Dermatoscopy, also known as dermoscopy, is a non-invasive diagnostic technique that allows thorough in vivo examination of skin lesions. By using a handheld device called a dermatoscope, structures not normally visible to the naked eye such as pigment network, streaks, dots and globules can be seen in the epidermis and dermis. This aids early detection of skin cancers and other skin conditions.

What is a Dermatoscope?

A dermatoscope is a handheld device consisting of a lens and a light source that transmits visible light through skin layers. This allows for 10 times magnification of structures in the epidermis and superficial dermis. Dermatoscopes are either polarized light or immersion oil based. Polarized light dermatoscopes use crossed polarized filters to block out surface reflections from the skin. Immersion oil based models require application of fluid onto the skin to fill gaps between the lens and skin surface to improve contrast. Both types of dermatoscopes provide a closer look at morphological patterns within pigmented lesions.

Major Components of a Dermatoscope

All dermatoscopes have the following basic components:

Lens: Provided magnification ranging from 5x to 30x. Higher magnification allows for better visualization of finer structures.

Light Source: Either LEDs or halogen bulbs illuminate the skin lesion evenly from above.

Polarized Filters: Polarized light models use crossed polarizing filters to eliminate skin surface glare.

Immersion Fluid Chamber: Immersion oil based dermatoscopes have a well around the lens that holds transparent fluid applied to the skin.

Attachment Camera: Many recent models can connect to a mobile/tablet via Bluetooth for documentation and teleconsultation.

How is a Dermatoscopy Exam Performed?

The examination involves the following steps:

1. Cleanse the area to be examined and remove any surface dirt, oil or debris.

2. Apply immersion fluid for oil immersion models or place the lens gently on the skin for polarized light models.

3. Hold the dermatoscope steady above the lesion and slowly scan the entire area with both low and high magnification.

4. Identify relevant pigment networks, globules, dots, streaks and morphological features.

5. Compare findings to dermoscopic images of common benign and malignant lesions for differential diagnosis.

6. Photograph representative views of the lesion for documentation and comparison over follow ups.

Benefits of Dermatoscopy in Clinical Practice

Dermatoscopy has many advantages over visual inspection alone:

Earlier Detection of Melanoma and Non-Melanoma Skin Cancers

Studies show dermatoscopy increases the diagnostic accuracy of pigmented skin lesions from 50–60% to around 90%. This allows lesions to be detected at thinner stages with less invasive treatment options.

Reduce Unnecessary Excisions

Features seen on dermatoscopy can help distinguish between benign pigmented nevi from malignant melanoma, reducing excision of benign lesions.

Monitor Changing Lesions

Serial digital dermatoscopy photos allow monitoring of evolving characteristics within pigmented lesions. Significant changes indicate a need for biopsy.

Examine entire Body Surface Area

The portable nature of dermatoscopes means the entire body surface including hard to visualize areas like the scalp and back can undergo surveillance for new or changing lesions.

Teachings Tool for Trainees

Dermatoscopy  provides a “windows to the base of the epidermis and superficial dermis”. This makes it an excellent educational tool to learn morphological patterns associated with various skin disorders.

In Summary

Dermatoscopy is an important non-invasive auxiliary diagnostic method in dermatology and skin cancer screening. By providing 10x optical magnification of skin lesions, it reveals subtle features invisible to the naked eye aiding early diagnosis and management decisions. With further research and technological advancements, its clinical applications are sure to expand in the years to come.

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