10.5826/dpc.1202a65
text/xml
2160-9381
1811
en
Pablo Fernandez-Penas
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Supine dermoscopy for improved visualisation of lower limb lesions  
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2022-05-02
2021-05-27
2022-05-02
2022-05-24
e2022065
Dermatol Pract Concept
Pablo Fernandez-Penas
2022/05/02
10.5826/dpc.1202a65
e2022065
Department of Dermatology, Westmead Hospital, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
2160-9381
en
e2022065
Supine dermoscopy for improved visualisation of lower limb lesions  
https://dpcj.org/index.php/dpc/article/download/1811/1558
      Supine Dermoscopy for Improved Visualisation
                 of Lower Limb Lesions
       Kelvin Truong1,2, Melissa Peera1,2, Raquel Ruiz Araujo1,2, Pablo Fernandez-Penas1,2


1 Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
2 Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia



Citation: Truong K, Peera M, Ruiz Araujo R, Fernandez-Penas P. Supine dermoscopy for improved visualisation of lower limb lesions.
Dermatol Pract Concept. 2022;12(2):e2022065. DOI: https://doi.org/10.5826/dpc.1202a65
Accepted: August 19, 2021; Published: April 2022
Copyright: ©2022 Truong 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: Kelvin Truong, Department of Dermatology, D5A, Westmead Hospital, PO BOX 533, Westmead NSW 2145,
Australia. E-mail: kelvin.truong@sydney.edu.au




Case Presentation                                                       reduce venous congestion (Figure 1). This is particularly im-
                                                                        portant in gravity-dependent areas such as the lower limbs.
Dermoscopic evaluation of suspicious lesions in the context             Furthermore, use non-contact polarized dermatoscopes or
of venous insufficiency, such as varicose veins, venous stasis,         immersion fluids of a high viscosity with contact dermato-
and lipodermatosclerosis, remains a diagnostic challenge.               scopes, to minimize blanching of vessels and thereby max-
The background erythema created by non-lesional vascula-                imizing visualization of vascular architecture in cutaneous
ture often obscures the assessment of true lesional structures.         lesions [1].


Teaching Point                                                          References
Dermoscopy helps assess for atypical vascular morphol-                       1. Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricalà C,
ogy such as predominantly central vessels, polymorphous                         ­Argenziano G. How to diagnose nonpigmented skin tumors: a re-
vessels, and milky red-pink areas, which is critical in dif-                     view of vascular structures seen with dermoscopy: part I. Melano-
                                                                                 cytic skin tumors. J Am Acad Dermatol. 2010;63(3):361–374; quiz
ferentiating malignant from benign pigmented skin lesions,
                                                                                 375-366. DOI: 10.1016/j.jaad.2009.11.698. PMID: 20708469.
especially in the context of amelanotic and hypomelanotic
                                                                             2. Menzies SW, Kreusch J, Byth K, et al. Dermoscopic Eval-
melanoma [1,2].                                                                  uation of Amelanotic and Hypomelanotic Melanoma. Ar-
    To better delineate skin lesion vasculature from back-                       chives of Dermatology. 2008;144(9):1120–1127. DOI:
ground vascular noise, consider laying patients supine to                        10.1001/­archderm.144.9.1120. PMID: 18794455.




Image Letter | Dermatol Pract Concept. 2022;12(2):e2022065                                                                                      1
Figure 1. (A,C,E) Dermoscopy of cutaneous lesions of the lower leg with patients standing up. Minimal pressure was applied. Note the
­prominent background blood vessels which may obscure proper examination of the skin lesion of interest. (B,D,F) Dermoscopy of the same
 lower leg skin lesions with patients laying supine. Minimal pressure was applied. Reduced background blood vessels allow for clearer visu-
 alization of the lesion. Dermoscopic pictures taken with Medicam 1000, FotoFinder Systems.




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