10.5826/dpc.1204a250
text/xml
2160-9381
2441
en
Cliff Rosendahl
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Polarizing-specific white lines
Not all polarized-light dermatoscopes may display diagnostically critical polarizing-specific features
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-10-31
2022-03-06
2022-10-31
2022-12-05
e2022250
Dermatol Pract Concept
Cliff Rosendahl
2022/10/31
10.5826/dpc.1204a250
e2022250
General Practice Clinical Unit, Medical School, The University of Queensland, Australia; School of Medicine, Tehran University of Medical Sciences, Iran
2160-9381
Polarizing-specific white lines
en
e2022250
Cohen YK, Elpern DJ, Wolpowitz D, Rosendahl C. Glowing in the dark: case report of a clue-poor melano
Not all polarized-light dermatoscopes may display diagnostically critical polarizing-specific features
https://dpcj.org/index.php/dpc/article/download/2441/1787
 Not All Polarized-light Dermatoscopes May Display
 Diagnostically Critical Polarizing-specific Features
     Chin Whybrew1, Pawel Pietkiewicz2, Ihor Kohut3, Justin C. Chia4, Bengu Nisa Akay5,
                                    Cliff Rosendahl6,7


1 GP, Stoke Road Surgery, Bishops Cleeve, Cheltenham, UK
2 General and Oncological Surgery Clinic I, Greater Poland Cancer Center, Poznan, Poland
3 Skin Health Center, Ternopil, Ukraine
4 Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
5 Ankara University Medicine Faculty, Department of Dermatology, Ankara, Turkey
6 General Practice Clinical Unit, Medical School, The University of Queensland, Australia
7 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran



Key words: dermoscopy, dermatoscopy, shiny white structures, polarizing-specific white lines
Citation: Whybrew C, Pietkiewicz P, Kohut I, Chia JC, Akay BN, Rosendahl C. Not all polarized-light dermatoscopes may display
diagnostically critical polarizing-specific features. Dermatol Pract Concept. 2022;12(4):e2022250. DOI: https://doi.org/10.5826/
dpc.1204a250
Accepted: April 27, 2022; Published: October 2022
Copyright: ©2022 Whybrew et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Cliff Rosendahl, General Practice Clinical Unit, Medical School, The University of Queensland, Larbonya Crescent,
Capalaba, Queensland, Australia 4157. Phone: +61 419 769 970 Fax: +617 3245 3011 Email: cliff@omera.com.au




Introduction                                                             shiny white structures/streaks [4] (defined as short, bright,
                                                                         white lines distributed in a parallel or orthogonal orienta-
Since the introduction of polarized-light dermatoscopes it               tion, which can only be seen with polarized dermatoscopy),
has become evident that there are some fundamental differ-               four-dot clods (rosettes) and polarizing-specific structureless
ences in image characteristics, in comparison to those pro-              areas [4].
vided by non-polarized dermatoscopy [1].                                      Each of these polarizing-specific features are known to
    Non-polarized dermatoscopy provides color rendition                  have diagnostic relevance, but notably, it has been shown
without dilution of colors such as gray and blue by polariz-             that shiny white structures/streaks can be critical in the di-
ing filters, and it provides a clear display of white clods and          agnosis of melanoma [5] and in a meta-analysis they have
dots (milia-like cysts) in seborrheic keratoses [1-3].                   been shown to have the equal highest odds ratio (OR) of
    Polarized dermatoscopy on the other hand displays fea-               6.7 for the diagnosis of melanoma, compared to pseudopods
tures not seen in non-polarized dermatoscopy, including                  (equal), irregular pigmentation (OR 6.4), blue-white veil
                                                                         (OR 6.3) and peppering (OR 6.3) [4].




Research Letter | Dermatol Pract Concept. 2022;12(4):e2022250                                                                         1
Case Presentation                                                    white structures/streaks in polarized mode, the images be-
                                                                     ing essentially the same as produced in non-polarized mode
A 69-year-old woman with Fitzpatrick phototype-2 skin                ­(Figures 1 and 2).
presented with a pigmented skin lesion on the ankle. Der-                Figures 1-2 are labelled to display collages of polarized
matoscopic examination with six different dermatoscopes              and non-polarized dermatoscopic images acquired with an
revealed a chaotic pattern with clues to malignancy including        iPhone 6 (Figure 1) and a Nikon Coolpix 4500 (Figure 2).
white lines in non-polarized mode with all dermatoscopes, as         No image manipulation has been performed other than
well as shiny white lines/streaks in polarized mode with five        cropping.
dermatoscopes (Figures 1 and 2). Dermatopathology con-                   The authors all assert that the features demonstrated
firmed superficial spreading melanoma in situ.                       with respect to the Heine DELTA 30 are consistent with
    Prior to biopsy, multiple images were taken with the six         those observed by each of them in clinical practice.
dermatoscopes coupled with 2 different camera devices. Be-
cause polarizing-specific features can be angle-dependent,
for image acquisition each dermatoscope was rotated each             Conclusions
time it was used in polarizing mode to produce the greatest
                                                                     Clinicians are invited to independently test these findings,
display of shiny white structures/streaks possible.
                                                                     as it is important for dermatoscopists to be cognizant of the
    Five dermatoscopes: Heine DELTA 20T, and Heine
                                                                     characteristics of the instruments they use due to potential
DELTAone (Heine Optotechnik GmbH & Co. KG),
­
                                                                     impact on diagnostic performance.
DermLite DL4 (3Gen, Inc.), Opticlar (Albert Waeschle
­
Ltd) and Illuco IDS 1100 (Illuco Co. Ltd.) displayed shiny
white structures/streaks in polarized mode, with some ap-
                                                                     Acknowledgement
parent variations in intensity, distinctly different from the
same device in non-polarized mode. The Heine DELTA 30                We acknowledge Dr Mohammadreza Rahimpour whose
(Heine ­Optotechnik GmbH & Co. KG) did not display shiny             original observations in 2020 initiated this assessment.




                Figure 1. Polarized and non-polarized images of a superficial spreading melanoma in situ, acquired with
                6 different dermatoscopes coupled with an iPhone 6 camera. All photographs were taken by the same
                photographer (author CW) and are displayed without manipulation other than cropping.



2                                                                         Research Letter | Dermatol Pract Concept. 2022;12(4):e2022250
                Figure 2. Polarized and non-polarized images of a superficial spreading melanoma in situ acquired with 6
                different dermatoscopes coupled with a Nikon Coolpix 4500 camera. All photographs were taken by the
                same photographer (author CW) and are displayed without manipulation other than cropping.




References                                                             4. Williams NM, Rojas KD, Reynolds JM, Kwon D, Shum-Tien J,
                                                                          ­Jaimes N. Assessment of Diagnostic Accuracy of D   ­ ermoscopic
 1. Benvenuto-Andrade C, Dusza SW, Agero ALC, et al. Differences           Structures and Patterns Used in Melanoma Detection: A Systematic
    Between Polarized Light Dermoscopy and Immersion Contact               Review and Meta-analysis. JAMA D   ­ ermatol. 2021;157(9):1078-
    Dermoscopy for the Evaluation of Skin Lesions. Arch Derma-             1088. DOI: 10.1001/­jamadermatol.2021.2845. PMID: 34347005.
    tol. 2007;143(3):329-338. DOI: 10.1001/archderm.143.3.329.             PMCID: PMC8339993.
    PMID: 17372097.                                                    5. Cohen YK, Elpern DJ, Wolpowitz D, Rosendahl C. Glowing in
 2. Pan Y, Gareau DS, Scope A, Rajadhyaksha M, Mullani NA,                 the dark: case report of a clue-poor melanoma unmasked by po-
    Marghoob AA. Polarized and Nonpolarized Dermoscopy: The                larized dermatoscopy. Dermatol Pract Concept. 2014;4(1):83-87.
    Explanation for the Observed Differences. Arch Dermatol.               DOI: 10.5826/dpc.0401a14. PMID: 24520521. PMCID:
    2008;144(6):828-829. DOI: 10.1001/archderm.144.6.828.                  PMC3919847.
    PMID: 18559791.
 3. Rosendahl C, Marozava A. Dermatoscopy and Skin Cancer.
    ­Banbury. UK.: SCION; 2019:pp 9-10.




Research Letter | Dermatol Pract Concept. 2022;12(4):e2022250                                                                            3
