Elsevier

Clinics in Dermatology

Volume 31, Issue 6, November–December 2013, Pages 671-676
Clinics in Dermatology

The light and the dark of dermatoscopy in the early diagnosis of melanoma: Facts and controversies

https://doi.org/10.1016/j.clindermatol.2013.05.003Get rights and content

Abstract

Early diagnosis remains the best method to reduce melanoma and non-melanoma skin cancer–related mortality and morbidity. Dermatoscopy was first introduced at the end of the last century, and besides the strict criticism that it initially received, the majority of the scientific community presently considers it revolutionary in the field of melanocytic lesion diagnostics. Cumulative evidence provides definite data that dermatoscopy improves the clinicians' diagnostic accuracy for melanoma compared with other clinical diagnostic approaches. There remain some barriers for its use such as lack of training, lack of time, and lack of reimbursement, as well as persisting skepticism about its true utility. In the current contribution, we focus on false beliefs and facts concerning dermatoscopy in the early diagnosis of melanoma and shed some light on some of the remaining “dark sides” of this issue.

Introduction

Melanoma diagnosis has evolved over the past decades from the era of itching, bleeding, and ulceration to the clinical ABCDs until dermatoscopy was introduced at the end of the last century.1

As happens commonly with innovations in medicine, dermatoscopy has initially become a subject of controversy. Questions and criticism concerning its true value to diagnose melanomas that might otherwise have been missed by a good pair of eyes was one of the main sources of debate.2 Since then, cumulative evidence has been collected that provides today definite data that dermatoscopy improves the clinicians diagnostic accuracy for melanoma compared with other clinical diagnostic approaches.3

As a result, dermatoscopy is standard of care in specialized pigmented lesion clinics, and most recent guidelines strongly advocate its use during skin cancer screening.3., 4.

Despite this mounting evidence, there remain some barriers for its use such as lack of training, lack of time, and lack of reimbursement, as well as persisting skepticism about its true utility.5

This contribution focuses on false beliefs and facts concerning dermatoscopy in the early diagnosis of melanoma and will shed some light on some remaining “dark sides” of this issue.

Section snippets

The light of dermatoscopy: Myths, misbelieves, and facts

Myth: Dermatoscopy does not add much to a good pair of skilled eyes.

Some years ago, Lombardo posed the stimulating question: “What dermatoscopy has to add to the clinical skills of a physician who has a good pair of eyes and can perform a biopsy, … and would anyone forgo a biopsy on the basis of these (dermatoscopic) patterns?” contesting the role of dermatoscopy in the diagnosis of melanoma.6

To reply to this statement, one has to keep in mind that dermatoscopy is not a separate diagnostic

Conclusions

Dermatoscopy is the standard of care in the diagnosis of skin tumors. It is an inexpensive, rapid, and safe procedure that allows a better selection of lesions requiring biopsy compared with the naked eye.

Apart from its definite advantages, certain limitations still exist. Considering both, with a high level of scientific evidence and given drawbacks, we believe that it is time for dermatoscopy to receive the official appreciation and recognition it deserves.

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