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SIAscope Training Course Example lesions

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Page 1: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

SIAscope Training Course

Example lesions

Page 2: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Training lesions

• This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy) diagnosis.

• Answer the questions on the different kinds of lesions in the following slides.

• Use the evidence in the features to make a diagnosis.

Page 3: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Feature checklist

• The three features which research has identified as the most useful in melanoma diagnosis are as follows:– Dermal melanin– Displaced blood with erythematous blush– Holes in collagen

• These features will now be defined.

Page 4: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Dermal Melanin

• Shown on the SIA-DM (dermal melanin) SIAgraph

• Areas of colour (green – blue – red)• Goes from least (green) to most (red)

involvement (combination of depth + concentration)

• A contiguous area of dermal melanin within the lesion– NB excluding hairs.

Page 5: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Displaced blood

• Shown on the SIA-B (blood) SIAgraph

• A contigious absence of blood within the lesion

• Area of white

Page 6: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Erythematous blush

• Shown on the SIA-B (blood) SIAgraph

• Increased vascularity around the periphery of the lesion for at least ¾ of its circumference (when compared to surrounding skin, within confines of lesion.)

• Seen as darker red area within a lesion

Page 7: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Holes in Collagen

• Shown on SIA-C (collagen) SIAgraph

• A contiguous absence of collagen within the lesion but discounting hair follicles.

• Black “holes” in collagen

Page 8: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Example lesions

• The following slides contain SIAgraphs of different lesions, in addition to a few case notes.

• Using the definitions from the previous slide, try to decide whether or not a feature is present in a lesion.

Page 9: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Example lesions

• Then press one of the bottom buttons to answer the question.

• Click in the centre of the slide for an explanation of the feature.

• Turn your computer’s sound on if possible.

Page 10: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the chest of a 53 year old male.

Page 11: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 12: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• There is no contiguous absence of collagen within the lesion. (Black areas)

Page 13: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 14: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• There is no contigious absence of blood within the lesion. (White areas)

Page 15: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 16: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• There is no blue on the SIA-DM.

Page 17: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

• No collagen holes

• No displaced blood

• No dermal melanin

Page 18: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Compound Naevus

• Remember, although they have melanocytes in the dermis, most compound naevi do not have dermal melanin.– Melanocytes have stopped producing

melanin.

Page 19: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the back of a 43 year old male.

Page 20: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 21: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• There are black areas within the body of the lesion on the SIA-C, which are not hair follicles.

• Using a SIAscope would allow you to zoom in on areas of doubt, to clarify whether or not the feature exists.

Page 22: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)
Page 23: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 24: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• There is a large white area in the centre of the lesion.

Page 25: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is Erythematous blush present in this lesion?

Yes No

Page 26: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• There is increased vascularity around the periphery of the lesion for at least ¾ of its circumference.

• Compared to the surrounding skin.

• This is a strong example of both displaced blood and erythematous blush.

Page 27: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 28: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• This is shown in several colours, showing that the lesion has a large dermal component.

Page 29: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

• Holes in collagen

• Displaced blood plus erythematous blush

• Dermal melanin

Page 30: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Melanoma. • Clark’s level 3+

– Holes in the collagen SIAgraph show that the melanoma has penetrated to the bottom of the papillary dermis.

– The SIAscope cannot image any further than the bottom of the papillary dermis.

• As the reticular dermis does not scatter light sufficiently.

Page 31: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• An 18 year old male presented with this lesion on the back.

Page 32: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 33: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• Displaced blood is not present in this lesion.– WHY?

• There are no areas demonstrating an absence of blood (white).

Page 34: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

NoYes

Page 35: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• There are no black areas within the lesion.

• In this case, matching fluid has not been used, and the collagen view is slightly distorted.– In difficult cases, rescanning the lesion

using matching fluid may help improve the clarity of the collagen image.

Page 36: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 37: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• Areas of dermal melanin are shown in blue on the SIA – DM.

• Areas of blue ARE visible in a rim around the top right of the SIA-DM.– However, they are not within the lesion, and are

probably a result of light leakage when taking the handset.

• Remember to use matching fluid – – Lesions without dermal melanin can appear to

have dermal melanin if scanned without fluid

Page 38: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Would you excise this lesion?

• No collagen holes

• No displaced blood

• No dermal melanin

Page 39: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Benign

• Dysplastic Naevus

Page 40: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the forearm of an 84 year old female.

Page 41: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 42: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• There is no contiguous absence of collagen within the lesion.

Page 43: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 44: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• However, note that the lesion consists of blood, making the diagnosis of haemangioma most likely.

Page 45: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 46: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• Dermal melanin is shown on the SIAgraph.• However, this may be haemasiderin, a

breakdown product of blood that mimics dermal melanin on dermal melanin SIAgraph.

• If dermal melanin is shown in a haemangioma, it is normally only green in colour, and not blue or red.

Page 47: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Haemangioma

• No collagen holes

• No displaced blood

• Dermal melanin indicated (Haemasiderin)

Page 48: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the face of a 54 year old female.

Page 49: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 50: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• All over the lesion are large black areas – these are holes.

Page 51: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)
Page 52: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 53: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• There are large areas where there is significantly less blood than in the surrounding tissue.

Page 54: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is erythematous blush present in this lesion?

Yes No

Page 55: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• There is increased vascularity around the periphery of the lesion for at least ¾ of its circumference.

Page 56: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 57: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• Throughout the lesion.

• Note the blue around the edge of the lesion, caused by grease/dirt on the lens or light leakage.

• Note that for the majority of the lesion, a red colour is shown, implying a large amount of melanin in the dermis.

Page 58: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Would you remove this lesion?

• Holes in collagen

• Displaced blood and erythematous blush

• Dermal melanin

Page 59: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Melanoma

• Clark’s level 3+

• Large areas of invasion with a great deal of melanin in the dermis indicate a poor prognosis in this case.

Page 60: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the lower leg of an 89 year old male.

Page 61: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 62: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• Black areas are present, although they are not as obvious as in the last case.

Page 63: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)
Page 64: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 65: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

Page 66: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is erythematous blush present in this lesion?

Yes No

Page 67: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• The SIAscope handset is unable to image the entirety of this lesion.

• However, we can see increased vascularity at the periphery of the lesion for a significant proportion of the visible area.

Page 68: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 69: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• Note that there is less red colour than in the previous lesion, implying less invasion.

Page 70: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

• Holes in collagen

• Displaced blood plus erythematous blush

• Dermal melanin

Page 71: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Melanoma

Page 72: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the forearm of a 55 year old male.

Page 73: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 74: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

Page 75: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 76: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

Page 77: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is erythematous blush present in this lesion?

Yes No

Page 78: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes

Page 79: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 80: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• Once again, three levels are shown even though the lesion is small.

Page 81: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

• No collagen holes

• Displaced blood plus erythematous blush

• Dermal melanin

Page 82: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Although this lesion is small, using the SIAgraphs gives us additional information to aid diagnosis.

• The lesion is a melanoma.

• Clark’s level 2– Melanin in the dermis but no holes in the

collagen.

Page 83: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the abdomen of a 56 year old male.

Page 84: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 85: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• A difficult case though, as collagen is thinner in small areas inside the circle.

• These areas could be the start of holes.

Page 86: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 87: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• But it’s not easy to see.• This is an unusual case where disagreement is possible.• Using the “image enhance” button can help in cases like this.

Page 88: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is erythematous blush present in this lesion?

Yes No

Page 89: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• Although it is less pronounced than in some lesions.

Page 90: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 91: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• 3 levels.

Page 92: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is you diagnosis?

• And would you remove this lesion?

• No collagen holes

• No displaced blood plus erythematous blush

• Dermal melanin

Page 93: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Melanoma– This is a case where there are no holes in

the collagen or displacement/blush combination.

– However, if a lesion has dermal melanin, the doctor should consider precautionary excision in any case.

– Especially if the dermal melanin is deep.

Page 94: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the face of a 46 year old female.

Page 95: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 96: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• The collagen within the lesion is very smooth.

Page 97: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 98: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• There is very little change in vascularity within the lesion, implying that the lesion is largely epidermal in nature.

Page 99: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 100: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

Page 101: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

Page 102: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Seborrhoeic Keratosis

Page 103: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the shoulder of a 13 year old female.

Page 104: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 105: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

Page 106: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 107: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• There are areas of white in the blood SIAgraph of the lesion, but these are not contiguous.

• This is a very difficult example.

Page 108: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 109: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

Page 110: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

• And would you excise this lesion?

• No collagen holes

• No displacement plus blush

• Dermal melanin (3 levels)

Page 111: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Compound Naevus– Only one of the diagnostic indicators is

present in this lesion.– Seeing compound naevi with such large

levels of dermal involvement is quite rare.– Melanoma is rare in people 13 years of

age, although the shoulder may be an area of high sun exposure.

Page 112: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the shoulder of a 13 year old female.

Page 113: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 114: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

Page 115: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 116: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

• The lesion has an even increase in vascularity throughout.

Page 117: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes No

Is dermal melanin present in this lesion?

Page 118: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

Page 119: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

• No collagen holes

• No displacement plus blush

• No dermal melanin

Page 120: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Junctional Naevus

• This should be an easy diagnosis.

Page 121: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

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• This lesion presented on the forehead of a 36 year old female.

Page 122: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Are collagen holes present in this lesion?

Yes No

Page 123: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

Page 124: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is displaced blood present in this lesion?

Yes No

Page 125: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

No.

Page 126: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Is dermal melanin present in this lesion?

Yes No

Page 127: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Yes.

• Note the areas of light leakage around the edges of this SIAgraph.

• This lesion was on the patient’s forehead, a difficult area to examine without light leakage occurring.

• Loosening the skin as much as possible around the lesion may help in cases like this.

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What is your diagnosis?

• No collagen holes

• No displaced blood plus erythematous blush

• Dermal melanin

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Diagnosis

• Intra-dermal Naevus

• Unusually, the melanocytes in the dermis are still producing melanin.

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• This lesion presented on the face of a 46 year old female.

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Are collagen holes present in this lesion?

Yes No

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No.

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Is displaced blood present in this lesion?

Yes No

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No.

• Note the hair, which shows up white.

• Comparison to the ELM / dermoscopy view helps to clarify this.

• The half fade button is useful when trying to match up hairs etc.

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Yes No

Is dermal melanin present in this lesion?

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No.

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• Would you excise this lesion?

• No collagen holes

• No displacement plus blush

• No dermal melanin

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Diagnosis

• Seborrhoeic Keratosis

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• This lesion presented on the lower leg of a 51 year old female.

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Are collagen holes present in this lesion?

Yes No

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No.

• The zoom function is useful in cases like this, where some areas within the lesion seem to have approximately the same amount of collagen as the surrounding skin.

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Is displaced blood present in this lesion?

Yes No

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Yes.

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Is erythematous blush present in this lesion?

Yes No

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Yes.

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Is dermal melanin present in this lesion?

Yes No

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Yes.

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What is your diagnosis?

• No collagen holes

• Displaced blood plus erythematous blush

• Dermal melanin

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Diagnosis

• Melanoma

• Small holes in the collagen make this a Clark’s 3+.

• However, as the holes are small it is unlikely that the melanoma has progressed beyond Clark’s level 3.

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• This lesion presented on the back of a 22 year old male.

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Are collagen holes present in this lesion?

Yes No

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No.

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Is displaced blood present in this lesion?

Yes No

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No.

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Is dermal melanin present in this lesion?

Yes No

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Yes.

Page 157: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

What is your diagnosis?

• No collagen holes

• No displaced blood plus blush

• Dermal melanin

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Diagnosis

• Melanoma– A thin melanoma, with some dermal

component.– There is a great deal of vascularity in this

lesion, and a significant amount of fibrosis.– Once again, a doctor would think hard

before sending home any lesion with dermal melanin.

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A more difficult case…

• This case contains some more complicated histology, some of which may be confusing for doctors beginning to use the SIAscope.

• One example of a histological feature that may appear confusing in SIAgraphs is haemasiderin, a breakdown product of blood that mimics dermal melanin.

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• This lesion presented on the lower leg of a 63 year old male.

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Are collagen holes present in this lesion?

Yes No

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Yes.

• This is an infiltrative BCC.

• Remember, to ensure proper identification of collagen holes, matching fluid must be used.

• The amount of artifact caused by each hair in this scan implies that matching fluid has not been used.

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Is displaced blood present in this lesion?

Yes No

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No.

• However, note the lacunes of blood.

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Is dermal melanin present in this lesion?

Yes No

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No.

• As you know, sometimes haemasiderin can be detected as dermal melanin. In a lesion of this sort, sometimes dermal melanin is detected in the areas where there are lacunes of blood.

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Diagnosis

• Pigmented Basal Cell Carcinoma

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• This lesion presented on the lower leg of a 16 year old male.

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Are collagen holes present in this lesion?

Yes No

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Yes.

• There are collagen holes in this lesion.

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Is displaced blood present in this lesion?

Yes No

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Yes.

• Displaced blood is present in this lesion.

• Note the lacunes of blood, with clearly demarcated edges, in this lesion.

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Is erythematous blush present in this lesion?

Yes No

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Yes.

• Increased vascularity around the periphery of the lesion for at least ¾ of its circumference (when compared to surrounding skin, within confines of lesion.)

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Is dermal melanin present in this lesion?

Yes No

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Yes.

• Dermal melanin is present.

Page 178: SIAscope Training Course Example lesions Training lesions This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy)

Diagnosis

• Haemangioma

• The SIAscope helps more in some cases and less in others!

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End of Example Lesions

• By now you should feel able to comment intelligently on the SIAgraphs of various clinical conditions including melanoma.

• Use the SIAscope (or an emulator) for more practice.