Should one immediately biopsy or wait 4 months and repeat dermoscopy?

201605-0017 edited

What about the 3 point checklist where one looks to see if there is asymmety or an atypical network or blue -white structures as described in
Elseviers text on Dermoscopy the Essentials and other texts which describe this 3 point checklist.
I feel even if there is no history of cancer and no history of a family cancer looking at any lesion with color that is not basically centered, that color itself just might be considered an atypical network. I am guessing there are those of you that might want to disagree. Now here is a question. Does the black skin vs white skin tend to have less malignancies when the color is not basically directly in the center of the lesion?

This area is raised and are there furrows or ridges or both? What to do?

See the picture below. Please ask yourself is

darkened pigment present or not? What

questions should be asked in your history?


201605-0014 edited


Image above taken using Firefly Dermatoscope
One question that should be asked is if the polarization was turned on or off and to what degree the polarization is present. Milia cysts for example are better seen with nonpolarized dermatoscopes because they are more superficial. The greater the polarization the deeper the view is a general concept I learned from the Atlas of Dermoscopy edited by Ashfaq A. Marghoob mentioned earlier in this blog.

Do not only rely upon only one textbook. Why not consider purchasing more than one dermoscopy textbook or going online to different sites?

Elseviers text on Dermoscopy the Essentials

is a book where the pictures have arrows describing the lesions. For example in seborrehic keratosis the milia cysts in this book has arrows present so the reader can recognize what milia cysts are.

Once the reader understands how milia cysts look they can go to the text mentioned earlier where it was described that such cysts show up better using nonpolarized dermoscopy. When one looks at a picture of milia cysts under nonpolarized dermoscopy one then can recognize the picture of such cysts in a text.
Thus I believe more than one dermoscopy textbook can be helpful. Every textbook out there has knowledge that one can consider helpful.

At the dermfoot seminar I learned an opinion that regarding toenail dermoscopy perhaps viscous immersion fluid is necessary

For about $110 dollars to get a pocket dermatoscope and I believe the picture on amazon had a measurement on the lens. I am wondering if this just might be a good value? My personal opinion is I prefer using a dermatoscope that I consider strong polarization.

The molescope that attached to the iphone and has its uploadable is this software HIPPA compliant?

Just look at that $79 price for the molescope without the software.
I just saw the following on the molescope website: Please note that MoleScope is not a diagnostic or a therapeutic device. It is intended for imaging, archiving and communication only

Below is one cheap price advertised $119 I believe

I do not use this dermatoscope that much because I do not like the magnification. However if one has a toenail lesion one could tape on a samsung phone and use the phone to enlarge the image. The image is nonpolarized light so one would need to use some sort of clear ultrasound gel to be applied to the toenail. These are my personal opinions.

Questions that I need answered about skin in blacks and the ridge pattern and when to biopsy and my guesses.

The ridge pattern in whites is great for telling if a lesion is malignant 98% of the time. But in black skin the benign macules often have a dark pattern. Thus I am guessing that if a ridge pattern is present in dark skin one does not necessarily have to biopsy. I am guessing that a dark skin person might show a lattice pattern with a fibrillar pattern and even if it is a ridge pattern it is benign and one does not have to biopsy. I am further guessing that if the lesion is less than .7cm one does not have to biopsy. This all has to do with volar regions on the bottom of the feet. I am also guessing that on the bottom of the feet if the lesion or color is not uniformly distributed or the pattern is really nonuniform one should biopsy even if smaller than .7cm.