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Harald Kittler - One of the best experts on this subject based on the ideXlab platform.
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the value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions a prospective study
Journal of The European Academy of Dermatology and Venereology, 2017Co-Authors: E Wurm, Christoph Sinz, Rainer Hofmannwellenhof, Caterina Longo, Giovanni Pellacani, H P Soyer, Salvador Gonzalez, Verena Ahlgrimmsiess, Pascale Guitera, Harald KittlerAbstract:Background: Flat pigmented facial lesions are difficult to diagnose even with dermatoscopy. It is controversial how additional information obtained by in vivo reflectance confocal microscopy (RCM) impacts the diagnosis and management. Objective: To examine what in vivo reflectance confocal microscopy of flat pigmented facial lesions adds to clinical examination using dermatoscopy including digital dermatoscopic monitoring. Methods: We prospectively collected 70 cases of flat pigmented facial lesions and recorded diagnoses and management decisions by experts based on direct clinical examination aided by dermatoscopy including digital dermatoscopic monitoring and by remote experts who reviewed the corresponding confocal images. The expert confocal readers were blinded to the clinical and dermatoscopic appearance of the lesion. Results: The sensitivity of dermatoscopy plus digital dermatoscopic monitoring was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 84.0% (95% CI 70.89% to 92.83%). The sensitivity of RCM was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 82.0% (95% CI 68.56% to 91.42%). Conclusion: Although most flat pigmented facial lesions can be managed by clinical examination and dermatoscopy alone, confocal microscopy is a useful adjunct in selected lesions. If RCM is not correlated with clinical and dermatoscopic information, there is risk of overdiagnosis of actinic keratosis, however.
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long term evaluation of the efficacy of digital dermatoscopy monitoring at a tertiary referral center
Journal Der Deutschen Dermatologischen Gesellschaft, 2017Co-Authors: Christoph Rinner, Christoph Sinz, Philipp Tschandl, Harald KittlerAbstract:SummaryBackground and objectives We examined the value of monitoring patients with multiple nevi using sequential digital dermatoscopy imaging at a tertiary referral center. Patients and methods This is a retrospective cohort study including 2,824 patients and 23,241 monitored lesions. We calculated trends in key parameters such as the number of melanomas and nevi monitored and excised. Results During follow-up, we excised 1,266 lesions in 709 patients, including 146 (11.5 %) melanomas. The percentage of in situ melanomas detected at follow-up was significantly higher than at baseline (46.6 % versus 23.4 %, p ≤ 0.001). The risk of detecting a melanoma during follow-up was higher for patients with a melanoma at baseline, compared to those without (relative risk: 3.59, 95 % CI: 2.15 to 6.00). The number of documented lesions showed a positive correlation with the benign/malignant ratio, and excisions at baseline decreased significantly over the course of the study period. Conclusion Digital dermatoscopy monitoring improves the detection of thin melanomas in patients with multiple nevi. Patients with a melanoma at baseline are at an increased risk of developing a melanoma during follow-up and should therefore be a target group for sequential dermatoscopy imaging.
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teaching dermatoscopy of pigmented skin tumours to novices comparison of analytic vs heuristic approach
Journal of The European Academy of Dermatology and Venereology, 2015Co-Authors: Philipp Tschandl, Karin Schmid, Harald Kittler, Iris Zalaudek, Giuseppe ArgenzianoAbstract:Background There are two strategies to approach the dermatoscopic diagnosis of pigmented skin tumours, namely the verbal-based analytic and the more visual-global heuristic method. It is not known if one or the other is more efficient in teaching dermatoscopy. Objective To compare two teaching methods in short-term training of dermatoscopy to medical students. Methods Fifty-seven medical students in the last year of the curriculum were given a 1-h lecture of either the heuristic- or the analytic-based teaching of dermatoscopy. Before and after this session, they were shown the same 50 lesions and asked to diagnose them and rate for chance of malignancy. Test lesions consisted of melanomas, basal cell carcinomas, nevi, seborrhoeic keratoses, benign vascular tumours and dermatofibromas. Performance measures were diagnostic accuracy regarding malignancy as measured by the area under the curves of receiver operating curves (range: 0–1), as well as per cent correct diagnoses (range: 0–100%). Results Diagnostic accuracy as well as per cent correct diagnoses increased by +0.21 and +32.9% (heuristic teaching) and +0.19 and +35.7% (analytic teaching) respectively (P for all <0.001). Neither for diagnostic accuracy (P = 0.585), nor for per cent correct diagnoses (P = 0.298) was a difference between the two groups. Conclusions Short-term training of dermatoscopy to medical students allows significant improvement in diagnostic abilities. Choosing a heuristic or analytic method does not have an influence on this effect in short training using common pigmented skin lesions.
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dermatoscopy of amelanotic and hypomelanotic melanoma
Journal Der Deutschen Dermatologischen Gesellschaft, 2014Co-Authors: Jelena Stojkovicfilipovic, Harald KittlerAbstract:Summary Amelanotic melanoma is a subtype of cutaneous melanoma without pigment. The clinical diagnosis is challenging because it may mimic benign or malignant melanocytic and non-melanocytic neoplasms and inflammatory skin diseases. In synchrony with the improvement of the diagnosis of pigmented lesions, dermatoscopy may assist the clinician in the diagnosis of non-pigmented skin neoplasms in general and of amelanotic melanoma in particular. We have searched the literature to extract the most relevant dermatoscopic clues to diagnose amelanotic and hypomelanotic melanomas by dermatoscopy. In addition we present eight consecutive cases and discuss their clinical and dermatoscopic characteristics in the light of published data.
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diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions
Journal of The American Academy of Dermatology, 2011Co-Authors: Cliff Rosendahl, Alan Cameron, Philipp Tschandl, Harald KittlerAbstract:Background It is unknown whether dermatoscopy improves the diagnostic accuracy for all types of pigmented skin lesions or only for those that are melanocytic. Objective We sought to assess if the addition of dermatoscopy to clinical examination with the unaided eye improves diagnostic accuracy for all types of pigmented lesions. Methods We analyzed 463 consecutively excised pigmented skin lesions collected during a period of 30 months in a primary care skin cancer practice in Queensland, Australia. Results Of 463 lesions, 217 (46.9%) were nonmelanocytic. Overall 30% (n = 138) were malignant including 29 melanomas, 72 basal cell carcinomas, and 37 squamous cell carcinomas. The diagnostic accuracy for malignant neoplasms measured as area under receiver operating characteristic curves was 0.89 with dermatoscopy and 0.83 without it ( P Limitations Estimates of diagnostic accuracy are influenced by verification bias. Conclusions Dermatoscopy improves the diagnostic accuracy for nonmelanocytic lesions. A simple algorithm based on pattern analysis is suitable for the detection of melanoma and nonmelanoma skin cancer.
Holger A Haenssle - One of the best experts on this subject based on the ideXlab platform.
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early detection of cutaneous melanoma by sequential digital dermatoscopy sdd
Journal Der Deutschen Dermatologischen Gesellschaft, 2013Co-Authors: Sophie L Kraus, Holger A HaenssleAbstract:Summary The early diagnosis and excision of cutaneous melanoma is essential for an improved prognosis of the disease. Besides the investigation of pigmented lesions with the unaided eye and conventional dermatoscopy, long-term sequential digital dermatoscopy has been shown to improve the sensitivity of melanoma detection, especially in high-risk patients. In addition to the static clinical and dermatoscopic assessment, the sequential digital dermatoscopy strategy helps to detect changes over time. This review summarizes the latest developments in the field of sequential digital dermatoscopy, describes current strategies for the selection of patients and lesions to monitor, and suggests objective criteria that should lead to an excisional biopsy.
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seven point checklist for dermatoscopy performance during 10 years of prospective surveillance of patients at increased melanoma risk
Journal of The American Academy of Dermatology, 2010Co-Authors: Holger A Haenssle, Bianca Korpas, Christian Hansenhagge, Kjell M Kaune, Ullrich Krueger, Albert Rosenberger, Michael P Schon, Timo Buhl, Steffen EmmertAbstract:Background The retrospectively developed 7-point checklist is one of the most applicable dermatoscopic algorithms for clinical use. However, until today no prospective data on the diagnostic performance of this algorithm were reported. Objective Our aim was to assess the sensitivity, specificity, and diagnostic accuracy of the 7-point checklist in the setting of a prospective long-term study. Methods Patients at increased melanoma risk (n = 688) were screened at regular intervals by naked-eye examination, the dermatoscopic 7-point checklist, and digital dermatoscopy follow-up (10-year study interval). Results We detected 127 melanomas including 50 melanomas in situ. The mean Breslow thickness of invasive melanomas was 0.57 mm. A total of 79 melanomas displayed the 7-point checklist melanoma threshold of 3 or more points (62% sensitivity, compared with 78%-95% in retrospective settings). In all, 48 melanomas scored fewer than 3 points and were excised because of complementary information (eg, lesional history, dynamic changes detected by digital dermatoscopy). The specificity of the 7-point checklist was 97% (compared with 65%-87% in retrospective settings). Regression patterns, atypical vascular patterns, and radial streaming were associated with the highest relative risk for melanoma (odds ratio 3.26, 95% confidence interval 2.05-5.16; odds ratio 3.04, 95% confidence interval 1.70-5.46; odds ratio 2.91, 95% confidence interval 1.64-5.15; P P Limitations Calculation of the specificity was a limitation. True negative lesions were defined by a score less than 3 points and either the histopathological diagnosis of nonmelanoma or the absence of dynamic changes during digital dermatoscopy follow-up (nonexcised, nonsuspicious, no change). Conclusions The 7-point checklist for dermatoscopy was less sensitive but highly specific in this prospective clinical setting. Complementary information clearly increased the sensitivity. Regression patterns or radial streaming in nevi of patients at high risk should raise a higher melanoma suspicion than might be concluded from retrospective studies.
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melanoma arising in segmental nevus spilus detection by sequential digital dermatoscopy
Journal of The American Academy of Dermatology, 2009Co-Authors: Holger A Haenssle, Kjell M Kaune, Michael Padeken, Kaimartin Thoms, Timo Buhl, Steffen Emmert, Michael P SchonAbstract:Background Nevus spilus (NS) defines a cafe-au-lait macule with superimposed maculopapular speckles. Although the cafe-au-lait macule often presents at birth, the darker pigmented speckles increase in number and size during a period of several years. The need for close follow-up of patients with NS is underlined by reports of several cases of cutaneous melanoma developing within such lesions. Methods We followed up 4 adult patients (3 male, one female; mean age 38 years) with unilateral segmental NS of the thoracic or abdominal region. The NS was present at birth in all 4 patients. Follow-up by sequential digital dermatoscopy and digital overview images was scheduled every 6 to 12 months. Results During surveillance (mean follow-up time, 8.15 years), 3 melanocytic lesions were excised. In one patient focal enlargement prompted excision of two dysplastic compound nevi. In another patient new black dots and focal peripheral hyperpigmentation were detected by comparison with previous images. Histologic analysis confirmed the diagnosis of invasive melanoma (Breslow thickness, 0.6 mm). Limitations This observational clinical study included a small number of patients. Sequential digital dermatoscopy of large NS in children may lead to unnecessary excisions because of physiologic changes. Conclusion We suggest close follow-up of patients with segmental NS whenever complete excision is not possible. In adults, follow-up by digital dermatoscopy and excision of lesions with dynamic changes may assist in the early detection of melanoma.
Cliff Rosendahl - One of the best experts on this subject based on the ideXlab platform.
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accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin
Journal of The American Academy of Dermatology, 2017Co-Authors: Christoph Sinz, Philipp Tschandl, Horacio Cabo, Ralph P. Braun, Cliff Rosendahl, Andreas Blum, Bengü Nisa Akay, Giuseppe Argenziano, Jeanyves GourhantAbstract:Background Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. Objective To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. Methods We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience. Results The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P P Limitations The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias. Conclusions Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.
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DERMATOLOGY PRACTICAL & CONCEPTUAL
2016Co-Authors: Mike Inskip, Jill Magee, David Weedon, Cliff RosendahlAbstract:www.derm101.com Atypical fibroxanthoma of the cheek—case report with dermatoscopy and dermatopatholog
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trichilemmoma in continuity with pigmented basal cell carcinoma with dermatoscopy and dermatopathology
Dermatology practical & conceptual, 2015Co-Authors: Moayad Al Kaptan, Joseph Kattampallil, Cliff RosendahlAbstract:A case of trichilemmoma in continuity with a pigmented basal cell carcinoma is presented with dermatoscopy and dermatopathology. The distinction between the two lesions was evident dermatoscopically and was confirmed dermatopathologically. While trichilemmoma has been reported in association with basal cell carcinoma and dermatoscopy images of four previous cases of trichilemmoma have been published, no previous dermatoscopy image has been published of trichilemmoma associated with basal cell carcinoma.
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the impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in australia
Journal of The American Academy of Dermatology, 2012Co-Authors: Cliff Rosendahl, Tobias Wilson, Jeffrey Keir, G Canning, Diann Eley, Ian Mccoll, Gail M. Williams, David WilkinsonAbstract:Background Dermatoscopy improves accuracy of melanoma diagnosis, but the impact of subspecialization in skin cancer practice among general practitioners on melanoma diagnostic accuracy is not known. Objective To assess the impact of dermatoscopy use and subspecialization on the accuracy of melanoma diagnosis by general practitioners. Methods We did a prospective study on the Skin Cancer Audit Research Database and measured melanoma ‘number needed to treat' (NNT), with 21,900 lesions excised to diagnose 2367 melanomas. Results Melanoma NNT fell from a high of 17.0 (95% confidence interval [CI] 14.5-20.7) among general practitioners with a generalist practice to 9.4 (CI 8.9-10.1) among those with a specific interest in skin cancer, and 8.5 (CI 8.1-9.0) among those practicing only skin cancer medicine ( P P P P = .41) when adjusted for practice type and other variables. Limitations There is selection bias with respect to participating doctors and completeness and accuracy of data are not independently verified in the Skin Cancer Audit Research Database (SCARD). Conclusions General practitioners who subspecialize in skin cancer have a higher use of dermatoscopy and diagnose melanoma with greater accuracy than their generalist counterparts.
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dermatoscopy in routine practice chaos and clues
Australian Family Physician, 2012Co-Authors: Cliff Rosendahl, Alan Cameron, Ian Mccoll, David WilkinsonAbstract:Background: Skin cancer is a major cause of mortality and morbidity in Australia, and primary care doctors can, and should, treat most cases. Objective: In this article we outline one method for the effective use of dermatoscopy in diagnosing melanoma and other skin malignancies in general practice. Discussion: The use of a Dermatoscope in clinical practice has been shown to increase diagnostic accuracy and is considered the standard of care in assessing patients with pigmented skin lesions. Its use is also being increasingly applied to the diagnosis of nonpigmented skin lesions. Like any clinical tool, training is required for effective use. 'Chaos and clues' is a straightforward method of rapidly assessing suspicious pigmented skin lesions using a Dermatoscope; its use can lead to improved diagnosis of melanoma and other skin malignancies.
Iris Zalaudek - One of the best experts on this subject based on the ideXlab platform.
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the use of dermatoscopy in diagnosis and therapy of nonmelanocytic skin cancer
Journal Der Deutschen Dermatologischen Gesellschaft, 2016Co-Authors: Teresa Deinlein, Georg Richtig, Ingrid H. Wolf, Edith Arzberger, Christoph Schwab, Rainer Hofmannwellenhof, Federica Scarfì, Iris ZalaudekAbstract:Summary Today, dermatoscopy is an integral part of every clinical skin examination, as it markedly enhances the early detection of melanocytic and nonmelanocytic skin cancer (NMSC) compared to naked-eye inspection. Besides its diagnostic use, this noninvasive method is increasingly important in the selection of as well as the response assessment to various therapies used for NMSC, including basal cell carcinoma, actinic keratoses, squamous cell carcinoma, and also rare tumors such as Merkel cell carcinoma, angiosarcoma, or dermatofibrosarcoma protuberans. Thus, dermatoscopy is a valid tool for the preoperative assessment of tumor margins in basal cell carcinoma, but also for follow-up of actinic keratoses after topical treatment. The present article presents an overview on the use of dermatoscopy in the diagnosis and therapy of various types of NMSC.
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teaching dermatoscopy of pigmented skin tumours to novices comparison of analytic vs heuristic approach
Journal of The European Academy of Dermatology and Venereology, 2015Co-Authors: Philipp Tschandl, Karin Schmid, Harald Kittler, Iris Zalaudek, Giuseppe ArgenzianoAbstract:Background There are two strategies to approach the dermatoscopic diagnosis of pigmented skin tumours, namely the verbal-based analytic and the more visual-global heuristic method. It is not known if one or the other is more efficient in teaching dermatoscopy. Objective To compare two teaching methods in short-term training of dermatoscopy to medical students. Methods Fifty-seven medical students in the last year of the curriculum were given a 1-h lecture of either the heuristic- or the analytic-based teaching of dermatoscopy. Before and after this session, they were shown the same 50 lesions and asked to diagnose them and rate for chance of malignancy. Test lesions consisted of melanomas, basal cell carcinomas, nevi, seborrhoeic keratoses, benign vascular tumours and dermatofibromas. Performance measures were diagnostic accuracy regarding malignancy as measured by the area under the curves of receiver operating curves (range: 0–1), as well as per cent correct diagnoses (range: 0–100%). Results Diagnostic accuracy as well as per cent correct diagnoses increased by +0.21 and +32.9% (heuristic teaching) and +0.19 and +35.7% (analytic teaching) respectively (P for all <0.001). Neither for diagnostic accuracy (P = 0.585), nor for per cent correct diagnoses (P = 0.298) was a difference between the two groups. Conclusions Short-term training of dermatoscopy to medical students allows significant improvement in diagnostic abilities. Choosing a heuristic or analytic method does not have an influence on this effect in short training using common pigmented skin lesions.
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the dermatoscopic universe of basal cell carcinoma
Dermatology practical & conceptual, 2014Co-Authors: Aimilios Lallas, Elvira Moscarella, Zoe Apalla, Caterina Longo, Giuseppe Argenziano, Francesca Specchio, Margaritha Raucci, Iris ZalaudekAbstract:Following the first descriptions of the dermatoscopic pattern of basal cell carcinoma (BCC) that go back to the very early years of dermatoscopy, the list of dermatoscopic criteria associated with BCC has been several times updated and renewed. Up to date, dermatoscopy has been shown to enhance BCC detection, by facilitating its discrimination from other skin tumors and inflammatory skin diseases. Furthermore, upcoming evidence suggests that the method is also useful for the management of the tumor, since it provides valuable information about the histopathologic subtype, the presence of clinically undetectable pigmentation, the expansion of the tumor beyond clinically visible margins and the response to non-ablative treatments. In the current article, we provide a summary of the traditional and latest knowledge on the value of dermatoscopy for the diagnosis and management of BCC.
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the light and the dark of dermatoscopy in the early diagnosis of melanoma facts and controversies
Clinics in Dermatology, 2013Co-Authors: Zoe Apalla, Cinzia Ricci, Elvira Moscarella, Aimilios Lallas, Simonetta Piana, Caterina Longo, Giuseppe Argenziano, Iris ZalaudekAbstract:Early diagnosis remains the best method to reduce melanoma and non-melanoma skin cancer- related mortality and morbidity. Dermatoscopy was first introduced at the end of the last century, and besides the strict criticism that it initially received, the majority of the scientific community presently considers it revolutionary in the field of melanocytic lesion diagnostics. Cumulative evidence provides definite data that dermatoscopy improves the clinicians' diagnostic accuracy for melanoma compared with other clinical diagnostic approaches. There remain some barriers for its use such as lack of training, lack of time, and lack of reimbursement, as well as persisting skepticism about its true utility. In the current contribution, we focus on false beliefs and facts concerning dermatoscopy in the early diagnosis of melanoma and shed some light on some of the remaining "dark sides" of this issue. © 2013 Published by Elsevier Inc.
Andreas Blum - One of the best experts on this subject based on the ideXlab platform.
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accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin
Journal of The American Academy of Dermatology, 2017Co-Authors: Christoph Sinz, Philipp Tschandl, Horacio Cabo, Ralph P. Braun, Cliff Rosendahl, Andreas Blum, Bengü Nisa Akay, Giuseppe Argenziano, Jeanyves GourhantAbstract:Background Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. Objective To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. Methods We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience. Results The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P P Limitations The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias. Conclusions Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.
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tape dermatoscopy constructing a low cost Dermatoscope using a mobile phone immersion fluid and transparent adhesive tape
Dermatology practical & conceptual, 2015Co-Authors: Andreas Blum, Jason GiacomelAbstract:Importance: Medical professionals and indeed the general public have an increasing interest in the acquisition of dermatoscopic images of suspect or ambiguous skin lesions. To this end, good dermatoscopic image quality and low costs are important considerations.
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"Tape dermatoscopy": constructing a low-cost Dermatoscope using a mobile phone, immersion fluid and transparent adhesive tape.
Dermatology practical & conceptual, 2015Co-Authors: Andreas Blum, Jason GiacomelAbstract:IMPORTANCE: Medical professionals and indeed the general public have an increasing interest in the acquisition of dermatoscopic images of suspect or ambiguous skin lesions. To this end, good dermatoscopic image quality and low costs are important considerations.\n\nOBSERVATIONS: Images of seven lesions (seborrheic keratosis, melanoma in-situ, blue and dermal nevus, basal cell carcinoma and two squamous cell carcinomas) were taken. A novel technique of "tape dermatoscopy" involved: Using immersion fluid (i.e., water, olive oil, disinfectant spray) placed on the flat or slightly elevated lesion;Covering the lesion with transparent adhesive tape with lateral tension;Using ambient indoor or outdoor lighting for illumination (rather than flash photography);Positioning a photographic device at an angle of approximately 45° from the side of the lesion to avoid light reflection;Recording a focused image with a mobile phone or digital camera at a distance of approximately 25-30 cm from the lesion; andEnlarging the image on the screen of the device. Essential dermatoscopic features enabling a correct diagnosis were visible in 6 of the 7 lesions. 'Tape dermatoscopy" images of the lesions were compared to standard dermatoscopy (using a Fotofinder handyscope® in combination with a mobile phone). The latter confirmed the dermatoscopic features in six of seven lesions.\n\nCONCLUSIONS AND RELEVANCE: "Tape dermatoscopy" images can be recorded by medical personnel and even the general public without a Dermatoscope. However, the limitations of this method are that images may be unfocused, exophytic tumors may be difficult to assess, excess pressure on tumoral blood vessels may lead to compression artefact, dermatoscopic features that are only visible under polarized light are unable to be detected (particularly "crystalline" or "chrysalis" structures) and tumors in certain anatomic locations may be difficult to assess (e.g., edges of nose, ears [demonstrated in one case], nails). Comparative prospective studies are necessary in order to test reproducibility of these preliminary findings, to establish special indications for the technique, and to develop guidelines for its effective use.