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Dermatology Practice Today

The Use of Dermatoscopes

Published March 28, 2013 9:04 AM by Raymond Shulstad
I had a student ask me recently if I had a dermatoscope and if I could show her how to use it. The answer was simple enough. No, I don't need one. This of course led to the logical question...Why? This blog post was inspired by this exchange.

The simplest answer to this question is that if I see something that looks abnormal, I biopsy it. If a patient is reporting a progression, or symptomology, of a lesion that is potentially abnormal, I biopsy it. For this reason, I have no need for a dermatoscope. I am not saying that there is not adequate science to support the use of these devices. Although, consistency and accuracy amongst novice users is poor. 

The use of the dermatoscope will never convince me that a lesion I believe to be potentially abnormal, either by clinical evaluation or patient history, doesn't need to be biopsied. The liability involved in not doing so is too great. To illustrate this point further I gave my student the following scenario.

What happens if I believe something is abnormal, take a biopsy, and it shows the lesion is benign? The patient is left with a small scar. What if I evaluate a suspicious pigmented lesion with a dermatoscope, believe it is benign based on this evaluation, and I am wrong? Well, the worst case scenario is that this lesion is a melanoma and the patient could die as a result of my mistake. Therefore, if a lesion makes me want to reach for a dermatoscope, I'm leaving it in my pocket and consenting the patient for a biopsy.

Therefore, when asked why I don't have a dermatoscope? It would not benefit my clinical practice. Take a good history. Do a complete examination in sufficient light. Wear glasses if you need them or surgical loops to see small lesions. If there is a question as to malignancy, biopsy it. If you have a dermatoscope, use it. But if you do, unless you are a highly trained expert with thousands of supervised hours evaluating lesions under dermoscopy...I would suggest you biopsy.  

1 comments

Dear colleague

Every specialty has its instruments and devises and lab values to assist in making diagnoses.

The accuracy on visual inspection (check the literature) is approximately 60% in deciding whether a pigmented lesion is melanoma or a nevus. Dermoscopy is the most important instrument in assisting a clinician in decision making process. Like any instrument, there is a learning curve. But once you learn the features and the vocabulary, you will never want to examine a patient without this most important device.

It is standard of care in Europe and dermatology residents are all being trained in its use. Experts in the US in the field of diagnosing pigmented lesions use dermoscopy in their practice.

I am a nurse practitioner and in order for our specialty to be acknowledged as dermatology-standard care givers it is imperative that we practice with the current standards.

Margaret , Dermatology - Nurse Practiioner, University of Miami School of Medicine April 9, 2013 11:57 AM
Miami FL

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    Occupation: Physician assistant and nurse practitioners
    Setting: Various dermatology settings
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