Dermatoscopy can Impact Biopsy Method

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Dermatoscopyhas impacted diagnostic accuracy for skin malignancy to the extent that this now has the potential to influence choices of surgical biopsy procedures for the benefit of patients. For this potential to be realised dermatoscopy and surgical decision-making need to be integrated. This can happen in dermatology, primary care and surgical practice. This editorial will consider what is possible by applying recent advances in dermatoscopy to optimise decisions on biopsy method in the management of all suspected skin malignancies, both melanocytic and non-melanocytic.

Dermatoscopyis a relatively recent non-invasive diagnostic tool only having made an impact on the management of skin malignancy in the last 30 years. It was shown to significantly improve diagnostic accuracy for pigmented melanocytic lesions as early as 2001 and for pigmented non-melanocytic lesions in 2010 but it was not until 2018 that dermatoscopy was shown to improve diagnostic accuracy for non-pigmented skin lesions in general. In Australia and New Zealand, the countries with the highest incidence of skin cancer in the world, dermatoscopy has been standard of care with respect to the management of pigmented skin lesions since 2008. Parallel to the compelling evidence for its efficacy the uptake of dermatoscopy is increasing as evidenced by membership of the International Dermoscopy Society, now exceeding 14,000 individuals from 168 countries.

Dermatoscopyuse varies world-wide which is understandable with technology which did not exist when senior dermatologists, surgeons and general practitioners (GPs) were trainees. A cross sectional study in the USA in 2010 reported that 79% of dermatologists had used a dermatoscope. In a survey in the UK in 2012, 98.5% of respondents, mainly consultant dermatologists and registrars reported regular dermatoscopy use. A survey on dermatoscopy use by Australian dermatologists published in 2011 reported a rate of 98% compared to 33% for Australian GPs in 2007.