Comparison between naked eye and dermoscopy evaluation in areas with telangiectasia of the lower limbs without previous treatment Thesis by Camila Kill da Silva. Advisor: Roberto Augusto Caffaro and Eduardo Ramacciotti

Prospective study involving 19 patients of both sexes, aged between 18 and 60 years, Fitzpatrick I and III, with a diagnosis of telangiectasia of the lower limbs that had never been treated. The aim of the study is to determine whether the dermatoscope is a useful tool for diagnosing skin pigmentation in untreated areas of telangiectasia and in aligning expectations between physician and patient. Data collection took place at a single time for each participant and was divided into three stages. An evaluation was performed with the naked eye and dermoscopy of the areas with telangiectasias demarcated on each limb to determine the presence of pigment and which color of this pigment. In the third stage, the photographs of the dermoscopy performed were evaluated by a dermatologist experienced in pigmentation. It was also requested the evaluation of each area by the patient regarding the presence of pigmentation and what pain. For the analysis, the Kappa concordance index and the simple concordance were used. Most were female (89.5%) aged 46.5 years (± 8.2) and BMI 27.4 (± 4.1). The white race represented 52.6%. About 21% were Fitzpatrick I, 47.5% Fitzpatrick II and 31.5% Fitzpatrick III. A comparison was made between the consensus of the examiners at eye versus the consensus of the examiners at dermoscopy, which showed a simple agreement of 80% (CI 65.7-94.3%), demonstrating that the dermoscope was not decisive for the diagnosis of pigmentation. In the intra-examiner analysis, the concordance index was as high as the examiner’s experience in vascular surgery. The highest agreement occurred with examiner A (89.5% CI 77.9-100%). When comparing the examiners among themselves, the highest agreement occurred between the most experienced, A and C, both with the naked eye (71.1%) and dermoscopy (76.3%). In the comparative analysis between the assessment of the patient’s own limb versus the consensus of examiners with the naked eye, the agreement was only 41.2%. Our study demonstrated that the dermoscope was not decisive for the diagnosis of skin pigmentation or in the alignment of expectations between physician and patient. Our data demonstrate that a good doctorpatient relationship and the effort for the patient to understand his illness and treatment is more effective in aligning expectations than the introduction of a diagnostic technique for this purpose.

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