Arch Dermatol /vol 137, JUNE 2001
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 covered.
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 of Miami
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, well or-ganized.
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 of Miami
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 collection.
Paolo Romanelli, MD, third year dermatology resident, University of Miami
Robert H. Johr, MD Pigmented Lesion Clinic University of Miami School of Medicine