Simple, easy dermatoscopy

October 21, 2005

Although dermatoscopy has been available in Europe and the United States for many years, complicated formulas used with the device are often time-consuming and confusing, explains Babar K. Rao, M.D., a dermatologist in practice in New Jersey and New York.

Although dermatoscopy has been available in Europe and the United States for many years, complicated formulas used with the device are often time-consuming and confusing, explains Babar K. Rao, M.D., a dermatologist in practice in New Jersey and New York.

"I started with all those dermatoscopy formulas that they are using to evaluate if lesions should be removed or not. A course is given every year at the Academy meeting and I am part of that course, but in the end it gets so complicated that even I get confused," Dr. Rao says.

So he decided he would develop a more simplified method.

Three steps

In the clinic, Dr. Rao notes that the dermatologist realistically does not have the time to calculate the formulas for each mole while the patient is waiting.

"In the end, dermatologists in a gestalt way end up concluding, because of observation, if they are or are not going to remove the lesion," he says.

Because of this uncertainty over many, many years, he says he devised the three-step approach, which is not much different than the other approaches, except that it does not use any formula.

The method

1. To begin, observe the patient and determine if the lesion is melanocytic or non-melanocytic.

2. If it is melanocytic, determine if it is one of the known common patterns. If it matches a known pattern, go to step three. If the lesion does NOT match the common mole patterns (meaning it is an uncommon pattern), the lesion should be removed.

3. Look for melanoma features - regression, atypical network, atypical pigment, multiple colors, irregular streaks, irregular dots and globules. If present, remove lesion.

False positives

Dr. Rao concedes that this approach may not be as exact as those using formulas.

"The only difference between this approach and the other formula-type approaches is that I may have a few false positives. This means that I thought it was a melanoma and it was not; but that is OK," Dr. Rao tells Dermatology Times.

For example, if a patient has 100 moles, five may look unusual, he says. If a dermatologist does not use a dermatoscope because he or she is uncomfortable with it, probably all five moles will be removed. But by using this simple approach, the dermatologist will probably only remove one of them.

This simple and easy approach to dermatoscopy will reduce the number of biopsies needed, and then a melanoma will not be missed Dr. Rao says.

"When using the formulas or other lengthy approaches, the false positives may be less than (with) the way I do it, but then only very few people in the country understand those approaches. I want to teach every dermatologist to be able to use a dermatoscope, and make sense out of it," he says.