Dermoscopy gaining acceptance

San Diego - Although he wasn't convinced initially, a dermoscopy expert contends that this tool is quickly proving its value in diagnosing pigmented lesions and beyond.

"I wasn't a believer when dermoscopy first came out. I thought it was probably just a device to help a presbyopic dermatologist see things better close-up," says David L. Swanson, M.D., assistant professor of dermatology at the Mayo Clinic in Scottsdale, Ariz.

However, he tells Dermatology Times that once one begins using a dermoscope, "One realizes that it's as valuable a tool to a dermatologist as a stethoscope is to an internist."

On the other hand, he adds, "Dermatologists shouldn't feel badly that they can't make a diagnosis without a biopsy."

More importantly, Dr. Swanson says, "Dermatologists who utilize dermoscopy can be much more selective in what they do biopsy."

Also, dermoscopy provides reassurance, but it's not an exclusive way to determine with absolute certainty which lesions require biopsies and which don't, Dr. Swanson says.

"The dermoscope is an adjunct to good clinical judgement," he says.

In addition to pigmented lesions, he says dermoscopy has utility in identifying conditions characterized by nonpigmented lesions, such as basal cell carcinoma (BCC), Bowen's disease and scabies.

"Monelithrix and trichorrhexis nodosa also can be seen with a dermoscope," Dr. Swanson adds.

By the same token, he says dermoscopy can help Mohs surgeons to make preliminary judgments regarding margins when removing melanocytic lesions.

"Not only are more and more physicians using dermoscopy," Dr. Swanson says, "but patients are demanding it. We have patients contacting our clinic inquiring whether dermoscopic examination is being done."

In this climate of increased awareness, he says that it behooves physicians to learn how to do dermoscopy as both a quality measurement and a patient service.

"Residents are also demanding to learn dermoscopy," Dr. Swanson notes.

In fact, he says a recent survey of Canadian residents shows lack of dermoscopy training ranks among the most severe perceived shortcomings in academic training programs (Freiman A et al. Arch Dermatol. 2005 Sep;141(9):1100-4.). "Unfortunately," Dr. Swanson says, "probably less than half of the physicians in academic centers perform dermoscopy, although that is changing."

Disclosure: Dr. Swanson reports no financial interests relevant to this article.