaced in 0.16- or 0.4-mm intervals.
Book Details
- Hardcover: 168 pages
- Publisher: Springer; 1 edition (September 25, 2008)
- Language: English
- ISBN-10: 3540789723
- ISBN-13: 978-3540789727
- Product Dimensions: 10.4 x 7.7 x 0.6 inches
List Price: $139.00