Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2024;14(4):e2024263 1 Microinvasive Retained Foreign Body Removal With the Use of a Dermoscopic Working Ring Paweł Pietkiewicz1,2, Cristian Navarrete-Dechent3 1 Centrum Medyczne Zwierzyniecka, Zwierzyniecka, Poznań, Poland 2 Polish Dermatoscopy Group, Poznań, Poland 3 Melanoma and Skin Cancer Unit, Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile Citation: Pietkiewicz P, Navarrete-Dechent C. Microinvasive Retained Foreign Body Removal With the Use of a Dermoscopic Working Ring. Dermatol Pract Concept. 2024;14(4):e2024263. DOI: https://doi.org/10.5826/dpc.1404a263 Accepted: May 19, 2024; Published: October 2024 Copyright: ©2024 Pietkiewicz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Paweł Pietkiewicz, Polish Dermatoscopy Group, Zwierzyniecka Street 30/28, 60-814 Poznań. Telephone: 602 133 503 Email: pietkiewicz.pp@gmail.com Case Presentation A middle-aged woman and a middle-aged man with retained cutaneous foreign bodies (FB) presented to the Dermatology Outpatient Department. The former was a hairdresser by occupation and suffered from prolonged localized eczema of the thumb, which was sustained by the presence of the hair shaft fragments embedded both into the skin and un- der the nail plate. The second patient arranged a full body skin check after findings of cutaneous melanoma at the Sur- gical Outpatient Department a few weeks before the visit. Retained nylon sutures were identified with a dermoscope within the post-surgical scar. Teaching Point The presence of retained cutaneous FB is difficult to de- tect without the dermoscope or hand lens and may lead to infections or development of FB granulomas [1,2]. Their safe removal can be challenging and time-consuming. As a dermoscope is usually held in one hand and the instrument used for extraction is in another, loss of focus during the procedure is not uncommon, contributing to stress for the operator. A diSTANCE metal working ring, whose idea/ design originated from one of the coauthors (P.P.) is a sup- plementary adapter for Heine Delta30 Pro dermatoscope (Heine Optotechnik). It stabilizes focus and features three large windows for instrument insertion for effective and mi- croinvasive FB removal, e.g., fine pincer for subungual hair or needle for retained sutures (Figure 1, A-F). Allowing just minimal direct contact with the site, it provides clear and stable visualization of the FB and therefore reduces the risk of trauma, scarring, and infection and is more comfortable for the patient. 2 Image Letter | Dermatol Pract Concept. 2024;14(4):e2024263 References 1. Sonthalia S, Jha AK, Kaliyadan F. Dermoscopy for the detection and safe extraction of an intracutaneous foreign body. J Am Acad Dermatol. 2018;79(2):e19–20. DOI:10.1016/j.jaad.2018.03.003 2. Sonthalia S, Yumeen S, Kaliyadan F. Dermoscopy Overview and Extradiagnostic Applications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Accessed December 22, 2023. http://www.ncbi.nlm.nih.gov/books/NBK537131/ Figure 1. (A) A metal diSTANCE working ring attached to the Delta30Pro dermatoscope with three wide windows for instrument insertion that facilitated a stable focus when removing the foreign body (e.g., retained sutures, hairs, glass shards, plant thorns, splinters). (B) Three fine retained hairs present for some weeks under the thumbnail in a hairdresser (black arrowheads). Their presence resulted in a periungual eczematous reaction confirmed by der- moscopy (magnification ×10). (C) With a stable focus provided by the working ring attached to the dermatoscope, a fine needle, directed towards the bottom surface of the nail plate to avoid nailbed trauma, was used to move the hairs distally and removed with a pincer (magnification ×20). (D) Retained blue nylon sutures in the surgical scar (black arrowhead; magnification ×10). (E) After site disinfection, a sterile needle a was used for minimal incision of the skin overlying the suture (magnification ×10×). (F) Levering the nylon thread allowed microinvasive removal of the thread’s tail with a pincer, with minimal bleeding. All the images were captured with non-contact polarized videodermoscopy (Heine Delta30Pro with diSTANCE working ring [Heine Optotechnik]) attached to an iPhone 6.