Chicago —Although the increase in melanoma incidence shows no sign of stopping, the use of dermatoscopy will help dermatologists diagnose and treat it earlier and may therefore help lower the incidence of metastatic disease, according to Mark F. Naylor, M.D., in a presentation at the American Academy of Dermatology's Academy '05, here.
"The sun-seeking behavior of the public is the major reason for the increase," Dr. Naylor tells Dermatology Times. He is clinical associate professor at the University of Oklahoma Health Sciences Center.
"The tanning industry encourages the belief that tans look sexy, and this belief drives the melanoma epidemic," he says. "As long as people are intentionally exposing themselves for the purpose of looking pretty, we'll see the numbers rise. We're losing the battle because we're fighting sex and a big industry."
"If dermatologists will use dermatoscopy, we can diagnose melanoma earlier and save more lives, without depending on a change in human behavior," Dr. Naylor says, referring to tanning.
Regarding the value of this addition to the dermatologist's armamentarium in the fight against melanoma, Dr. Naylor's message is simple: "If you're not already using a dermatoscope, find one and start using it," he urges. "If more of us use this device, we could diagnose melanoma earlier and save more lives."
He notes that dermatoscopy, also called dermoscopy, is more widely used in Europe than in the United States.
"Part of the lag is that the instrumentation is cumbersome and difficult," he says. "Most dermatologists in the United States see 20 to 40 patients a day or more, a larger patient load than typically seen by European dermatologists. Therefore, with clunky technology that uses oil, and which therefore slows us down, it's difficult to sell this as a practical technique."
Another stumbling block is a psychological barrier in the self-perception of U.S. dermatologists, he adds.
"American dermatologists think they're the best, and that a naked-eye diagnosis is good enough, but we would do better at diagnosing melanoma earlier with dermoscopy," he says.
He notes that newer, smaller units are becoming available. Such units are smaller, hand-held devices that don't require oil.
"These will make it easier to use dermoscopy and still see 20 to 40 patients a day," he says.
Because certain abnormalities are more visible under dermatoscopy than with the naked eye, the dermatoscopic criteria for biopsy are different because they target the characteristics of early melanoma, Dr. Naylor says. For example, the presence of a blue-white veil over a lesion warrants biopsy, as does an abnormal pigment network. Light areas within a lesion, or "dropout areas," may indicate the presence of regression, where the immune response has destroyed some of the tumor.
Other abnormalities that are detectable on dermatoscopy include the presence of "radial streaming," which consist of ray-like extensions of black material away from the edges of the tumor, and dots and globules.
"These are the main features ... that can only be seen with the dermatoscope," Dr. Naylor says. "If you see these, you're more likely to biopsy and obtain an earlier diagnosis, which enhances survival."