SIAscope Training Course

1. SIAscope Training Course Example lesions

2. Training lesions • This course trains you in identifying SIAgraph features, as well as linking them with ELM (dermoscopy) diagnosis. • Answer the questions on the different kinds of lesions in the following slides. • Use the evidence in the features to make a diagnosis.

3. Feature checklist • The three features which research has identified as the most useful in melanoma diagnosis are as follows: • Dermal melanin • Displaced blood with erythematous blush • Holes in collagen • These features will now be defined.

4. Dermal Melanin • Shown on the SIA-DM (dermal melanin) SIAgraph • Areas of colour (green – blue – red) • Goes from least (green) to most (red) involvement (combination of depth + concentration) • A contiguous area of dermal melanin within the lesion • NB excluding hairs.

5. Displaced blood • Shown on the SIA-B (blood) SIAgraph • A contigious absence of blood within the lesion • Area of white

6. Erythematous blush • Shown on the SIA-B (blood) SIAgraph • Increased vascularity around the periphery of the lesion for at least ¾ of its circumference (when compared to surrounding skin, within confines of lesion.) • Seen as darker red area within a lesion

7. Holes in Collagen • Shown on SIA-C (collagen) SIAgraph • A contiguous absence of collagen within the lesion but discounting hair follicles. • Black “holes” in collagen

8. Example lesions • The following slides contain SIAgraphs of different lesions, in addition to a few case notes. • Using the definitions from the previous slide, try to decide whether or not a feature is present in a lesion.

9. Example lesions • Then press one of the bottom buttons to answer the question. • Click in the centre of the slide for an explanation of the feature. • Turn your computer’s sound on if possible.

10. 26_05_00_16_56 • This lesion presented on the chest of a 53 year old male.

11. Are collagen holes present in this lesion? Yes No

12. No. • There is no contiguous absence of collagen within the lesion. (Black areas)

13. Is displaced blood present in this lesion? Yes No

14. No. • There is no contigious absence of blood within the lesion. (White areas)

15. Is dermal melanin present in this lesion? Yes No

16. No. • There is no blue on the SIA-DM.

17. What is your diagnosis? • No collagen holes • No displaced blood • No dermal melanin

18. Diagnosis • Compound Naevus • Remember, although they have melanocytes in the dermis, most compound naevi do not have dermal melanin. • Melanocytes have stopped producing melanin.

19. 19_05_00_16_47 • This lesion presented on the back of a 43 year old male.

20. Are collagen holes present in this lesion? Yes No

21. Yes. • There are black areas within the body of the lesion on the SIA-C, which are not hair follicles. • Using a SIAscope would allow you to zoom in on areas of doubt, to clarify whether or not the feature exists.

23. Is displaced blood present in this lesion? Yes No

24. Yes. • There is a large white area in the centre of the lesion.

25. Is Erythematous blush present in this lesion? Yes No

26. Yes. • There is increased vascularity around the periphery of the lesion for at least ¾ of its circumference. • Compared to the surrounding skin. • This is a strong example of both displaced blood and erythematous blush.

27. Is dermal melanin present in this lesion? Yes No

28. Yes. • This is shown in several colours, showing that the lesion has a large dermal component.

29. What is your diagnosis? • Holes in collagen • Displaced blood plus erythematous blush • Dermal melanin

30. Diagnosis • Melanoma. • Clark’s level 3+ • Holes in the collagen SIAgraph show that the melanoma has penetrated to the bottom of the papillary dermis. • The SIAscope cannot image any further than the bottom of the papillary dermis. • As the reticular dermis does not scatter light sufficiently.

31. 1491688_a • An 18 year old male presented with this lesion on the back.

32. Is displaced blood present in this lesion? Yes No

33. No. • Displaced blood is not present in this lesion. • WHY? • There are no areas demonstrating an absence of blood (white).

34. Are collagen holes present in this lesion? Yes No

35. No. • There are no black areas within the lesion. • In this case, matching fluid has not been used, and the collagen view is slightly distorted. • In difficult cases, rescanning the lesion using matching fluid may help improve the clarity of the collagen image.

36. Is dermal melanin present in this lesion? Yes No

37. No. • Areas of dermal melanin are shown in blue on the SIA – DM. • Areas of blue ARE visible in a rim around the top right of the SIA-DM. • However, they are not within the lesion, and are probably a result of light leakage when taking the handset. • Remember to use matching fluid – • Lesions without dermal melanin can appear to have dermal melanin if scanned without fluid

38. Would you excise this lesion? • No collagen holes • No displaced blood • No dermal melanin

39. Diagnosis • Benign • Dysplastic Naevus

40. 728834_a • This lesion presented on the forearm of an 84 year old female.

41. Are collagen holes present in this lesion? Yes No

42. No. • There is no contiguous absence of collagen within the lesion.

43. Is displaced blood present in this lesion? Yes No

44. No. • However, note that the lesion consists of blood, making the diagnosis of haemangioma most likely.

45. Is dermal melanin present in this lesion? Yes No

46. Yes. • Dermal melanin is shown on the SIAgraph. • However, this may be haemasiderin, a breakdown product of blood that mimics dermal melanin on dermal melanin SIAgraph. • If dermal melanin is shown in a haemangioma, it is normally only green in colour, and not blue or red.

47. Diagnosis • Haemangioma • No collagen holes • No displaced blood • Dermal melanin indicated (Haemasiderin)

48. 05_06_00_08_59 • This lesion presented on the face of a 54 year old female.

49. Are collagen holes present in this lesion? Yes No

50. Yes. • All over the lesion are large black areas – these are holes.