| Abstract | Dermoskopska dijagnostika razvila se kao dijagnostička metoda unazad 20ak godina te se danas široko koristi. Radi se o neinvazivnoj in vivo metodi koja koristi zrcalne leće kako bi uvećala kožnu leziju i njezine strukture „golom oku“ nevidljive. U dermoskopskoj dijagnostici do danas razvijen je veliki spektar uređaja, međutim, najviše se koristi ručni dermoskop s polariziranim svjetlom, uvećanja 10 puta. Dermoskopska slika prikazuje boje, strukture, globalne i lokalne značajke, a sve navedeno korelira s histološkim entitetima promatrane lezije. Metoda dermoskopije pruža indirektni uvid u dubinu lezije, njenu evoluciju, prirodu rasta i ostalo. Pri evaluaciji pacijenata za dermoskopski pregled važno je obratiti pozornost na tip kože pacijenta, broj lezija i njihov raspored na koži, dob pacijenta, količinu izloženosti solarnom zračenju i detaljne anamnestičke podatke. Kliničkim pregledom mogu se odrediti lezije od interesa, iako je preporuka pregledati što veći broj lezija, te potom u prvih nekoliko trenutaka pri dermoskopskom pregledu odrediti radi li se o melanocitnoj ili nemelanocitnoj leziji. Nakon toga, korištenjem nekoliko validiranih algoritama dermoskopski nalaz evaluira se prema benignosti odnosno malignosti lezije. Spomenuti najčešće korišteni algoritmi za melanocitne lezije su: pattern analysis, ABCD rule, 7-point checklist, Menzies method. Melanocitne lezije od posebnog značaja su nevusi i melanomi. Diferencijacija među nevusima i melanomima je iznimno važna obzirom da je melanom vrlo agresivan tumor sklon ranom hematogenom i limfogenom metastaziranju. Dermoskopska dijagnostika melanoma razlikuje se prema lokalizaciji lezije na koži (udovi, lice, nokatna ploča, trup, stopala, dlanovi itd.), a prema lokalizaciji se razlikuje i složenost donošenja dijagnoze. Veliki napredak koji je donijela dermoskopija je i mogućnost praćenja kožnih lezija kroz duži vremenski period, što je posebno važno za rizične pacijente s mnogobrojnim atipičnim nevusima. U kontekstu nemelanocitnih lezija dermoskopija također ima veliku ulogu, prije svega u dijagnosticiranju bazocelularnog i planocelularnog karcinoma i njihove diferencijacije od seborejične keratoze, dermatofibroma, hemangioma i ostalih benignih lezija. Iako krajnju dijagnozu neke kožne lezije može potvrditi tek histopatološki nalaz, dermoskopska dijagnostika prema rezultatima brojnih istraživanja, ima visoku osjetljivost i specifičnost kako za melanocitne lezije tako i za nemelanocitne lezije. Dermoskopska dijagnostika pokazala je veliku korist za kliničare u smislu jednostavnosti primjene, niske cijene i visoke točnosti, ali najvažnija je korist za pacijente obzirom da omogućava ranije otkrivanje tumora, bolju prognozu bolesti i posljedično bolju kvalitetu života. |
| Abstract (english) | Dermoscopy developed as a diagnostic method about 20 years ago and is now widely used. It is a non-invasive in vivo method that uses lens to enhance the skin lesion and its structures that are invisible to the "naked eye". In dermoscopy, a large spectrum of devices has been developed so far, but the most commonly used is manual polarized light dermoscope with 10 times magnification. The dermoscopic image shows the colors, the structure, the global and the local characteristics, all of which correlates with the histological entities of the observed lesion. In fact, the dermoscopic image can give us an indirect insight into the depth of the lesion, its evolution, the nature of growth, etc. When evaluating patients for dermoscopic examination, it is important to pay attention to the skin type of the patient, the number of lesions and their distribution on the skin, the age of the patient, the amount of exposure to solar radiation and the detailed anamnestic data. Clinical examination can determine lesions of interest for the dermoscopy, although it is recommended to examine as many lesions as possible, and then in the first few moments of a dermoscopic examination determine whether it is a melanocytic or nonmelanocytic lesion. Thereafter, by using several algorithms, the dermoscopic finding is evaluated for the benignity or malignancy of the lesion. The most commonly used algorithms for melanocytic lesions are: pattern analysis, ABCD rule, 7-point checklist, Menzies method. Melanocytic lesions of importance are nevi and melanomas. Differentiation between both is extremely important considering that melanoma is one of the most aggressive skin tumors. Dermoscopic diagnosis of melanoma is different according to its localization on the skin (limbs, face, subungual, body, feet, palms, etc.), and therefore the complexity of diagnosis is increasing. The great progress made by dermoscopy is the ability to monitor skin lesions throughout time, which is particularly important for patients with higher risk and with numerous atypical nevi. In the context of nonelanocytic lesions, dermoscopy also plays a major role, primarily for the diagnosis of basal cell and squamous cell carcinoma as malignant entities and their differentiation from sebaceous keratosis, dermatofibromas, hemangiomas and other benign lesions. Although the definitive diagnosis of some skin lesions can be given after histopathological evaluation, dermoscopy, according to the results of numerous researches, has high sensitivity and specificity for both melanocytic lesions and nonmelanocytic lesions. Dermoscopy has shown great benefits to clinicians in terms of simple applicability, low cost and high accuracy, but most importantly it is beneficial for patients since it enables early detection of tumors, better prognosis of disease and consequently better quality of life. |
