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  • 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.


  • Dermoscopy is an in vivo, noninvasive technique in which oil or fluid (eg, mineral oil, gel, alcohol, 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 (aka 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.


  • 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 with 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 (clinically false-negative melanoma).

  • Increases the diagnosis of inflammatory lesions (ie, lichen planus, psoriasis, seborrheic dermatitis, rosacea, discoid lupus erythematosus, granulomatous diseases).

  • Increases the diagnosis of infestations (eg, scabies, head lice, crab lice).

  • Increases the diagnosis of alopecia (eg. androgenic alopecia, alopecia areata) and hair shaft pathology (eg, monilethrix, trichorrhexis invaginata).

  • Helps to avoid unnecessary surgery.

  • Helps to plan surgery.

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

  • Patient reassurance.

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


  • 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 ...

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