Fundamentals of diagnosis

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Disease definition

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The history

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  • 9  Cox NH. Dermatological aspects of the NHS National Cancer Data Project. Br J Dermatol 2003;149:108991. Cross Ref link Pubmed link
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  • 11  Grattan CEH, Humphreys FY. Guidelines for evaluation and management of urticaria in adults and children. Br J Dermatol 2007;157:111623. Cross Ref link Pubmed link
  • 12  Smith CH, Anstey AV, Barker JN, et al. British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005. Br J Dermatol 2005;153:48697. Cross Ref link Pubmed link

Ethnicity and cultural factors

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  • 15  Sladden MJ, Dure‐Smith B, Berth‐Jones J, Graham‐Brown RAC. Ethnic differences in the pattern of skin disease seen in a dermatology department: atopic dermatitis is more common in Asian referrals in Leicestershire. Clin Exp Dermatol 1991;16:3489. Cross Ref link Pubmed link
  • 16  Williams HC, Pembroke AC, Forsdyke H, et al. London born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol 1995;32:21217. Cross Ref link Pubmed link

Quality of life in dermatology patients

  • 17  Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:21016 Cross Ref link Pubmed link
  • 18  Lewis‐Jones MS, Finlay AY. The Children's Dermatology Life Quality Index (CDLQI): Initial validation and practical use. Br J Dermatol 1995;132:9429 Cross Ref link Pubmed link
  • 19  Motley RJ, Finlay AY. Practical use of a disability index in the routine management of acne. Clin Exp Dermatol 1992;17:13. Cross Ref link Pubmed link

Examination of the skin

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  • 22  Resnik KS, Ackermann AB. On standard definitions of individual skin lesions. Arch Dermatol 1998;134:6367. Cross Ref link Pubmed link
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  • 25  Lawrence CM, Cox NH. Physical Signs in Dermatology, 2nd edn. London: Mosby, 2002:112.
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  • 28  Cox NH. Palpation of the skin—an important issue. J Roy Soc Med 2006;99:598600. Cross Ref link Pubmed link
  • 29  Cox NH. A literally blinded trial of palpation in dermatologic diagnosis. J Am Acad Dermatol 2007;56:94951. Cross Ref link Pubmed link

Description of skin lesions

    Additional clinical investigations

      Wood's light examination

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      Clinical microscopy, dermoscopy and other imaging systems

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      • 42  Binder M, Schwarz M, Winkler A, et al. Epiluminescence microscopy: a useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol 1995;131:28691. Cross Ref link Pubmed link
      • 43  Argenziano G, Fabbrocini G, Carli P, 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 1998;134:156370. Cross Ref link Pubmed link
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      • 45  Rudnicka L, Rakowska A, Olszewska M. Trichoscopy: how it may help the clinician. Dermatol Clin 2013;31:2941. Cross Ref link Pubmed link
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      Other imaging systems for localized lesions

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      • 48  Haniffa MA, Lloyd JJ, Lawrence CM. The use of a spectrophotometric intracutaneous analysis device in the real‐time diagnosis of melanoma in the setting of a melanoma screening clinic. Br J Dermatol 2007;156:13502. Cross Ref link Pubmed link
      • 49  Govindan K, Smith J, Knowles L, et al. Assessment of nurse‐led screening of pigmented lesions using SIAscope. J Plast Reconstr Aesthet Surg 2007;60:63945. Cross Ref link Pubmed link
      • 50  Tehrani H, Walls J, Price G, et al. A novel imaging technique as an adjunct to the in vivo diagnosis of nonmelanoma skin cancer. Br J Dermatol 2006;155:117783. Cross Ref link Pubmed link
      • 51  Wood A, Morris H, Emery J, et al. Evaluation of the MoleMate training program for assessment of suspicious pigmented lesions in primary care. Inform Prim Care 2008;16:4150. Pubmed link
      • 52  Gerger A, Koller S, Kern T, et al. Diagnostic applicability of in vivo confocal laser scanning microscopy in melanocytic skin tumors. J Invest Dermatol 2005;124:4938. Cross Ref link Pubmed link
      • 53  Pellacani G, Guitera P, Longo C, et al. The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions. J Invest Dermatol 2007;127:275965. Cross Ref link Pubmed link
      • 54  Guitera P, Moloney F, Menzies SW, et al. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol 2013;149:6928. Cross Ref link Pubmed link
      • 55  Bennassar A, Carerrera C, Puig S, et al. Fast evaluation of 69 basal cell carcinomas with ex‐vivo fluorescence confocal microscopy. JAMA Dermatol 2013;149:83947. Cross Ref link Pubmed link
      • 56  Rao BK, Mateus R, Wassef C, et al. In vivo confocal microscopy in clinical practice: Comparison of bedside diagnostic accuracy of a trained physician and distant diagnosis of an expert reader. J Am Acad Dermatol 2013;69:295300. Cross Ref link Pubmed link

      Identification of scabies mites

      • 57  Austin VH. Mineral oil versus KOH for Sarcoptes. J Am Acad Dermatol 1982;7:555. Cross Ref link
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      • 59  Bezold G, Lange M, Schiener R, et al. Hidden scabies: diagnosis by polymerase chain reaction. Br J Dermatol 2001;144:61418. Cross Ref link Pubmed link

      Other simple microscopy procedures

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      • 61  Marks R, Dawber RPR. Skin surface biopsy: an improved technique for the examination of the horny layer. Br J Dermatol 1971;84:11723. Cross Ref link Pubmed link
      • 62  Barton SP, King CS, Marks R, et al. A technique for studying the structural detail of isolated human corneocytes. Br J Dermatol 1980;102:6373. Cross Ref link Pubmed link

      Fine‐needle aspiration of lymph nodes

      • 63  Cangiarella J, Symmans WF, Shapiro RL, et al. Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes. Cancer 2000;25:626.
      • 64  Voit CA, van Akkooi AC, Eggermont AM, et al. Fine needle aspiration cytology of palpable and nonpalpable lymph nodes to detect metastatic melanoma. J Natl Cancer Inst 2011; 7;103:17717 Cross Ref link Pubmed link
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      Radiological and imaging examinations

      • 66  Kleinermann R, Whang T, Bard R, Marmur E. Ultrasound in dermatology: principles and applications. J Am Acad Dermatol 2012;67:47887. Cross Ref link Pubmed link
      • 67  Harland CC, Bamber JC, Gusterson BA, Mortimer PS. High frequency, high resolution B‐scan ultrasound in the assessment of skin tumours. Br J Dermatol 1993;128:52532. Cross Ref link Pubmed link
      • 68  Zemtsov A, Dixon L. Magnetic resonance in dermatology. Arch Dermatol 1993;129:21518. Cross Ref link Pubmed link
      • 69  Sanig P, Le Breton C, Pavlovic M, et al. Magnetic resonance imaging in adults presenting with severe acute infectious cellulitis. Arch Dermatol 1994;130:11508. Cross Ref link Pubmed link
      • 70  Franck JM, MacFarlane D, Silvers DN, et al. Atrophoderma of Pasini and Pierini: atrophy of dermis or subcutis? J Am Acad Dermatol 1995;32:1223. Cross Ref link Pubmed link
      • 71  Wong WL, Chevretton E, McGurk M, Croft D. Pet‐FDG imaging in the clinical evaluation of head and neck cancer. J R Soc Med 1995;88:46972.
      • 72  Böni R, Huch‐Böni RA, Steinert H, et al. Staging of metastatic melanoma by whole‐body positron emission tomography using 2‐fluorine‐18‐fluor‐2‐deoxy‐d‐glucose. Br J Dermatol 1995;132:55662. Cross Ref link Pubmed link
      • 73  Selva‐O'Callaghan A, Grau JM, Gámez‐Cenzano C, et al. Conventional cancer screening versus PET/CT indermatomyositis/polymyositis. Am J Med 2010;123:55862. Cross Ref link Pubmed link
      • 74  Aboyans V, Lacroix P, Doucet S, et al. Diagnosis of peripheral arterial disease in general practice: can the ankle–brachial index be measured either by pulse palpation or an automatic blood pressure device? Int J Clin Pract 2008;62:10017. Cross Ref link Pubmed link

      Skin testing (prick and scratch, intradermal and patch testing)

      • 75  Pepys J. Skin tests. Br J Hosp Med 1984;32:1204. Pubmed link
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      • 81  Hu F, Fosnaugh RP, Bryan HG, et al. Human skin window: a cytologic method for the study of allergic inflammation. J Invest Dermatol 1961;37:40919. Cross Ref link Pubmed link
      • 82  Rebuck JW, Crowley JH. A method of studying leukocytic functions in vivo. Ann NY Acad Sci 1955;59:757805. Cross Ref link Pubmed link

      Immediate‐weal tests

      • 83  Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987;79:66077. Cross Ref link Pubmed link
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      • 92  Thind CK, Brooker I, Ormerod AD. Teledermatology: a tool for remote supervision of a general practitioner with special interest in dermatology. Clin Exp Dermatol 2011;36:48994. Cross Ref link Pubmed link
      • 93  Berghout RM, Eminovic N, de Keizer NF, et al. Evaluation of general practitioner's time investment during a store‐and‐forward teledermatology consultation. Int J Med Inform 2007;76 Suppl. 3:S38491.
      • 94  Romero G, Sanchez P, Garcia M, et al. Randomized controlled trial comparing store‐and‐forward teledermatology alone and in combination with web‐camera videoconferencing. Clin Exp Dermatol 2009;35:31117. Cross Ref link Pubmed link
      • 95  Warshaw EM, Hillman YJ, Greer NL, et al. Teledermatology for diagnosis and management of skin conditions: a systematic review. J Am Acad Dermatol 2011;64:75972. Cross Ref link Pubmed link
      • 96  Warshaw EM, Gravely AA, Nelson DB. Accuracy of teledermatology/teledermoscopy and clinic‐based dermatology for specific categories of skin neoplasms. J Am Acad Dermatol 2010;63:34852. Cross Ref link Pubmed link
      • 97  Warshaw EM, Lederle FA, Grill JP, et al. Accuracy of teledermatology for pigmented neoplasms. J Am Acad Dermatol 2009;61:75365. Cross Ref link Pubmed link
      • 98  Senel E, Baba M, Durdu M. The contribution of teledermatoscopy to the diagnosis and management of non‐melanocytic skin tumours. J Telemed Telecare 2013;19:603. Cross Ref link Pubmed link
      • 99  Tan E, Yung A, Jameson M, et al. Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial). Br J Dermatol 2010;162:80311. Cross Ref link Pubmed link
      • 100  Aldridge RB, Naysmith L, Ooi ET, et al. The importance of a full clinical examination: assessment of index lesions referred to a skin cancer clinic without a total body skin examination would miss one in three melanomas. Acta Derm Venereol 2013;93(6):68992. Cross Ref link Pubmed link
      • 101  Cox NH. Palpation of the skin – an important issue. J R Soc Med 2006;99:598600. Cross Ref link Pubmed link
      • 102  Loane MA, Bloomer SE, Corbett R, et al. A comparison of real‐time and store‐and‐forward teledermatology: a cost‐benefit study. Br J Dermatol 2000;143:12417. Cross Ref link Pubmed link
      • 103  van der Heijden JP, de Keizer NF, Bos JD, et al. Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. Br J Dermatol 2011;165:105865. Cross Ref link Pubmed link
      • 104  Wootton R, Bloomer SE, Corbett R, et al. Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost–benefit analysis. BMJ 2000;320:12526. Cross Ref link Pubmed link
      • 105  Osei‐Tutu A, Shih T, Rosen A, et al. Mobile teledermatology in Ghana: Sending and answering consults via mobile platform. J Am Acad Dermatol 2013;69:e901. Cross Ref link Pubmed link
      • 106  Fruhauf J, Hofman‐Wellenhof R, Kovarik C, et al. Mobile teledermatology in sub‐Saharan Africa: a useful tool in supporting health workers in low‐resource centres. Acta Derm Venereol 2013;93:1223. Pubmed link
      • 107  Lamel SA, Haldeman KM, Ely H, et al. Application of mobile teledermatology for skin cancer screening. J Am Acad Dermatol 2012;67:57681. Cross Ref link Pubmed link
      • 108  Borve A, Holst A, Gente‐Lidholm A, et al. Use of the mobile phone multimedia messaging service for teledermatology. J Telemed Telecare 2012;18:2926. Cross Ref link Pubmed link
      • 109  Borve A, Terstappen K, Sandberg C, et al. Mobile teledermoscopy – there's an app for that! Dermatol Pract Concept 2013;3:418. Cross Ref link Pubmed link
      • 110  Balato N, Megna M, Di Costanzo L, et al. Educational and motivational support service: a pilot study for mobile‐phone‐based interventions in patients with psoriasis. Br J Dermatol 2013;168:2015. Cross Ref link Pubmed link
      • 111  Koller S, Hofmann‐Wellenhof R, Hayn D, et al. Teledermatological monitoring of psoriasis patients on biologic therapy. Acta Derm Venereol 2011;91:6805. Cross Ref link Pubmed link
      • 112  van der Heijden JP, de Keizer NF, Voorbraak FP, et al. A pilot study on tertiary teledermatology: feasibility and acceptance of telecommunication among dermatologists. J Telemed Telecare 2010;16:44753. Cross Ref link Pubmed link
      • 113  Weinstock MA, Nguyen FQ, Risica PM. Patient and referring provider satisfaction with teledermatology. J Am Acad Dermatol 2002;47:6872. Cross Ref link Pubmed link
      • 114  Williams TL, Esmail A, May CR, et al. Patient satisfaction with teledermatology is related to perceived quality of life. Br J Dermatol 2001;145:91117. Cross Ref link Pubmed link
      • 115  Whited JD, Warshaw EM, Edison KE, et al. Effect of store and forward teledermatology on quality of life: a randomized controlled trial. JAMA Dermatol 2013;149:58491. Cross Ref link Pubmed link

      Mobile smartphone applications

      • 116  Madan V, Jamieson L, Wynn RF, et al. Multifocal vascular lesions and thrombocytopenia in a 10‐year‐old boy: retrospective review of a recently recognized rare congenital disorder. Clin Exp Dermatol 2010;35:9424. Cross Ref link Pubmed link
      • 117  Brewer AC, Endly DC, Henley J, et al. Mobile applications in dermatology. JAMA Dermatol 2013;149:13004. Cross Ref link Pubmed link