Dermoscopy slowly gaining derm acceptance

"Dermoscopy greatly helps in the clinical evaluation of pigmented lesions and, since all dermatologists evaluate pigmented lesions, it is well suited for every dermatologist's practice," says Ashfaq A. Marghoob, M.D., assistant professor of dermatology, Memorial Sloan-Kettering Cancer Center.

However, he estimates that only about 25 percent of dermatologists currently use dermoscopy at all. That figure represents an increase over a few years ago, but much resistance still persists among dermatologists in fully embracing dermoscopy.

"However, while many hold this view to be true, they, at the same time, will often examine these lesions with a magnifying glass," he tells Dermatology Times. "The reason they use a magnifying glass is to get a closer look. Dermoscopy is just one more tool to get an even better, more detailed and closer look. The information gained from the visual examination, magnifying lens and dermoscopy all work in concert to provide the observer with detailed lesion characteristics, which, in turn, allows the clinician to confidently decide whether the lesion in question needs to be biopsied or can be followed."

Older dermatologists seem particularly reluctant to embrace dermoscopy, according to Dr. Marghoob. And since they are responsible for training younger dermatologists, relatively few students gain exposure to this technology. Only about a quarter of residency programs teach the subject in any formal manner.

"Hopefully, as younger dermatologists and residents learn dermoscopy," Dr. Marghoob says, "they will disseminate that information and will start teaching the next generation of dermatologists the added value of dermoscopy."

He adds, "Dermoscopy utilizes transillumination in which the light strikes the skin at an angle and thereby reduces the amount of light reflected off the top layer of the skin. Thus, it allows us to see structures below the top layer of the skin which are otherwise not discernible with the naked eye."

In attempting to persuade dermatologists to embrace dermoscopy, Dr. Marghoob asserts that progressing from simple visual examination to magnifying glass to dermoscopy forces one to concentrate on the lesion.

"That alone has utility because it focuses your attention and helps you decide as to whether the lesion needs to be biopsied or not," he explains.

Accuracy improved Dermoscopy moreover improves diagnostic accuracy, according to Dr. Marghoob.

"That has been shown in multiple studies," he says. "Physicians experienced in the use of dermoscopy will increase their diagnostic accuracy by approximately 10 to 20 percent over that of naked-eye examinations (Kittler H, Pehamberger H, Wolff K, et al. Diagnostic accuracy of dermoscopy. Lancet Oncol 2002;3:159-165.)(Atlas of Dermoscopy. Editors: Marghoob AA, Braun RP, Kopf AW. London, Taylor and Francis 2005.)," says Dr. Marghoob.

In an as-yet-unpublished study, Dr. Marghoob and colleagues found dermoscopy boosts doctor confidence in their clinical diagnoses.