I bought 2 other brands of dermatoscopes and found the Dermlite 4 was the best so far. It has the highest degree of polarization I know of, with plastic ice caps to prevent spread of infection, and has a pigment boost. It also has the ability to toggle between polarized and nonpolarized modes, the largest viewing field I know of, attaches to my Samsung phone and certain iPhones.
I was finally successful in having a podiatric pathology report sent back to me with a copy of the dermatoscopic image taken from my Dermlite 4. This sets a new standard in podiatric pathology reporting which I believe is the future gold standard. Now that I have it, I don’t know what I would do without my Dermlite 4 dermatoscope.
Once one decides on a dermatoscope, this can be a lifetime investment. Only after deciding what features one wants in terms of degree of polarization, etc…. then I believe it is best to shop around for the best price. I am guessing if one attends a convention where dermoscopy is taught there just might be discounts available.
Sometimes patients refuse to excise their warts and opt for chemical treatment. Dermoscopy can provide information about the halo surrounding blood vessels. I thought it would make sense that if the white halo present surrounding the hairpin shaped vessels in seborrheic keratosis, then similarly in a wart that same white color would be present in any halo surrounding vessels.
I believe this pinkish or reddened color could also be due to trauma. If one is faced with the possibility of trauma or malignancy, perhaps it is better to be cautious and to biopsy the area. It might be helpful if the following information is sent with the biopsy specimen to a dermatopathologist:
1. any history of trauma to the lesion,
2. any history of skin cancer,
3. any family history of skin cancer
4. a dermatocopic image of non contact polarized dermocopy and non polarized dermoscopy. The non polarized dermoscopy might show a blue white veil, any milea cysts. The non contact polarized dermoscopy would best emphasize the vascular structures and the color of any surrounding halo as well as the shape and distribution of vascular structures. If the dermatopathologist is not familiar with dermoscopy perhaps the laboratory might have the availability of a consultant that is.
How can a lesion “obviously” be benign without dermoscopy? For example a lesion might have the charateristics of milia-like cysts, and comedo-like openings we all think is a seborrheic keratosis. Yet only through dermoscopy can one under polarized light see that the vascular structures might not have a white halo around hairpin vessels. What if under nonpolarized dermoscopy a blue white veil is seen in what you thought was a seborrehic keratosis? If such a blue-white veil is asymmetrically placed and has a dark blue color I would be concerned.
All a podiatrist really needs is to spend 2 hours at the dermfoot lecture with Dr. Marghoob. They may not be trained to diagnose specific structures yet they will be taught some basic screening method as to when to biopsy and when not to.
I never said I was a good artist. Yet when I give a lecture I want everyone to understand the concept of melanocytes traveling from the basal layer to the stratum corneum.
Second concept: there are Rete Ridges that are sometimes affiliated with flat skin and other rete ridges affiliated with a ridge. This is sometimes not the case in situations such as any dermatologic condition that might obliterate viewing the dermal epidermal junction. What about a Halo Nevus where the lymphocytic infiltrate is so thick that one cannot tell the melanocytes in the papillary dermis.
Once a pathologist diagnosed a Halo Nevus in the foot. I never heard of a Halo Nevus being present in the foot. I began to question this and I had my Dermatopathology Text by Raymond Barnhill. A Halo Nevus has a great deal of lymphocytes yet the picture on the report showed very little lymphocytic infiltrate. Thus I began to question dermatopathology reports.
Then again chances are it could be a Halo Nevus in the late stages with a decreased lymphocytic infiltrate.
Why not consider getting different opinions from different dermatopathologists?