Interactive CD of Dermoscopy
By Giuseppe Argenziano, MD,H. Peter Soyer, MD,Vincenzo De Giorgio,
MD, Domenico Piccolo, MD, Paolo Carli, MD, Mario Delfino, MD,
Angela Fer-rari, MD,Rainer Hofmann-Wellenhof, MD, Daniela Massi,
MD, Giampiero Mazzocchetti, MD,Massimiliano Scal-venzi, MD,
Ingrid H. Wolf, MD, 1 CD-ROM, requirements (minimum): Pen-tium
133 MHz, 32-Mb RAM, 24´ CD-ROMdriver, 800´600 resolution, and
16- bit color graphics capability (the CD-ROM was tested with
Microsoft Windows 95, 98, and NT4.0, and it can work on the
Apple operating system if Windows emulation software is in-stalled),
book: 208 pp, $290, ISBN 88-86457-30-8, Milan, Italy, Edra Medical
Publishing and New Media, 2000.
If it is possible that a CD on a sci-entific
subject such as dermoscopy could ever be considered a master-piece
or a work of art, then as an ex-perienced dermoscopist I would
have to say that the Interactive CD of Dermoscopy is an impressive
la-bor of love, a work of art, and a sci-entific masterpiece.
The CD and ac-companying book have an enormous amount of information,
mostly vi-sual, that makes a difficult subject easier if not
easy to learn. The principal authors are true dermoscopic experts
with exten-sive clinical and teaching experi-ence. No concept
or detail is left un-explained. In most of the points made there
are excellent inter-observer agreements; however, throughout
the CD the authors add the disclaimer that with dermos-copy
there will never be 100% in-terobserver agreement. Whichever
pathway you choose to take and study among the many given, if
you put in the time (and I have to em-phasize that learning
this CD-aided technique will take time and effort) you will
learn and/or master dermoscopy. This important tech-nique has
been clearly shown to sig-nificantly increase the rate of cor-rect
clinical diagnoses of pigmented skin lesions.
The accompanying book should be read first. It covers all of
the basics that are expanded on in the CD. It is an excellent
quick ref-erence if you do not have time to get to your computer,
and it is also good reading if you are on the run. The CD is
divided into sec-tions. In the section titled “Course” you can
learn the basic dermoscopic criteria such as how to differentiate
melanocytic from nonmelanocytic pigmented skin lesions, pattern
analysis, the ABCD rule of dermatoscopy, and the 7-point checklist.
Menzies “variation on the theme” of pattern analysis is not
Definitions are short and to the point so that without great
effort you can move into the interactive self-assessment portion
of each point taught. The bulk of the CD is truly in-teractive
where you get to analyze images and compare your analysis with
that of the authors. Repetition is the name of the game, and
that is the way you will improve your skills. There is an impressive
number (2000) of high quality clinical and matching dermoscopic
images. If, for example, you are study-ing the ABCD rule of
dermatoscopy, the exact method is clearly written out with each
image to be analyzed. With the click of a mouse, you mark what
you see in the image and then move on to see the authors’ analysis
of the same image. Afterwards, you have the option of reading
the case history where once again the dermoscopic criteria are
listed. Repetition and variation on the theme, as the authors
so often state, are key to mastering this technique. One suggestion
for the second edition is to clearly mark with symbols all of
the points made about an image. This is done throughout the
book and CD, but not for all of the cases.
The Course section has 2 sub-sections that are innovative: one
sub-section teaches the criteria used to evaluate the depth
of a melanoma with the criteria listed and includes many examples;
the other subsection titled “Pitfalls” is further di-vided
into false-negative lesions, look-alike lesions, and the gray
zone. Gray-zone lesions cannot be diagnosed clinically, histologically,
or even with dermoscopy. This sobering subsection makes you
realize that dermoscopy is not 100% diagnos-tic, and the more
experience you have making dermoscopic-clinico-pathologic correlations,
the less chance you will make serious mis-takes with your patients.
Throughout both the book and CD there is an extensive listing
of the pertinent literature. There is also a special section
titled “References” where there is a short summary of 113 articles.
After you have learned the ba-sics, it is time to study the
“Data-base,” which is as vast as the Austrian/Italian Alps themselves.
Once again, there are several pathways to choose from to study.
You can search out specific criteria, a specific clinical diagnosis,
or a specific algo-rithm. Levels of diagnostic difficulty range
from low to high, and you can even choose which part of the
body you want to study. This is clinically relevant because
there are site-specific criteria that you have to learn.
To give you an idea of how ex-tensive the database is, I wanted
to study dotted vessels, a criterion that can be seen in melanoma.
I found 27 invasive melanomas, 1 in situ mela-noma, 8 Spitz
nevi, 6 Clark nevi, and 3 Bowen disease with variations on the
theme of that atypical vascular pattern. There are 230 dermoscopic
images demonstrating an abnormal pigment network, 448 ex-amples
of irregular dots and globules, and 252 melanomas in general.
The melanomas are then broken down into subcategories depending
on the depth of invasion. The entire CD is like this. After
a short time you will learn how to easily navigate through the
CD. (Nonetheless, another suggestion for the second edition
is to enable the user to minimize what is on the computer
monitor so that it would be easier to move to something else
and come back to what you were studying at a later time.)
You do not have to be a computer geek to work with this CD-ROM.
It seems to me that many of my colleagues are intimidated by
this subject and are reluctant to get started. As part of my
review, I asked first, second, and third year dermatology residents
to review the book and CD, and here is what they had to say:
I really liked the self-assessment portions of the CD; essentially
it was as if you were able to review multiple cases with a private
tutor. I thought the self-assessment portions were a very effective
use of the CD format and an excellent way to learn dermoscopy.
Tony Sullivan, MD, first year dermatology resident, University
of Miami, Miami, Fla
The format was logical and user friendly with excellent quality
photographs. It enables the user to progress at a pace which
corresponds to their level of expertise. The book is a great
companion to the CD since it can be used anywhere, especially
in the clinic where access to a computer may be limited. After
using the CD I felt able to apply the principles of dermoscopy
in a clinical setting.
Andrew Green, MD, first year dermatology resident, University
The CD is an excellent tool to expose one to a magnitude of
skin lesions let alone introduce the concept of dermoscopy.
Every dermatology resident needs this CD guide. Easy to understand,
Gervaise Gerstwen, MD, first year dermatology resident, Mt Sinai
Hospital, New York, New York
An excellent guide to dermoscopy. The CD and book are easy to
use with excellent clear examples. Not only are there excellent
photographs of the lesions discussed, but the histology makes
correlation easier to understand. The format is fun, and informative.
The extensive database grouped according to difficulty is an
outstanding means to practice the principles outlined in the
book and CD. The self-assessment section, with the aid of point
and click criteria and a side-by-side answer to compare your
skills, made practice easy. I highly recommend the use of this
book and CD for anyone interested in dermoscopy.
Mark Cohen, MD, second year dermatology resident, University
A very elegant and useful guide to dermoscopy combining the
Italian passion for style and the Austrian rigor for science.
The CD and book have absolutely immaculate pictures of clinical
presentation and pathology that make the reader eager to learn
more and more about dermoscopy. The chapter on regression structures
is the most informative and clear that I have read during my
training in dermatology. In conclusion, this is a superb work
that every serious dermatologist should have in his or her book
Paolo Romanelli, MD, third year dermatology resident, University
Robert H. Johr, MD Pigmented Lesion Clinic University of Miami
School of Medicine