JAAD dermoscopy case of the month series Ashfaq A. Marghoob, MD Hauppauge, New York
T
he ‘‘big bang’’ for modern-day dermoscopy began in 1987 with 2 articles outlining the dermoscopic patterns of pigmented skin lesions published in the Journal of the American Academy of Dermatology (JAAD).1,2 Since the publication of these seminal papers, there has been an explosion of over 3000 articles and book chapters containing ever-expanding information illuminating the dermoscopic morphology of not only pigmented skin lesions and skin cancers, but also for a host of other conditions including amelanotic lesions, inflammatory conditions, infections and infestations, hair disorders, and mucosal and nail lesions. In addition, dermoscopy has provided insights into the biology of lesions and has altered and improved management strategies for a myriad of dermatologic conditions. Although improvements in diagnostic accuracy afforded by dermoscopy have translated into the earlier detection of skin cancer, it has also helped reduce the number of unnecessary biopsies of benign lesions, which translates into a lowering of the benign-to-malignant biopsy ratio. There remains no doubt that this simple handheld looking glass has had a tremendous impact on how we evaluate skin lesions. For example, it has revolutionized the way clinicians inspect and think about melanocytic neoplasms. It has impacted our understanding of the varied morphologies of melanoma, and their growth patterns and biology; influenced our thoughts about nevi; and changed our views about nevogenesis. Although dermoscopy
was initially used to evaluate pigmented lesions, over the past 2 decades there has been a paradigm shift in the use of dermoscopy from an instrument used primarily to evaluate pigmented neoplasms to an instrument routinely used by many clinicians to assist them during the dermatologic examination in diagnosing a vast spectrum of diseases from cancer to scabies, to monitor treatment response, to study the in vivo biology of lesions, and much more. Case reports are a means of bringing attention to unusual, rare, or exceptional cases. They also provide a means of describing new entities, procedures, and insights. Much that is taken for granted today such as the morphologic features of recurrent nevi, scabies, and structures suggestive of amelanotic melanoma was first described in case reports before becoming vetted and confirmed in larger studies. This issue of JAAD is dedicated to a compilation of recent dermoscopy case reports. I am sure you will enjoy the many interesting observations and insights provided by the authors of these articles.
From the Dermatology Service, Memorial Sloan Kettering Cancer Center. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Ashfaq A. Marghoob, MD, Dermatology Service, Memorial Sloan Kettering Cancer Center, 800 Veterans
Memorial Hwy, Hauppauge, NY 11788. E-mail: marghooa@ mskcc.org. J Am Acad Dermatol 2015;72:S1. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.10.029
REFERENCES 1. Pehamberger H, Steiner A, K Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions. J Amer Acad Dermatol. 1987;17:571-583. 2. Steiner A, Pehamberger H, K Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Amer Acad Dermatol. 1987;17:584-591.
S1
T
he ‘‘big bang’’ for modern-day dermoscopy began in 1987 with 2 articles outlining the dermoscopic patterns of pigmented skin lesions published in the Journal of the American Academy of Dermatology (JAAD).1,2 Since the publication of these seminal papers, there has been an explosion of over 3000 articles and book chapters containing ever-expanding information illuminating the dermoscopic morphology of not only pigmented skin lesions and skin cancers, but also for a host of other conditions including amelanotic lesions, inflammatory conditions, infections and infestations, hair disorders, and mucosal and nail lesions. In addition, dermoscopy has provided insights into the biology of lesions and has altered and improved management strategies for a myriad of dermatologic conditions. Although improvements in diagnostic accuracy afforded by dermoscopy have translated into the earlier detection of skin cancer, it has also helped reduce the number of unnecessary biopsies of benign lesions, which translates into a lowering of the benign-to-malignant biopsy ratio. There remains no doubt that this simple handheld looking glass has had a tremendous impact on how we evaluate skin lesions. For example, it has revolutionized the way clinicians inspect and think about melanocytic neoplasms. It has impacted our understanding of the varied morphologies of melanoma, and their growth patterns and biology; influenced our thoughts about nevi; and changed our views about nevogenesis. Although dermoscopy
was initially used to evaluate pigmented lesions, over the past 2 decades there has been a paradigm shift in the use of dermoscopy from an instrument used primarily to evaluate pigmented neoplasms to an instrument routinely used by many clinicians to assist them during the dermatologic examination in diagnosing a vast spectrum of diseases from cancer to scabies, to monitor treatment response, to study the in vivo biology of lesions, and much more. Case reports are a means of bringing attention to unusual, rare, or exceptional cases. They also provide a means of describing new entities, procedures, and insights. Much that is taken for granted today such as the morphologic features of recurrent nevi, scabies, and structures suggestive of amelanotic melanoma was first described in case reports before becoming vetted and confirmed in larger studies. This issue of JAAD is dedicated to a compilation of recent dermoscopy case reports. I am sure you will enjoy the many interesting observations and insights provided by the authors of these articles.
From the Dermatology Service, Memorial Sloan Kettering Cancer Center. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Ashfaq A. Marghoob, MD, Dermatology Service, Memorial Sloan Kettering Cancer Center, 800 Veterans
Memorial Hwy, Hauppauge, NY 11788. E-mail: marghooa@ mskcc.org. J Am Acad Dermatol 2015;72:S1. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.10.029
REFERENCES 1. Pehamberger H, Steiner A, K Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions. J Amer Acad Dermatol. 1987;17:571-583. 2. Steiner A, Pehamberger H, K Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Amer Acad Dermatol. 1987;17:584-591.
S1
