FOOT DERMATOLOGY NEEDS DERMATOSCOPES

foot dermatology


DOCTOR DANIEL CHASKIN PODIATRIST 63-48 FOREST AVENUE RIDGEWOOD N.Y. 11385 (718) 417-4895
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.
 Do podiatrists treat warts without dermoscopy?

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.
Is there an obviously benign foot lesion without dermoscopy?

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.
Dermatopathological vs Dermatoscopic images

In order for anyone to study dermatoscopy it is helpful to understand (dermatopathology) pictures about the histological structures on slides.

This is important because depending on if a vertical image or a horizontal image was taken, very different structures can appear quite similar.

For example a vertical image of a pathology slide of adipocytes without nuclei can so closely resemble a horizontal polarized dermatoscopic image of dermatofibromas without a peripheral network.)

I purchased called Essential Dermatopathology that has online access for the entire text as well as on online image bank.

I still feel the comprehensive textbook about Dermatopathology by Raymond Barnhill that I purchased is more detailed in different ways.

My question is what dermatopatholgy texts do other podiatrists use?
The Halo Nevus pathology report with a low lymphatic infiltrate got me to question future dermatopathology reports.

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?



Pseudopods

What is the gold standard for being able to detect pseudopods? Pseudopods can indicate precancerous problems. What if the histological sectioning of a specimen misses the presence of pseudopods?

One gets training and experience by reading texts, going to courses. At the MSK cancer institute the 2nd lecture given in a 2 day intensive lecture series on intermediate dermoscopy lectures contained the following information given by Ralph Braun MD from the Dept of Dermatology in Switzerland:

Pseudo-pods were shown as histologic findings on a histology slide. One of the 2 dermoscopy texts I am curently reading show pseudo-pods on a slide.

Most dermatopathologists do not mention about the presence of pseudopods because the pathology labs either do not have access to dermatoscopic images and or they do not use such images in sectioning such specimens.

If a pathology lab actually used such dermatopathologic images and sectioned them propperly and found irregularly distributed pseudo-pods this just might save lives. Dermoscopy just might save lives.

Even if a podiatrist does not understand the full interpretation of dermatoscopic images if a pathology lab sending a dermatoscopic image on an encrypted disk where the dermatopathologist knows the password would allow the dermatopathologist to better interpret such findings.

A pseudopod a histological finding when a specimen is sent with a dermatoscopic image is only one example of this situation as to why pathology labs should encourage podiatrists to use dermatoscopes.

The argument may be made that it is a podiatrists responsibility to interpret a dermatoscopic image properly. Perhaps a similar argument may be made that if a pathology lab receive a dermatoscopic image the dermatopathologist has the responsibility to “properly” section the specimen so as to properly report a picture of the histological finding of a pseudopod.

As far as students disagreeing with their professors, why not also consider disagreeing with your dermatopathologist by going to dermatopathological textbooks and considering the accuracy of a report given by a dermatopathologist. I learned at the intermediate lecture series at MSK to question a pathologist report and to not always accept the report if one does not understand the histological structures.

One detailed dermatopathologic textbook I bought was the third edition of Dermatopathology edited by Raymond Barnhill.

1. Dermoscopy is a huge topic and contains a lot of volume.

2. There are several issues that are mixed into this subject matter.

3. Foreign verbiage is needed anytime a new topic is brought up.

4. Even if pseudopods are not a cellular level parameter, their distribution as seen on a dermatoscopic image contributes valuable additional information. This better enables the dermatopathologist to make a more accurate diagnosis.

5. If a podiatrist is not experienced at interpreting strutures, they still may be performing biopsies of dermatologic lesions. Once a decision is made to biopsy, this is an opportunity for even inexperienced podiatrists to send dermatoscopic pictures to an experienced dermatopathologist with the biopsy specimens. Such additional information can ultimately lead to a more accurate dermatopathology report.




Posted on November 3, 2016
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Dermatofibroma has different patterns

5I just had an interesting dermoscopy case.

I was thinking that I was dealing with a fibroetithelioma of Pinkus because of a white network. However there were no vascular structures. Thus I began to instead think of a Dermatofibroma.

I learned at Derm Foot seminar that the dermatofibroma had a peripheral network and central scaring. I believe that Sloan Kettering had a much more intensive dermoscopy seminar. For example I learned there were so many different patterns for a dermatofibroma. I just obtained  an image of what I believe to be the multiple white scar-like patch throughout which is only present 4.8 percent of the time.

If any other podiatrists have dermatoscopic images of dermatofibromas what patterns did you find?
Posted on November 3, 2016
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Biomechanical faults affect melanocytic lesions but what about considering their affects on non melanocytic structures such as vascular tissues

These are questions and ideas I thought of myself. If shearing forces can affect the parallel furrow pattern why can’t similar forces affect other structures besides those seen in a melanocytic lesion? For example in a basil cell carcinoma why can’t shearing forces cause an arborizing vessel appearance to instead appear as polymorphous or dotted? Or why can’t the blue-white veil overlying raised area instead appear homogenous? Or why can’t a typical network appear atypical? Or why can’t a regular globular pattern appear irregular?

Why is a lattice pattern instead of a parallel furrow pattern present on the arch which clinically without a biomechanical analysis would appear non weightbearing? One cannot just look at the arch and assume it is non weight bearing.

The answer to this puzzle is that the biomechanical exam yields information unknown to only a dermatoscopic exam. There are different biomechanical faults in different planes be it your sagittal, transverse and frontal planes. Some of these faults occur on the rearfoot, some on the forefoot while some are uncompensated, partially compensated and fully compensated.

Key: After a complete biomechanical evaluation and fully checking the shoe gear and insoles, if there is a biomechanical deformity (with or without any degree of compensation) which results in biomechanical non weight bearing area with very limited shearing forces, plus a dermatoscopic exam with a fibrillar pattern then one must biopsy.

I thought of combining a gait analysis and static exam including shoe gear analysis and how such forces affect one’s dermatoscopic images. This topic is further discussed in the post below.
Posted on October 10, 2016
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Unrehearsed impromptu video with a goal to clarify the relationship between biomechanical faults affecting melanocytic lesions on the plantar skin of the feet

FOOT DERMOSCOPY- This video was not rehearsed. It was an impromptu recording made with me holding a cell phone camera. My goal was to clarify the relationship between biomechanical faults affecting melanocytic lesions on the plantar skin of the feet. I reviewed an axis of motion located on the transverse and frontal planes and clarified that the most motion occurs on the sagittal plane. I followed by emphasizing the sagittal plane compensation of a flexible plantarflexed first ray generally not resulting in a melanocytic lesion with a fibrillar pattern. The point is that anatomic location on the weight bearing portions of the foot alone is not the only factor in determining if a melanocytic lesion is a fibrillar pattern. Biomechanical faults too must be evaluated.
This is why dermoscopy and biomechanical exams must be tied together in the presence of melanocytic lesions on the plantar skin of the foot.
The plantar skin of the foot is your dermatoglyphic areas with ridges and furrows. I believe a better name for the furrows is flat skin.


Any time an unrehearsed spontaneous video is done sometimes points are left out. For example one has to first understand how to on a static exam determine if a plantarflexed ray is flexible. One could first hold the rearfoot in neutral some say so that the talar head is neither bulging medially or laterally and then maximally pronate the longitudinal axis of the midfoot by applying upwards pressure sub 5th metatarsal head and finally to check the range of motion of the first ray in the sagittal plane. If there is more motion available plantar to the level of the other lesser metatarsals one might just be dealing with a flexible plantarflexed ray. Then one should continue the examination by looking inside the shoe and to check for the weight distribution on the insole. If there is no depression sub first metatarsal head one can suspect a plantarflexed first ray. Because there is relative pronation of the rearfoot that occurs when the flexible plantar first ray compensates there might be a depression in the insert sub 2nd 3rd and 4th metatarsal heads. ( This occurs because relative rearfoot pronation results in hypermobility of the first ray.) In podiatric biomechanical exams one must take into consideration not only the static exam but the resulting effects on shoe gear, callous distribution, gait analysis. Finally on gait analysis one could check to see if there is relative pronation of the rearfoot that occurs if the calcaneus is pronating during the gait cycle when it should be supinating. These biomechanical concepts I learned during lectures at NYCPM approximately 1982. All my teachers in the orthopedics dept at NYCPM were very intelligent, caring and wonderful. I wish to thank every teacher I had. I am continuing to learn more every day. Furthermore, I believe that Root had an excellent textbook on biomechanics.
A lattice pattern does go over the ridges in an approximately perpendicular direction but the fibrillar pattern goes across the ridges at a diagonal pattern other than perpendicular.

If after a podiatric biomechanical gait analysis, static exam, examining the depression in the shoe gear if a flexible plantarflexed first ray is the final deformity, and if a melanocytic nevus is present with a fibrillar pattern sub first ray, in my opinion should be biopsied. The reasoning is that the flexible plantarflexed ray would not lead to enough shearing forces capable to result it the diagonal distribution of pigment across the ridges.

I wish to thank Derm Foot, Dr. Marghoob and the Atlas of Dermoscopy, the biomechanical lectures at NYCPM during 1982 and to all my teachers who I am so grateful for.
Posted on September 25, 2016
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Why am I pleased with my dermlite 4 dermatoscope

Suppose there are characteristics of milia-like cysts in seborrheic keratosis.
or shiney white structures in basal cell carcinoma, this is all the more reason to use a dermlite 4 dermatoscope with its high polarization and ability to toggle from polarized to nonpolarized. I believe it is common knowlege that milia cysts do not show up well on polarized dermoscopy and shiney white structures do not show up well using non polarized dermoscopy.

Posted on September 28, 2016
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Dermatoscopes just might be useful in the OR if the sterile field is not broken

Why can’t every hospital OR be fully equipped by having dermatoscopes available to its surgeons with sterilized ice caps so as to attempt to protect the sterile field. If there is a histologic interpretation of any lesion be it inside or outside of the OR, why not consider getting a picture with a dermatoscope? This just might prove useful to the pathologist or dermatopathologist. For example a dermatoscope might be useful in distinguishing between a subungual exostosis vs an osteochondroma?The one problem I can see is maintaining sterility. The dermatoscope is not sterile. However if a sterile drape is placed over the dermatoscope and the dermlite 4 is used and the Dermlite 4 has its ice cap sterilized it just might be possible to maintain a sterile field and get a clear picture of the intraoperative area.
Posted on October 9, 2016
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Dermatoscopes can be helpful in deciding whether to perform a shave vs a punch biopsy for lesions on dorsum of feet.

One concept I learned at the derm foot seminar might disagree about there being any “gold standard”. Actually the new current gold standard just might be including all your history of skin cancer or family history of skin cancer, exam clinical date including dermoscopic imaging as well as biomechanical exam, shoe gear analysis as well as biopsy report. In a different post I gave an opinion that a biopsy report of a shave into the papillary dermis that said the lesion was benign just might benefit from a dermatoscopic image which might possibly capture structures beneath the papillary dermis depending upon the dermatoscope used.  A benign report from a dermatopathogist regarding a superficial shave biopsy that only examines the papillary dermis just might not be that gold of a standard to soley rely on if a polarized dermoscopy image read by the podiatrist sees suspicious structures.

After reading the above I am making another conclusion:

Usually shave biopsies are used in the dorsum of the foot. If polarized dermatoscope shows suspicious structures on the dorsum of the foot then perform a punch biopsy. Dermoscopy is needed to tell what is the best biopsy method to use for dorsal lesions either a shave vs a punch or both a shave and a punch biopsy.

Biopsies can be indeterminate. On should correlate all the information available including dermoscopy. If a pathology report comes back as indeterminate, having a dermatoscopic image is helpful in finalizing the diagnosis. Dermoscopy is only one factor used in diagnosing problems. There is shoe pathology, etc… In this day and age where dermatoscopes are readily available and textbooks are out there why deprive a patient of access to such advanced imaging?

There is a difference between a magnified clinical picture of a toenail and a dermatoscopic image. One needs a dermatoscope with enough polarization or direct contact with an ultrasonic gel or clear gel.





Also, the need for polarization in the nails is not really needed as much as the proper contact medium and this should be an ultrasound gel.



I also learned at Derm Foot that is there is subcorneal hemorrhaging a ridge pattern on the bottom of the foot that is benign. If the blood can be scraped off and normal skin is beneath even if on a ridge it is benign. My opinion is that this concept also should extend to the toenail bed. If the blood can be scraped off and there is normal skin beneath on the toenail bed this is not a sign of a subungual melanoma.

In all due respect dermoscopy in podiatry is being used routinely by some. Just because podiatrists do not post about it here it is quite possible that as lot of podiatrists are using dermatoscopes. I am however devoting a lot of time towards learning this. I have 3 scopes and currently only make use of 2 of them. As technology improves one just may decide to upgrade their dermatoscope to one with a higher degree of polarization.

The Derm Foot seminar only was an introduction. The seminar emphasized mainly nails and the lesions on the glabrous skin on the plantar feet. I am attempting to dive deeper into structural analysis above Wallace’s line. There is so much to learn.
Posted on September 28, 2016
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Every Podiatry residency teaching program should have access to a dermatoscope

For example, how does one know if a Micro- Hutchensons sign is present without a dermatoscope? I learned about this from Derm-foot lectures. Now this is a hint. The archives of Dermatology can further expand upon this. How can podiatric residency training be comprehensive if a microhutchenson’s sign is missed because a teaching program does not have a dermatoscope? If podiatry residency programs are supposed to prepare residents with being able to sit for the ABPM certification exam and if the ABPM certification exam might possibly in the future cover the subject matter of dermoscopy then why not have every podiatric residency program in the country have the availability of highly polarized dermatoscopes?
Posted on September 28, 2016
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Basics about Foot Dermatology and using a Dermatoscope

A nonpolarized dermatoscope with a fluid medium allows a podiatrist to see soft tissue structures beneath the skin beneath the epidermis.

A polarized dermatoscope allows a podiatrist to see even into the papillary dermis.

I learned these concepts from the Derm Foot Lecture for which I am hoping more podiatrists will consider attending.

There are certain terms such as Wallace’s line, Dermatoglyphics, and

other terms that can readily be searched for online. There is a comprehensive text called Atlas of Dermoscopy that I will refer to later in this blog.
Posted on September 24, 2016
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What is dermatoglyphics?

Please go online and look up the word Dermatoglyphics. You probably will conclude the plantar aspect of the feet have dermatoglyphics or ridges present. I like to refer to the plantar skin that consists of skin without ridges and skin with ridges.

The article in Podiatry Today regarding Acral Lentiginous Melanoma referred to the plantar skin  I believe as consisting of ridges and furrows.
Parallel furrow pattern, Lattice pattern and Fibrillar pattern

The following is a brief explanation of concepts I learned at the Derm Foot Seminar:

Parallel furrow pattern is no pigment crosses over the ridges.

Lattice pattern some pigment crosses over the ridges in basically a perpendicular direction

Fibrillar pattern is pigment crosses over the ridges diagonally.

If any of the patterns are irregular and not consistent then one should consider taking a biopsy. I did not learn about an irregular lattic pattern and I am guessing that it does exist. MY ONE REQUEST IS IF ANYONE EVER SEEN AN IRREGULAR LATTICE PATTERN PLEASE COMMENT ON THIS.
Posted on September 24, 2016
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What is Wallace’s line?

This is discussed in many online sites. I think of a fingerprint on the hand or a foot print. Fingerprints have ridges which follow a certain pattern. The plantar ( or acral ) surfaces of the feet have ridges.

Please go online and look up the word Dermatoglyphics. You probably will conclude the plantar aspect of the feet have dermatoglyphics or ridges present.

At a certain level on the foot the dermatoglyphics begin to stop. This is called Wallace’s Line. This I learned at the Derm Foot Seminar. This is one reason why I am advocating that podiatrists go to the Derm Foot Seminar and the they consider purchasing the Atlas of Dermoscopy mentioned earlier.

Proximal to Wallace’s line one can  the 3 point check list that emphasizes if a lesion is asymmetric, has an atypical network, or has blue white structures. Dermoscopy the Essentials explains this quite clearly.

The Dermlight 4 has a strong polarization and pigment boost and a toggling function that in my opinion has state of the art in acquiring clear images.
Posted on September 24, 2016
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What about the image below?

There are polls in this blog. Please do not attempt to answer the polls until you read the Atlas of Dermoscopy, or other references. These polls can be very confusing and are not meant to be used as a teaching tool for those who are not very familiar with dermatoscopes. 20140111_1906311

Where is the pigment
The pigment is concentrated in the ridges
The pigment is concentrated in the furrows
The ridges are not seen.
The furrows are not seen.
There is a starburst pattern.
There are regression structures.
There is a negative pigment network
There is a negative pigment network
There is a homogenous pattern
Vote
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How big is the above lesion. The image has a ruler on it.
The lesion is less than .7cm
The lesion is greater than .7cm
Vote
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Posted on September 24, 2016
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What kind of image is this?

There are polls in this blog. Please do not attempt to answer the polls until you read the Atlas of Dermoscopy, or other references. These polls can be very confusing and are not meant to be used as a teaching tool for those who are not very familiar with dermatoscopes.

20140111_1907061

What kind of image is this
A nonpolarized image of the foot without pigment boost.
A nonpolarized image of the foot without pigment boost.
A highly polarized image of the foot without pigment boost.
A highly polarized image of the foot with pigment boost.
Vote
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Posted on September 24, 2016
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Pigment boost vs highly polarized image without pigment boot

20140111_1907231
Above is a dermlite 4 with pigment boost using the toggle function with the nonpolarized mode. What is wrong with the above picture?

What is wrong with the above picture?
An immersion fluid such as alcohol should have been used.
An immersion fluid such as ultrasound gel should have been used.
An immersion fluid such as alcohol or ultrasound gel should have been used.
Vote
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Posted on September 24, 2016
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Careful relying only upon a dermatopathologists report for a superficial shave biopsy of only the papillary dermis:



I would be very careful soley relying on a pathology report of a superficial shave biopsy only going into the papillary dermis additional imaging  using a highly polarized dermatoscope. A pathology report is only as good as the specimen gotten. A dermatoscopic image is only as good as the quality of polarization present in the dermatoscope used.

If a dermatopathologist reports no signs of malignancy on such a biopsy, this might be problematic.



Dermoscopy findings could possibly reveal problematic structures for example shiney white structures, problematic vascular structures etc. With such imaging I would in addition consider a punch biopsy even on a lesion of the dorsum of the foot. There are so many other suspicious structures out there once one goes proximal to Wallace’s line and leaves the world of dermatoglyphics. A highly polarized dermatoscope is capable of viewing structures underneath the papillary dermis. One has to realize that the color of the melanocytic pigment changes at this depth.

I did learn at the Dermfoot lecture about how lesions change in appearance at and above Wallaces line.

One more thing Orthokeratosis for example, would show up on a nonpolarized dermatoscope but then again I believe that such a dermatocopic image is not needed in the case of a superficial shave biopsy of the papillary dermis because in this case the problematic melanocytic changes would be picked up by the dermatopathologist.





Thus in conclusion for superficial shave biopsies of the papillary dermis I would add on the need for either an additional punch biopsy or a dermatoscopic image from a highly “polarized” dermatoscope. Thus the podiatrist can rely on their dermatoscopic interpretation as well as the report from the dermatopathologist. Of course the biomechanical fault if present can be documented in one’s chart as well as an evaluation of someone’s shoe gear and by combining all this information a final diagnosis can be made.


Posted on September 28, 2016
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New gold standard:

The need for polarization in the nails is not really needed as much as the proper contact medium and this should be an ultrasound gel.

I also learned at Derm Foot that is there is subcorneal hemmoraging a ridge pattern on the bottom of the foot that is benign. If the blood can be scraped off and normal skin is beneath even if on a ridge it is benign. My opinion is that this concept also should extend to the toenail bed. If the blood can be scraped off and there is normal skin beneath on the toenail bed this is not a sign of a subungual melanoma.
One concept I learned at the derm foot seminar might disagree about there being any “gold standard”. Actually the new current gold standard just might be including all your history of skin cancer or family history of skin cancer, exam clinical date including dermoscopic imaging as well as biomechanicl exam, shoegear analysis as well as biopsy report. In a different post I gave an opinion that a biopsy report of a shave into the papillary dermis that said the lesion was benign just might benefit from a dermatoscopic image which might possibly capture structures beneath the papillary dermis depending upon the dermatoscope used.

Biopsies can be indeterminate. On should correlate all the information available including dermoscopy. If a pathology report comes back as indeterminate, having a dermatoscopic image is helpful in finalizing the diagnosis. Dermoscopy is only one factor used in diagnosing problems. There is shoe pathology, etc… In this day and age where dermatoscopes are readily available and textbooks are out there why deprive a patient of access to such advanced imaging?
In all due respect dermoscopy in podiatry is being used routinely by some. Just because podiatrists do not post about it here it is quite possible that as lot of podiatrists are using dermatoscopes. I am however devoting a lot of time towards learning this. I have 3 scopes and currenly only make use of 2 of them. As technology improves one just may decide to upgrade their dermatoscope to one with a higher degree of polarization.

The Derm Foot seminar only was an introduction. The seminar emphasized mainly nails and the lesions on the glaborous skin on the plantar feet. I am attempting to dive deeper into structural analysis above Wallaces line. There is so much to learn.
Posted on September 28, 2016
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I found this on the internet “we reasoned that dermoscopy can benefit the pathologist examining excised specimens in identifying areas that were of concern to the clinician and in the decision regarding how to section the lesion and where to focus the histopathologic analysis.”

I finally found a dermatopathologist that is interested in reviewing the images that I will send him. Perhaps I can convince him to provide a secure upload site. In the meantime anytime an image cd goes out it must be encrypted by me. I use winzip. The problem is that once the win zip creates the zip file the recipient dermatopathologist must have some sort of zip software to unlock the encrypted images. Yet I found that if I use a win zip self extractor software I can send the images out without having the pathologist install any winzip software on his computer. Then again if this idea of sending dermatoscopic images is to occur on a wide scale basis the dermatopathologist should have a secure upload site.

IF DERMATOSCOPES ARE READILY AVAILABLE WHY DEPRIVE THE DERMATOPATHOLOGIST OF THE OPPORTUNITY TO TAKE SUCH INFORMATION AND USE IT IN THE FINAL PATHOLOGY REPORT? In this day and age patients should benefit from the future of dermatoscopes.

Now that I am using a Dermlite 4 dermatoscope with a pigment boost:

I am intending to go to different hospitals to lecture podiatry residents on the basics of dermatoscopes and incorporating them into biomechanical cases as well as podiatric medical examinations.

I also want to contact the specialty certifying board to let them know my opinions that the certifying exam needs more questions regarding dermoscopy.

Malpractice carriers from a risk management point of view will likely embrace the idea of podiatrists including dermatoscopes in their podiatric exams.

After studying dermoscopy I have learned a lot and still am learning more everyday.

After using the Derm Lite 4 dermatoscope I am quite pleased to have the opportunity to have such a clear image due to its intense polarization and thus ability to see such deeper structures.






Posted on September 22, 2016
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Every podiatry clinic should have dermatoscopes. In this day and age with the availability of dermatoscopes why deprive any patient of an exam with a dermatoscope so as to attempt to make the most informed decision as to whether a lesion does or does not need to be biopsied.

Ideally hospitals should use dermatoscopes before biopsy and send their skin specimens to a dermatopathologist. JAMA dermatology Dec 2007 says it is time for  ex vivo dermoscopy dematopathologists to learn dermoscopy

The point of the article I feel that is important is:

“we reasoned that dermoscopy can benefit the pathologist examining excised specimens in identifying areas that were of concern to the clinician and in the decision regarding how to section the lesion and where to focus the histopathologic analysis.”

Thus my conclusion is that if podiatry residents would use dermoscopy and know which areas to biopsy and then send the specimen to a dermatopathologist instead of a generalized pathologist then the dermatoscopic data could help the dermatopathologist into how to section the lesion and to analyze the histopathology.

Diagnosing foot melanoma saves lives.

I have podiatrust in the goals of having most if not every podiatric teaching clinic having access to a dermatoscope with adequate polarization.

By the way Steve McClaine MD and Ashfaq Marghoob MD were some of the authors of that article.

One caveat, I learned at the Derm Foot lecture that once one is around Wallaces line the line separating the dermatoglyphic skin from non glaberous skin the apperance of structures such as globules, networks appear. I encourage everyone to purchase the textbook Atlas of Dermoscopy by Dr. Mahoob who is one of the authors. One other caveat, I learned at the derm foot seminar that in Black skin the appearance of pigment in the ridges occur in benign nevi.

Hospitals that advertise they are giving high quality care should purchase dermatoscopes to be used in podiatry clinics because it is a public health concern if dangerous lesions are not biopsied such as an ameleanotic melanoma. Such a lesion just might have been detected by using a dermatoscope. Please understand that at the Derm Foot Lecture this was only an introduction to dermoscopy that focused on the dermatoglyphic structures below Wallaces line, nails, and some of the foot and leg. The problem is that there is so much more to learn regarding pattern analysis etc…. There are other texts regarding dermoscopy. I do not agree with everything I read in every text yet this is a great starting point.

Another caveat, there are other structures such as aborizing blood vessel that were not discussed at the derm foot lecture that are best seen under polarized light. This was a concept I saw in the Atlas of Dermoscopy a publication I am recommending to everyone. Back in 1983 in dermatology we discussed about basil cell carcinoma and such lesion with its pearly white borders, and telangectasias present. Imagine having a strong polarized dermatoscope back then in the early 1980’s. Well today is just like the 1980’s because podiatry clinics fail to embrace this state of the art instrumentation. Imagine a strong polarization with a pigment boost from a dermalite DL4 on an ameleanotic melanoma. This lesion which is so often missed and not biopsied especially in podiatry clinics without such instrumentation. The most advanced dermatoscopes in the hands of an educated  podiatric residents or an attending can save lives.
Posted on September 22, 2016
Leave a comment on Every podiatry clinic should have dermatoscopes. In this day and age with the availability of dermatoscopes why deprive any patient of an exam with a dermatoscope so as to attempt to make the most informed decision as to whether a lesion does or does not need to be biopsied.
Tinea pedis and dermatoscopes

What about using the dermatoscope to support the presence of  Hortaea werneckii an organism possibly causing the uncommon Tinea Nigra? At the Derm Foot lecture I learned about wispy pigmented spicules. At derm foot I learned that a dermatoscope has other uses than to rule out what needs to be biopsied. It could be helpful in diagnosing a fungus infection. Derm foot provides an introduction, yet there is so much more out there in texts, articles, etc…. This is what podiatry is all about. Treating foot problems. Modern podiatric treatment should include dermoscopy. In podiatry dermoscopy is not in its infancy. I am guessing more podiatrists are using it everyday. Why should any residency program be left behind when it comes to providing a quality education training program including such modern modalities?

Foot Dermatology
Foot Dermatology
I will be posting my thoughts about the Dermlite DL4

All my thoughts about the Dermlite DL4 are not yet complete:

Some of my thoughts are that the Dermlite DL4 has the best polarization so far. This is so needed to clearly see structures especially on the non volar surfaces of the foot. Structures are clearly seen by me when I use the Dermlite DL4.

It also has a pigment boost as well as the ability to toggle between the polarized and non polarized views by pushing a button.

I will be adding my thoughts regarding the Dermlite 4’s pigment boost.

So far, I am very pleased with the features on the Dermlite 4 compared to what I was using before.

The Dermlite DL4 is going to last me and I take it to the office, on house calls with me, etc…









Above Wallace’s line one accurately sees structures only if a dermatoscope has enough polarized light. Similarly below Wallace’s line on the dermatoglyphic areas of volar skin one might see more than just the furrow, lactic and fibrillar patterns. I believe a clear polarized image is needed for the globular, homogeneous and or reticular patterns to better dermoscopically diagnose a benign area.

What about if one has a polarized dermatoscopic image that shows greatly increased pigmentation beneath a hypopigmented lesion? That tells you that a biopsy is needed.

There is a difference between a dermatoscope that mainly magnifies vs one that clearly gives the podiatrist a polarized image of structures, networks, vessels, shiney white structures, deep blue colors, etc….

Please understand that most of my knowledge about dermoscopy I learned from  Dr. Ashfaq A. Marghoob at a lecture I attended and by using the textbook he edited Atlas of Dermoscopy.
Posted on September 9, 2016
Leave a comment on I will be posting my thoughts about the Dermlite DL4
Anatomical vs biomechanical factors that need to be examined to determine if a fibrillar pattern is indeed benign

I learned from the Derm Foot Lecture from Dr. Marghoob in Maryland approx. 2006 that on the arch of the foot there is mainly a lattic type pattern, the weight bearing part of the foot there is the fibrillar pattern and in between there is a furrow pattern.  One can conclude that if one sees the fibrillar pattern on a non weight bearing area of the foot it needs to be biopsied. I learned from Dr. Marghoob’s lecture in Maryland approx. 2016 and the atlas of dermoscopy that shearing forces from weight bearing areas can cause a fibrillar pattern.

The examining the anatomic location of a lesion is only part of the information available. There is also biomechanical information available that I  believe should be also considered with the dermatoscopic results.

The problem is that it is not so simple understanding where the weight bearing areas of the feet are  unless a full biomechanical and gait analysis is performed to determine which parts of the foot are most susceptible to shearing forces.  THE ANATOMIC LOCATION ON THE FOOT IS NOT THE ONLY FACTOR IN DETERMINING THE SUSCEPTIBILITY TO SHEARING FORCES. THERE ARE BIOMECHANICAL FACTORS AS WELL FROM BIOMECHANICAL FAULTS DETERMINED BY ONES STATIC EXAM AND GAIT ANALYSIS. The following biomechanical example is not something mentioned at the seminar but what I learned at NYCPM back in 1982.

One example is a lesion on the plantar aspect of the first metatarsal head area. As we all know the compensation occurs on the frontal and saggital planes as a suponatory rock of the rearfoot and a lot of pressure is on the plantar aspect of the first metatarsal head thus a benign fibrillar pattern as seen on the dermoscopy exam.

Yet if the biomechanical fault is flexible the saggital plane compensation of the plantarflexed first ray is dorsiflexion and less pressure results under the first metatarsal ray and therefore a lattice type lesion instead of a fibrillar dermatoscopic pattern all other factors being constant.

Thus if one sees a benign fibrillar pattern one just might not worry so much if the plantarflexed first ray deformity is rigid vs be it a flexible deformity. If one finds a fibrillar pattern on the plantar aspect of a flexible plantarflexed first ray then one just might need to biopsy this lesion. This is one example why I feel that all biomechanical exams both static exams and weightbearing exams must include dermoscopy. Also all pedal dermoscopy exams of the feet must include biomechanical gait analysis as well as static exams of the lower extremities.

I wish to thank Dr. Marghoob for opening my eyes and getting me even more interested in dermoscopy. Again I believe that full biomechanical exams should also consider including the dermatoscopic examination of pedal lesions.
Posted on August 31, 2016
Leave a comment on Anatomical vs biomechanical factors that need to be examined to determine if a fibrillar pattern is indeed benign
Biomechanical faults can affect the appearance of a dermatologic lesion. Dermatoscopy just might give more hidden information unseen by the naked eye.

Biomechanical faults may have resulted in changes in melanocytic lesions. Just as important at an x-ray is to examining one’s bones, the skin is a structure with changes that cannot be ignored in the static biomechanical exam. Dermatoscopes are needed to document that one is fully examining non osseous structures in the static part of a biomechanical exam.
It just might be useful information to fully appreciate the fully compensated, partially compensated,
non compensated biomechanical faults in the frontal, sagittal, and transverse planes and correlate such information with the results from
your dermatoscopic examination.
If it can be agreed that

1. The already required biomechanical exams in residency should include dermoscopy of melanocytic pedal lesions then

2. one might conclude that there is already an existing requirement to perform dermoscopy for melanocytic pedal lesions in residency as a part of such a required biomechanical exam. Reasoning is biomechanical faults of osseous and muscular structures alter pedal melanocytic patterns due to shearing forces. Biomechanical exams should include skin and its melanocytic lesions.

Perhaps every podiatric residency teaching program will begin to use dermatoscopes in the clinic. The particular brand used is not as important as the features present in a dermatoscope. To me a  dermatoscope I use should have adequate polarization and the ability to give a clear image so as to see the deep structures.

It may not be in the patients best interest to biopsy every foot lesion. The use of a dermatoscope is helpful in determining which lesions to biopsy. If a dermatoscopic exam performed by a podiatric resident in a clinic ultimately resulted in a decision to biopsy and to ultimately diagnose a foot melanoma the resulting referral to an oncologist could be life saving for the patient. If dermoscopy is taught in every podiatric residency clinic patients would likely benefit.

Just soon might be a requirement for such teaching programs to begin using such a diagnostic tool if needed to perform a comprehensive biomechanical exam in the presence of melanocytic nevi. In the past there have been cases where problems unrelated to foot melanoma such as heel pain  may have been treated and such a lesion was not even biopsied. My opinion to include dermoscopy in the “required” biomechanical exam in residency teaching programs just might help patient with melanocytic lesions. Once dermoscopy is performed then if a biopsy is needed then this can be helpful to patients in podiatric residency teaching programs. If dermoscopy is required by a podiatric residency program perhaps there is a greater possibility it will be taught.

Posted on August 30, 2016
Leave a comment on Biomechanical faults can affect the appearance of a dermatologic lesion. Dermatoscopy just might give more hidden information unseen by the naked eye.
Should one immediately biopsy or wait 4 months and repeat dermoscopy?

201605-0017 edited

Is this benign or does this require a biopsy
No the lesion is symmetrical and there are no atypical networks
No there is no history of skin cancer the lesion is symmetrical and patient can return in 4 months for followup dermoscopy exam to examine for changes
Punch Biopsy immediately
Punch Biopsy in the near future
Shave biopsy immediately
Shave biopsy in the near future
Punch biopsy the darkest area and shave the rest of the lesion immediately
Punch biopsy the darkest area and shave the rest of the lesion in the near future
Vote
View ResultsPolldaddy.com
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?
Posted on May 23, 2016
Leave a comment on Should one immediately biopsy or wait 4 months and repeat dermoscopy?
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

This raised lesion what do and what is going on? There may be more than one answer.
There is a lattice pattern going on
There is a benign furrow pattern
There is a ridge pattern
The lesion is regular
The lesion is irregular
One should punch biopsy the area
Vote
View ResultsPolldaddy.com


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.
Posted on May 19, 2016
Leave a comment on This area is raised and are there furrows or ridges or both? What to do?
What should one do with a suspicious lesion?????

201605-0003 edited
Image above taken with Firefly Dermatoscope

Posted on May 19, 2016
Leave a comment on What should one do with a suspicious lesion?????
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.
Posted on May 14, 2016
Leave a comment on Do not only rely upon only one textbook. Why not consider purchasing more than one dermoscopy textbook or going online to different sites?
Is the pigment concentrated in the furrows or the ridges? If you click the picture it will enlarge and you can study it closely.

201605-0096edited


Is the pigment concentrated in the furrows or the ridges?
The pigment is concentrated in the furrows
The pigment is concentrated on the ridges
The pigment is concentrated in both
There is no concentration of any pigment
Vote
View ResultsPolldaddy.com

Posted on May 13, 2016
Leave a comment on Is the pigment concentrated in the furrows or the ridges? If you click the picture it will enlarge and you can study it closely.
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.

Posted on May 9, 2016
Leave a comment on At the dermfoot seminar I learned an opinion that regarding toenail dermoscopy perhaps viscous immersion fluid is necessary
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

Foot Dermatology
Foot Dermatology
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.
Posted on May 9, 2016
Leave a comment on Below is one cheap price advertised $119 I believe
Can the firefly dermatoscope use ultrasound fluid regarding toenail examinations?

Can viscous immersion fluid using ultrasound gel be used with the firefly dermatoscope?
Posted on May 9, 2016
Leave a comment on Can the firefly dermatoscope use ultrasound fluid regarding toenail examinations?
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.
Posted on May 9, 2016
Leave a comment on Questions that I need answered about skin in blacks and the ridge pattern and when to biopsy and my guesses.
When not to biopsy

It is so important to understand when not to biopsy. This is one reason why podiatrists would benefit from joining the American Society of foot and Ankle Dermatology. At their seminar I asked one of the speakers what is a contraindication to a punch biopsy. As a part of the history one could ask are their any color changes or any temperature sensitivity and if not then document no allodynia and proceed with the punch biopsy. It is more difficult in the case where there are color changes or temperature sensitivity. In this case my suggestion is to document the patient understands the risks of RSDS or CRPS and to only proceed with the punch after a full dermatologic history regarding skin cancer or family history of skin cancer and after the use of a dermatoscope combined with a clinical exam.
Posted on May 8, 2016
Leave a comment on When not to biopsy
Did anyone ever hear of the dermatoscopes below ?

I never used the dermatoscopes below. Does anyone have any experience with the dermatoscopes below?











I am guessing that the features of the dermlight 3 and dermlight 4 are very close. Since I have the dermlight 4.  I can begin posting my thoughts about its strong polarization and clear image and ability to toggle at the push of a button from the polarized and nonpolarized views. This is ideal for me. Once I get the clear image into the chart I have the option of using the Firefly to show the patient the image on my laptop computer. I did have a problem that the windows 10 anniversery update so I had to roll back my laptop to windows 8 to use the firefly to show such an image.

disclaimer: I am an amazon associate and if you purchase any of the products listed by amazon by clicking the link I get paid a commission.You may not know this but Amazon pays a commission to people for advertising their products. I am guessing the commission is about

4 percent of the sale.
Posted on May 7, 2016
Leave a comment on Did anyone ever hear of the dermatoscopes below ?
I have been using the Firefly dermatoscope and now I am posting my thoughts on the Dermlight 4

I used the wired firefly dermatoscope. The magnification is quite good and there is the advantage of having the patient see the image on a pc computer.

There are  advantages to using the wired firefly dermatoscope compared to the wireless firefly.  Not only is it less expensive, the resolution I believe is better. I have been able to show patients on a computer screen the images.

However my personal opinion is that I appreciate the polarization feature on the Dermlight 4 to be better for me. I more clearly see structures using the Dermlight 4 especially on the nonvolar parts of the foot. Please shop around. The prices listed on the links just might not be the lowest prices. Perhaps e-bay has lower prices.



Again, you may think that the firefly that is wireless is better. I am guessing the wireless firefly dermatoscope may not have the as good a resolution and costs more than the wired firefly which attached into the usb hub of a computer. .



These are my personal opinions and are not to be used for any type of medical advice.

First you have to focus

I am guessing that milia cysts and superficial lesions are

best seen using the firefly by using a contact plate and turning the polarization ring to 15 degrees or 45 degrees. The one disadvantage of thecontact plate that attached to the extender is that there is light distraction from the periphery and the lights are reflected into the view on the periphery. If one does not use the contact plate it is difficult to see milia cysts.

Also when using the contact plate if one rotates the polarization ring to zero degrees or 90 degrees on glaborous skin one can see the wider ridges have those eccrine ducts. However if one rotates to 15 degrees or 45 degrees then one has difficulty seeing the eccrine ducts.

WARNING DO NOT APPLY FLUID OR HAND SANITIZER GEL ANYWHERE

EXCEPT TO THE OUTSIDE OF THE EXTENDER CAP AND CAREFUL NOT TO

LET ANY FLUID DRIP INTO THE FIREFLY LIGHTING UNIT. THIS JUST MIGHT CAUSE HARM TO THE UNIT.



THE DERMLIGHT 4 HAS A BUTTON THAT ALLOWS ONE TO TOGGLE BETWEEN POLARIZED AND NONPOLARIZED VIEWS AND THIS IS SO MUCH EASIER FOR ME TO USE THAN THE POLARIZATION RING ON THE FIREFLY. I BELIEVE THE POLARIZATION ON THE DERMLIGHT 4 IS SO POWERFUL.



Disclaimer: No post at this website or blog is considered to be any type of medical advice. It is only posting personal opinions.

Also I am an amazon associate and if you click any of the links and purchase the products I get paid a commission I am guessing of

about 4% of the sale.


Posted on May 6, 2016
Leave a comment on I have been using the Firefly dermatoscope and now I am posting my thoughts on the Dermlight 4
This book I am waiting for. After I heard Dr. Ashfaq A Marghoob speak I ordered this book.

I already have another book called Dermoscopy The Essentials yet I feel that I wanted to order Dr. Marghoob’s book after hearing him speak.



E bay or another site might have this book for a cheaper price so shop around.
Posted on May 6, 2016
Leave a comment on This book I am waiting for. After I heard Dr. Ashfaq A Marghoob speak I ordered this book.
What about a symmetrical lesion?

Did anyone ever see a symmetrical lesion with a negative network with curvilinear brown structures and hypopigmentation next to them?

I learned that it must be biopsied. Do benign lesions have the above

appearance. It is so difficult to tell.

Next question what about amelanotic cancers with shiny white structures

vessels or ulcerations? Well during that lecture I learned that when one used polarized light vs non polarized light the clearness of the vessels

changed. Thus perhaps changing the polarization of a dermatoscope may

sometimes help.

Bottom line is a comprehensive text is needed.

I learned from the lecture I attended and I am still awaiting the textbook that I ordered.
Posted on May 6, 2016
Leave a comment on What about a symmetrical lesion?
I feel that every podiatrist should consider joining the American Society of Foot and Ankle Dermatology

What other society is so dedicated and informative? Please visit http://www.dermfoot.com
and consider joining.
The lectures teach one when not to biopsy, when to biopsy, etc… and so much more. What a wealth of knowledge.
I believe this society in dedicating itself to educating others enables our patients to better be enabled to
examine, diagnose and treat dermatologic conditions of the feet.
Posted on May 5, 2016
Leave a comment on I feel that every podiatrist should consider joining the American Society of Foot and Ankle Dermatology
Foot Dermatology

Examining a skin lesion on the foot can be difficult without a dermatoscope.
There are different types of dermatoscopes.  I used
the firefly dermatoscope and I am used to it.

My comments on the Dermlite 4 are not yet complete:

So far my thoughts on the Dermlite 4 is it has such an increased polarization that is needed of the increased polarization that is so needed to clearly see structures especially on the non volar parts of the feet.

It also has a pigment boost as well as the ability to toggle between the polarized and non polarized views by pushing a button.

I will be adding my thoughts regarding the Dermlite 4’s pigment boost.

So far, I am very pleased with the features on the Dermlite 4 compared to what I was using before.

Some definitions and words in Dermoscopy may be new to all those that do not currently use such instrumentation:

Please go online and look up the word Dermatoglyphics. You probably will conclude the plantar aspect of the feet have dermatoglyphics or ridges present. I like to refer to the plantar skin that consists of skin without ridges and skin with ridges.

The article in Podiatry Today regarding Acral Lentiginous Melanoma referred to the plantar skin I believe as consisting of ridges and furrows.
This is discussed in many online sites. I think of a fingerprint on the hand or a foot print. Fingerprints have ridges which follow a certain pattern. The plantar ( or acral ) surfaces of the feet have ridges.

Please go online and look up the word Dermatoglyphics. You probably will conclude the plantar aspect of the feet have dermatoglyphics or ridges present.
What is Wallace’s line

At a certain level on the foot the dermatoglyphics begin to stop. This is called Wallace’s Line. This I learned at the Derm Foot Seminar. This is one reason why I am advocating that podiatrists go to the Derm Foot Seminar and the they consider purchasing the Atlas of Dermoscopy mentioned earlier.

Proximal to Wallace’s line one can the 3 point check list that emphasizes if a lesion is asymmetric, has an atypical network, or has blue white structures. Dermoscopy the Essentials explains this quite clearly.



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available certain areas:
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Ridgewood, N.Y. 11385
(718) 417-4895

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