Dermoscopy—The Ultimate Tool for Melanoma Diagnosis

Abstract

"We are beginning to move away from clinicopathologic diagnosis into an era of clinicoimaging diagnosis." This vision became a fact, as the dermatoscope represents nowadays the dermatologist stethoscope. This is not only because dermoscopy reveals a new and fascinating morphologic dimension of pigmented and nonpigmented skin tumors, but also because it improves the recognition of a growing number of skin symptoms in general dermatology. Melanoma detection remains the most important indication of dermoscopy and in melanoma screening the aim of dermoscopy is to maximize early detection while minimizing the unnecessary excision of benign skin tumors. In the last few years, 3 meta-analyses and 2 randomized studies have definitely proven that dermoscopy allows improving sensitivity for melanoma as compared to the naked eye examination alone. This is the consequence of at least 3 issues: first, the presence of early dermoscopy signs that are visible in melanoma much before the appearance of the classical clinical features; second, an increased attitude of clinicians to check more closely clinically banal-looking lesions; third, an improved attitude of clinicians to monitor their patients.

Dermoscopic characteristics of melanoma according to the criteria „ulceration“ and „mitotic rate“ of the AJCC 2009 staging system for melanoma

“…Furthermore, the addition of dermoscopy can reduce the rate of excision for diagnostic verification significantly [3–5]. …”

Evaluation of electrical impedance spectroscopy as an adjunct to dermoscopy in short-term monitoring of atypical melanocytic lesions

“…It is a tool that helps the clinician to assess and differentiate between melanocytic and non-melanocytic lesions and determine whether they are benign or malignant. Several diagnostic algorithms can be used (e.g., pattern analysis, 7-point checklist, ABCD, Menzies’ scoring method) [1,2]. Although dermoscopy is a very good complement to clinical evaluation, there will always be some lesions that lead to diagnostic uncertainty.…”

New Trends in Dermoscopy to Minimize the Risk of Missing Melanoma

“…In other words, they were tested on lesions that were already worrisome from a clinical point of view. Today, dermoscopy is not considered a second-line method for further evaluation of clinically equivocal lesions, but, instead, it represents a first-line tool for screening of patients with few or multiple nevi [1]. Under this scenario, dermoscopy is often employed to detect early melanoma among a plethora of clinically banal moles.…”

“…During the last decades, induction of dermoscopy in the clinical setting resulted in significant modifications in the management of melanocytic lesions [1]. Incidence of melanoma increases more rapidly than any other cancer, and this has partially been attributed to the development of highly sensitive diagnostic techniques—mainly dermoscopy—, which allowed the detection of clinically not identifiable tumors [2].…”