Since the first edition of this textbook, 10 years ago, the utilisation of dermoscopy has steadily evolved. Although the principles and technology remain relatively unchanged, the main development is in relation to the language and terminology used and the widespread adoption of dermoscopy across clinical practice, beyond skin lesion diagnosis alone.

An evolving trend has now been to describe dermoscopic structures in a language or terminology which translate easily worldwide. This means that the dermoscopic future, and this textbook, will have less ‘xanthomatous clouds’ and ‘cherry blossom vessels’ and more dots, globules, blotches, circles and lines.

Having a reproducible language is clearly an advantage for education and learning, reducing uncertainty and the potential for miscommunication. Additionally, this minimalistic language lends itself to wider applications from teledermoscopy to artificial intelligence.

This book has therefore evolved and adapted its terminology wherever possible to embrace this new standardisation of the dermoscopic language. However, there will be scenarios and examples where historical descriptions remain; please accept that it is done to give more colour to the depth to the diagnostic, descriptive palette, and hopefully not to cause confusion.

Learning is a complex process which is influenced by many factors. How we learn is unique to the individual. The historical medical mantra of ‘see one, do one, teach one’ has been repeated for generations, particularly when learning procedural based tasks. However, this mantra is not relevant for the diagnostic arena, as you would clearly need to see more than two melanomas before being competent in melanoma diagnosis. Moreover, for improving clinical diagnosis we rely on experience, based upon repeated clinical exposure, clinical teaching, in addition to learning from an arrangement of medical media.

In this edition of this textbook we aim to increase learning for skin cancers and particularly melanoma by highlighting the many ways in which melanoma presents. But, rather than attributing melanoma diagnosis as mercurial, unpredictable and random, we have illustrated reproducible distinct morphological patterns of melanoma. These repeatable patterns of presentation create a morphological map of melanoma. Additionally, by illustrating many examples of each feature we aim to influence perceptual learning and thereby increase the readers' confidence and diagnostic ability for melanoma detection.

Understanding the presentations of this most malign medical diagnosis is the primary aim of this book. For early diagnosis is the most important factor in influencing survival from melanoma.

These changes would not have been possible without the valuable contributions of my co‐editors Alex Chamberlain and John Paoli. Both are internationally known for their enthusiasm for dermoscopy education and their dermatological expertise. I have learnt numerous pearls of wisdom from these passionate diagnosticians over the course of this project. Alex has a natural flare for editing and when combined with John's multilingual approach to the dermoscopic literature the result is a comprehensive, focused and enhanced text. Their dermoscopic expertise has enriched this book with expert tips, accurate references and standardisation of terminology.

Together, this dermoscopic triumvirate has spent many months creating and editing content, and distilling the message of diagnosis in to a succinct and readable text. We hope you agree, and that you will find it a valuable addition to your clinical practice.

Jonathan Bowling

It has been a great pleasure to join with my colleagues John Paoli and Jonathan Bowling in co‐editing the 2^nd edition of Diagnostic Dermoscopy: The Illustrated Guide. I feel fortunate to have started my dermatology journey just as dermoscopy was taking off as a new discipline, hence my fascination and interest. This text brings together over 60 years of collective dermoscopy experience and the distance between our hometowns on opposite poles of the world has not dampened the collaborative process one bit. I owe plenty to mentors both in Australia and abroad, along with world experts I've been privileged to connect with at meetings and congresses. There has been no doubt that dermoscopy has absolutely changed the way we all approach diagnosis of skin lesions and with the concerted research efforts of many, the field has continued to evolve just when you thought everything had been described! I would urge those early in their journey to continue your professional development through reading, reflection and audit as we never truly stop learning.

I very much enjoyed the first edition of the ‘Bowling textbook’. It was very readable, the images were excellent and the pearls were non‐algorithm aligned. I happily recommended it to trainees and indeed endorsed it for the required reading list for the Australasian College of Dermatologists. My brief time working with Jonathan in 2007 in Oxford was a fruitful period and I'm thrilled that we've been able to collaborate again many years down the track. This text is aimed at all health practitioners willing to pick up a dermoscope. It has expanded since the 1^st Edition naturally. Hopefully it will garner greater enthusiasm amongst readers to share the passion, to teach, to publish and continue to push the limits of non‐invasive diagnosis.

Alex Chamberlain

Ever since I started teaching dermoscopy, I have recommended Jonathan Bowling's 1^st edition of Diagnostic Dermoscopy: The Illustrated Guide to my students. The combination of concise and simple descriptions of dermoscopic findings, the vast collection of cases and the practical color‐coding of the chapters for quick access to the chapter of interest make it a fantastic reference work for everyone learning dermoscopy. Thus, it was an enormous honour to be invited to contribute as a consultant editor together with Alex Chamberlain to this new edition you are holding in your hands.

The 2^nd edition offers even more cases to be enjoyed and learned from while sticking to Jonathan's winning concept of brief but comprehensive texts presented in an orderly fashion. The chapters on melanocytic lesions and melanoma have grown substantially. The melanoma chapter has been divided into four separate sections and the previous chapter on special sites has now become five for even easier reading and comprehension. Furthermore, new diagnoses have been added to the general dermatology chapter and completely new chapters on vascular structures, genetic conditions, entomodermoscopy and miscellaneous clinical scenarios have been added. Beyond new images and more practical chapter categorisation, we have also increased the number of valuable clinical tips and references, which can now be found at the bottom of almost every page. Finally, the dermoscopic terminology has been modernised and standardised as much as possible to avoid confusion when comparing our book with other relevant modern literature on dermoscopy.

It has been a true privilege and a very rewarding experience to collaborate with Jonathan and Alex on this book. I thoroughly enjoyed our weekly Zoom meetings, email conversations and WhatsApp discussions, which helped us overcome ten‐hour time zone differences and made the journey leading to the final product a real joyride. The changes and optimisations were a result of fruitful teamwork and our shared passion for dermoscopy and teaching. All in all, I feel very confident that this book will be enjoyed by you the reader.

John Paoli

Dermoscopy has been fully embraced by dermatologists and all those involved in skin cancer diagnosis as the gold standard tool used for clinical examination and diagnosis. It is simple to utilise, quick to apply and requires very little additional resource apart from the dermoscopy device/dermoscope itself.

However, without understanding the utility of dermoscopy, in wider clinical practice, the full diagnostic potential for the clinician may not be reached.

Format and imaging

This book is specifically a textbook with an emphasis on diagnosis, and diagnosis alone. In this way we are able to provide a comprehensive guide to the common presentations of skin lesions seen in clinics in addition to some of the more uncommon. From this starting point of diagnosis the rest of medical management flows. With greater confidence in diagnosis, a reduction in unnecessary biopsies can be achieved which frees resources to meet the increasing demand from rising skin cancer rates. Additionally, finding skin cancers at an earlier point in their evolution consumes less resources in surgical and medical management, and reduces patient morbidity and mortality.

For each topic covered, the clinical images are aimed to be standardised for illumination and orientation to aid recognition whilst illustrating the main clinical features. The adjoining dermoscopy image focuses upon key diagnostic features, which in combination with the clinical information should be all that is required for a specific diagnosis or at least a narrow differential diagnosis to be made.

Whenever possible, images of conditions have been taken across skin tones and with different dermoscope devices in different imaging modes to Illustrate the broad variety of presentations to the clinician.

Therefore, we anticipate that this book becomes a user‐friendly guide, to be used in clinic by not only clinicians and nurses but also by any allied paramedical staff involved in skin lesion diagnosis.

Teledermoscopy

This format also lends itself to the growing field of teledermoscopy.

With teledermoscopy becoming an integral part of clinical practice it is helpful to have a collection of illustrated cases for reference. Therefore, throughout this book, for each topic covered, a minimal dataset, is included. This dataset includes a brief clinical description of the lesion, anatomical site and age and sex of the patient, a clear clinical image and a corresponding dermoscopic image highlighting a diagnostic feature. This textbook therefore becomes a useful reference manual, of over 500 cases, for anyone involved in teledermoscopy consultations.

Dermoscopy devices

Over the last 10 years, the greatest change in dermoscopes has been the standardisation and incorporation of both polarising and non‐polarising imaging modes into the majority of dermoscopes. This leads to an increase in dermoscopic diagnostic information available for interpretation, with a simple toggle/push of a button to change between the two imaging modes. By switching between imaging modes, a composite ‘occipital cortex’ image can be created for interpretation and diagnosis.

There are multiple devices available for the clinician to choose. This book does not aim to advise on which device is best suited for the clinician. All we would advise is that the device sought is of a quality that allows the user to see a clear, bright, image for interpretation. The device must be robust enough for regular daily use and ergonomically designed so that it feels good in the clinician’s hand. High‐quality optics will ensure a crisp focused image for interpretation or image capture with a camera. The field of view needs to be of a size to provide a clear image but not too large to compromise optics or utility.

With all devices the ability to keep the dermoscope fully charged during clinical use is also an important consideration.

Therefore, for the variables mentioned above it would not be unusual for the dermoscopy enthusiast to have more than one dermoscope in regular clinical use.

Which dermoscope is best suited to your own practice is a personal choice for the clinician. Most importantly, the clinician should find a dermoscope that you want to pick up and use, feels good in your hand and fits in with your scope of clinical practice.

Clinical and histopathological correlation

We would like to emphasise that clinical diagnosis is a complex process and is based upon the summation of all relevant clinical information from the clinical history, clinical examination and dermoscopic examination.

Additionally, the importance of close clinico‐pathological correlation cannot be underestimated. As dermoscopy provides a horizontal aerial view of skin microstructures, these dermoscopic findings should always be provided (in addition to the detailed clinical history and findings from clinical examination) in all samples sent for histopathology. Simple refinements such as marking the specimen for orientation, adding a map of the area of pathological interest, can help diagnosis and improve the quality of the report.

If clinical concern remains despite histopathology reporting, we would advise seeking engagement with your histopathology colleagues, for a case review, to ensure that the correct diagnosis is reached ultimately to the benefit of the patient.

As clinicians, we are accountable for our decision making, which should be based on the best possible evidence. Hopefully this book will help in that decision‐making process.

The diagnosis is in the detail.

A pigmented macule on the arm of a 40‐year‐old woman confirmed as a 0.3 mm thick superficial spreading melanoma (SSM): dermoscopy shows eccentric irregular globules that can now also be seen on review of the clinical image.

A variably pigmented macule on the arm of a 60‐year‐old woman confirmed as a 0.8 mm thick SSM: dermoscopy shows eccentric regression and atypical pigmented globules that can now also be seen on review of the clinical image.

The details seen in this 0.8 mm thick SSM are more clearly seen on clinical examination following elimination of light scatter by application of alcohol gel.

Combining dermoscopic features from both non‐polarised and polarised imaging modes provides the maximum information for diagnosis in this 0.8 mm thick SSM.

International bank notes showing the microprint that is only visible on dermoscopy, illustrating the limitations of diagnostic detail seen on naked eye examination alone.

A melanocytic lesion on the knee of a 25‐year‐old woman: dermoscopy shows eccentric pigment globules and a focus of negative network in this case of melanoma in situ, which are only evident on dermoscopy.

Black is a feature of eumelanin located high in the epidermis and can be seen in ink spot lentigines, Spitz naevi and melanoma; brown is the most commonly observed colour of melanocytic lesions and is due to melanin in the epidermis.

Grey pigmentation is seen when eumelanin is located in the papillary dermis (e.g. regression); slate blue is seen when eumelanin is located in the deeper dermis (e.g. blue naevi).