The Dermatoscope as the Dermatologist’s Stethoscope The dermatoscope is becoming an increasingly valuable tool for the clinician with important benefits for patients. Specialists highlight recent developments. By Elvira Moscarella, MD; Caterina Catricalà, MD; Iris Zalaudek, MD; and Giuseppe Argenziano, MD

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he use of dermoscopy continues to increase worldwide. Approximately 4,500 clinicians from 110 countries have joined the International Dermoscopy Society (IDS) as regular members, and more than 600 participants from 44 countries attended the Second World Meeting of the IDS in Barcelona in 2009. The number of scientific publications in the field of dermoscopy increases each year, with 1,000 papers published between 2003 and 2007, a three-fold increase compared to the previous five years (see also www.dermoscopy-ids.org). Detection and early diagnosis of skin cancer remains the primary application of the technique, but a role for dermoscopy is now emerging in general dermatology. The use of dermoscopy now also applies to the diagnosis of a number of skin conditions including infections and inflammatory disorders, for which specific dermoscopic features have been recently described.1

Improved Melanoma Detection Dermoscopy is well established as a technique that significantly improves the sensitivity for melanoma detection compared to the naked-eye examination. Three meta-analyses and two randomized studies have clearly shown the value of dermoscopy in improving the accuracy in melanoma detection.2-6 A meta-analy-

34 | Practical Dermatology

| July 2010

sis, performed by Vestergaard, et al. in 2008, on studies comparing dermoscopy and naked eye examination conducted in a clinical setting, found the relative odds ratio for melanoma to be 15.6 (P=0.016) for dermoscopy compared to naked eye examination.6 Using dermoscopy leads to both a significant increase in the number of melanomas excised, and a significant reduction in the number of benign lesions excised for diagnostic verification. One of the reasons why dermoscopy improves melanoma detection is the possibility of diagnosing a melanoma before it displays the classical clinical features summarized in the ABCD rules. These criteria (asymmetry in shape, border irregularity, color varie-

Take-Home Tips. Detection and early diagnosis of skin cancer remains the primary application of dermoscopy, which now also applies to the diagnosis of a number of skin conditions including infections and inflammatory disorders. Dermoscopy allows the detection of early melanoma-specific criteria that are visible under the dermatoscope even when a melanoma is small in size (6 mm). Dermoscopy allows the detection of early melanomaspecific criteria that are visible under the dermatoscope even when a melanoma is small in size (