Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions.

OBJECTIVE To evaluate dermoscopic features and patterns of skin lesions by using conventional and polarized light dermoscopy (PD). DESIGN Observational study. SETTING Dermatology clinic at Memorial Sloan-Kettering Cancer Center. PATIENTS Ninety patients with skin lesions. INTERVENTIONS Skin lesions were imaged via conventional nonpolarized light contact dermoscopy (NPD), polarized light contact dermoscopy (PCD), and polarized light noncontact dermoscopy (PNCD). MAIN OUTCOME MEASURES The images from the 3 modalities were evaluated by 3 dermoscopists for colors, structures, and patterns. Level of agreement between modalities was assessed by percentage agreement and the kappa statistic. Qualitative differences between modalities were also assessed. RESULTS Ninety lesions comprising 55 melanocytic and 35 nonmelanocytic lesions were reviewed. There was excellent agreement for overall dermoscopic patterns between modalities, with kappa values ranging from 0.88 to 1.00. There was moderate to excellent agreement for most dermoscopic colors, with the exception of blue-white veil and pink (red) color. Most dermoscopic structures had fair to perfect agreement, with the exception of milialike cysts. Qualitative assessment suggested that melanin appeared darker and blue nevi had more shades of blue on PD compared with NPD images; vessels and red areas were better visualized with PD, suggesting that PD may be helpful in identifying malignancies; milialike cysts and comedolike openings were better visualized with NPD, suggesting that NPD is more helpful for identification of seborrheic keratosis; peppering, lighter colors, and blue-white areas were more evident under NPD, facilitating recognition of regression areas; and shiny-white streaks, possibly representing fibrosis, were seen more clearly under PD. CONCLUSIONS The capabilities of NPD, PCD, and PNCD are not equivalent, but complementary. Further studies are needed to evaluate the effect of these differences on clinical diagnosis.