Pigmented lesion clinic - Goals and Objectives - Dermatology

Goals and Objectives Pigmented Lesion Clinic
First-Year Residents:
PIGMENTED LESION CLINIC
RES C
As a dermatologist you will become an expert on skin cancer, as well as a the main
clinical advisor for patients at risk. You have to be able to perform a thorough total
body investigation to identify potential skin cancers clinically, and to decide whether a
lesion will require total excision or further follow-up. Dermoscopy is a great tool for the
diagnosis of early melanoma and other pigmented and non-pigmented tumors of the
skin.
This means you will have to:
1. Recognize the clinical features of common nevi, atypical nevi, melanoma, and other
pigmented skin lesions (pigmented BCC, seborrhoeic keratoses, angiomas, etc.)
2. Learn the basic terminology used to describe pigmented lesions examined with a
dermoscope
3. Learn the dermoscopic algorithm to differentiate between melanocytic and nonmelanocytic
pigmented lesions
4. Learn one of the dermoscopic algorithms to diagnose melanoma and be able to use
it in your daily routine (see readings below)
Required Readings for First-Year Residents:
1. Thompson JF et al. Cutaneous melanoma. Lancet 365:687-701, 2005
2. Braun RP et al. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol:109-21,
2005
3. Kittler H et al. Diagnostic accuracy of dermoscopy. Lancet Oncol 3:159-65, 2002
4. Curtin JA et al: Distinct sets of genetic alterations in melanoma. N Engl J Med
353:2135-47, 2005
5. Nachbar F, Stolz W et al. The ABCD rule of dermatoscopy. High prospective value in
the diagnosis of doubtful melanocytic skin lesions. J Am Acad Dermatol. 30:551-9,
1994
or
Argenziano G et al. Epiluminescence microscopy for the diagnosis of doubtful
melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new
7-point checklist based on pattern analysis. Arch Dermatol. 134:1563-70, 1998
or
Menzies SW et al. A sensitivity and specificity analysis of the surface microscopy
features of invasive melanoma. Melanoma Res. 6:55-62, 1996

Goals and Objectives Pigmented Lesion Clinic
Second-Year Residents:
PIGMENTED LESION CLINIC
RES C
You will learn to identify patients at increased risk for melanoma or who already have
melanoma, and to manage, educate, encourage, and lead them. By improving your
dermoscopy skills, and using short-term and long-term follow-up, you will improve
early detection of melanoma and other skin cancers, and reduce unnecessary
excisions, i.e. improve sensitivity and specificity of your melanoma diagnosis.
In more detail, you will:
1. Be able and confident in identifying lesions suspicious for melanoma, and other
pigmented tumors of the skin using dermoscopy.
2. Be familiar with dermoscopic patterns suggestive for melanoma and other pigmented
lesions, as well as with the concept of “featureless melanoma”.
3. Be able to outline a patient’s melanoma risk integrating patient’s common and
atypical melanocytic nevus counts, skin type, history, family history, and other
factors.
4. Learn to manage patients at high risk for melanoma, including required surgery, and
short- and long-term follow-up using digital images. You will learn the advantages
and disadvantages of shave biopsies versus complete excisions.
5. Be able to raise patient awareness of melanocytic nevi and melanoma risk without
creating fear. You will also be able to educate patients regarding skin selfexamination,
sun-protection, and required follow-up visits.
6. Learn dermoscopic features of acral and facial pigmented tumors.
Required Second-Year Readings:
1. Bauer J, Garbe C. Acquired melanocytic nevi as risk factor for melanoma
development. A comprehensive review of epidemiological data. Pigment Cell Res.
16:297-306, 2003
2. Pehamberger H, et al. In vivo epiluminescence microscopy of pigmented skin
lesions. I. Pattern analysis of pigmented skin lesions. J Am Acad Dermatol 17:571-
83, 1987
3. Steiner A, et al. In vivo epiluminescence microscopy of pigmented skin lesions. II.
Diagnosis of small pigmented skin lesions and early detection of malignant
melanoma. J Am Acad Dermatol 17:584-91, 1987
4. Menzies SW. Cutaneous melanoma: making a clinical diagnosis, present and future.
Dermatol Ther. 19:32-9, 2006
5. Kittler H et al. Identification of clinically featureless incipient melanoma using
sequential dermoscopy imaging. Arch Dermatol. 142:1113-9, 2006
6. Stolz W at al. Dermatoscopy for facial pigmented skin lesions. Clin Dermatol. 20:276-
8, 2002
7. Saida et al. Dermoscopy for acral pigmented skin lesions. Clin Dermatol. 20:279-85,
2002