Review
Dermoscopy is based on the simple principle of removing surface light reflection on pigmented lesions by viewing them through a fluid interface with a highly illuminated field. Over the past 20 years, dermoscopy has become a valuable method for evaluating pigmented skin lesions, and increases accuracy in clinical diagnosis. Dermoscopy: the essentials is an outstanding book compiled by five international authors who are experts in the field. They aimed to produce a book that provided a rapid means of expanding the clinician's capacity to identify critical diagnostic features of pigmented lesions.
The authors used the traffic light grid as an analogy to propose three critical features to decide whether lesions require removal. Removal is recommended for lesions with all three criteria (red light); for those with two criteria (orange light), removal or close monitoring is recommended; while those demonstrating one criterion (green light) can be left alone. This is a useful strategy, as it focuses the reader on the main challenge of dermoscopy, which is to minimise the risk of misdiagnosing a melanoma or a non-melanoma pigmented skin cancer, particularly pigmented basal cell carcinoma.
Difficult lesions such as featureless melanoma, hypopigmented lesions and melanomas arising in pre-existing naevi are included. One of the controversies in this book is the inclusion of equivocal skin lesions that on dermoscopy favoured the diagnosis of melanoma, but the biopsy findings were interpreted by the pathologist as a Clark's dysplastic naevus. In such cases, the authors probably had a split diagnosis and it would have been interesting to learn how this was resolved. The authors recommend review of the biopsy findings by a second pathologist in such cases. What may be needed is a closer study of such biopsies as they may harbour a subset of naevus-like melanomas that are not currently distinguished from Clark's dysplastic naevus.
The approach in this book is fresh and it represents an excellent method to improve one's skills in this field. The 375 illustrated case studies include clinical and dermoscopic images and cover a vast array of pigmented lesions that are instructive to both novices and experts. It would be almost impossible to have seen all the variations of pigmented lesions that are included in this volume in a single practice without having examined an enormous amount of material. The images are grouped and accompanied by concise checklists for analysis of both melanocytic and non-melanocytic skin lesions. The authors have also included brief targeted notes on the major features in each case that are highlighted in the photos.
In summary, the book fulfils the authors' aim to provide a highly illustrated text that can be used as an effective resource to expand one's diagnostic skills in dermoscopy.
Steven Kossard
Associate Professor in Dermatology
Skin & Cancer Foundation, Sydney
About the Author
