The Use of Dermatoscopes
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.