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SYNONYMS

  • Dermatoscopy

  • Skin surface microscopy

  • Epiluminescence microscopy (ELM)

  • Digital dermoscopy/digital ELM

  • Auflichtmikroscopie (German)

  • Dermoscopia/dermatoscopia (Spanish)

  • Dermoscopy and dermatoscopy are used interchangeably by experienced dermoscopists and in the literature

DEFINITION

  • Dermoscopy is an in vivo, noninvasive technique in which oil or fluid (eg, mineral oil, gels, alcohol, and water) is placed on the lesion

    • Fluid eliminates reflection of light from the surface of the skin allowing visualization of color and structure in the epidermis, dermoepidermal junction, and papillary dermis

    • The color and structure visualized cannot be seen with the naked eye or with typical magnification that clinicians use

    • Polarizing light and digital instrumentation do not require fluid

  • When using polarized light dermoscopy

    • Light from a polarized light source penetrates the stratum corneum with less scatter

    • A second polarizer screens out scattered surface light resulting in the physician seeing primarily light from the deeper structures

    • This removes the need for contact with the skin and the need for immersion fluids, resulting in faster examination times

  • There is noncontact and contact polarized dermoscopy

    • Gels can be used with contact polarized dermoscopy to enhance the appearance of vessels or eliminate the negative effects of dry skin

  • There is contact nonpolarized dermoscopy

    • Some criteria can be better visualized with polarized dermoscopy such as small vessels and blue-white color.

    • Some criteria can be better visualized with nonpolarized contact dermoscopy such as milia-like cysts seen in seborrheic keratosis and melanocytic lesions

    • Crystalline structures (a.k.a. shiny white structures) can only be seen with polarized dermoscopy

    • All the criteria needed to make a dermoscopic diagnosis can be made using any form of the technique

BENEFITS OF DERMOSCOPY

  • Helps to differentiate melanocytic from nonmelanocytic skin lesions

  • Helps to differentiate benign from malignant skin lesions

  • With dermoscopy, the sensitivity to diagnose melanoma is 85% and better compared to 65 to 80% when the technique is not used

  • Increases the diagnosis of early melanoma

  • Increases the diagnosis of amelanotic and hypomelanotic melanoma

  • Increases the diagnosis of melanoma incognito (false negative melanoma)

  • Increases the diagnosis of inflammatory lesions (ie, lichen planus, psoriasis, seborrheic dermatitis)

  • Increases the diagnosis of infestations (ie, scabies, head and crab lice)

  • Increases the diagnosis of hair shaft pathology (ie, monilethrix, trichorrhexis invaginata)

  • Helps to avoid unnecessary surgery

  • Helps to plan surgery

  • Helps to work better with a pathologist (asymmetrical high-risk criteria, dermoscopic–pathologic correlation)

  • Patient reassurance

  • Allows for follow-up of patients with a single nevus or multiple nevi digitally to find changes over time

Dermoscopic Digital Monitoring

  • There are pigmented skin lesions that are not high risk enough to warrant immediate histopathologic diagnosis, yet not so banal that there is no concern at all

  • There are melanomas that do not appear to be high risk clinically or with dermoscopy

  • They are only diagnosed after monitoring for dermoscopic changes over time when comparing baseline with subsequent digital images

  • Short-term monitoring is performed every ...

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