- Ivan Bristow
Seeing the light - the rise of dermoscopy in dermatology
Dermoscopy as a clinical aid to decision making has shown to improve the early detection of melanoma and other skin tumours over visual clinical examination. A recent study has been published in the British Journal of Dermatology which demonstrated that 89% of responding Dermatologists regularly use a dermatoscope in their practice . As a technique, it has seen a dramatic rise in popularity from the late 1980’s when it was first introduced and discussed in the dermatological literature. As a measure of this success, in 1990 you would find only 13 published papers on the subject available through PUBMED. Repeat that search today and the number of papers indexed is just short of 4000. The rise in popularity follows the increase in evidence supporting its utility over traditional methods. Initially, a technique practiced in specialist tertiary dermatology centres, we now see its regular use in dermatology departments and primary care. As is often quoted, the dermatoscope has become as important to a dermatologist as a stethoscope is to a physician. The ability to clearly visualise skin lesions at 10 times magnification has opened up a whole new world of visible structures, patterns and features which aid in the diagnosis of skin lesions.
In 2009, myself and Jonathan Bowling published one of the first papers on dermoscopy specifically aimed at introducing this technique to podiatrists . This paper in 8 years has been accessed over 7000 times and cited by other papers. But has dermoscopy really taken off in podiatry though? Well, since that time there have been few papers published in the American and UK podiatric literature on the topic but much of this knowledge could be readily obtained through the dermatological literature. Seminal work on dermoscopy of the acral areas  and nail unit [4, 5] has increased our knowledge and understanding of how these lesions on the foot may present and how they may be recognised earlier with the aid of dermoscopy. However, has the technique really become part of regular podiatric practice? Probably not but what have been the barriers?
When chatting to most podiatrists with an interest in dermatology, the most frequently quoted barrier is the lack of training and knowledge available. “Its all well and good to have a dermatoscope but what’s the use if I don’t know how to use it”? Increase in its use can only come through training and education. There are now more courses on offer than ever before. A number of dermoscopy courses are held annually with in the UK (and I will add these details to this website here). Coupled with this, a quick glance on the internet will highlight a plethora of free instructional videos – over 2000 according to my search under the simple term “dermoscopy”. My particular favourite is the “Dermoscopy made easy” series of videos presented by Ian McColl, a dermatologist based in Queensland, Australia. If you are curious about dermoscopy, I would recommend watching the “Watch & Learn: Dermscopy” video on youtube” (https://www.youtube.com/watch?v=dHXOwNU4tYY) which gives a simple overview on what it is. For the traditionalists, there are also a range of books on the subject and I would recommend the texts from renowned authors such as Bowling, Soyer, Johr and Menzies.
The cost of the equipment should not be off putting either. There are a range of dermatoscopes available and the good news is that they don’t wear out and rarely breakdown. With the advent of smart phones there is an increasing range of these devices specifically designed for simple attachment to smartphones allowing an image to be taken and stored on the device quickly. A quick and useful introductory guide is provided by Dr Jonathan Bowling on his dermoscopy website (http://www.dermoscopy.co.uk/faq.html). On this page, he highlights the various types and their advantages. However, I would strongly recommend trying individual devices out for yourself. These are frequently available in the exhibition halls at dermatology and podiatry meetings. So if you are unsure, please have a look at some of these resources and see what you think. Dermatology is a visual subject and dermoscopy can only help to highlight this.
1. Forsea, A.M., et al., Factors driving the use of dermoscopy in Europe: a pan-European survey. Br. J. Dermatol., 2016. 175(6): p. 1329-1337.
2. Bristow, I.R. and J. Bowling, Dermoscopy as a technique for the early identification of foot melanoma: a review. J. Foot Ankle Res., 2009. 2(14).
3. Miyazaki, A., et al., Anatomical and histopathological correlates of the dermoscopic patterns seen in melanocytic nevi on the sole: a retrospective study. J. Am. Acad. Dermatol., 2005. 53(2): p. 230-6.
4. Hirata, S.H., et al., Dermoscopic examination of the nail bed and matrix. Int. J. Dermatol., 2006. 45(1): p. 28-30.
5. Koga, H., T. Saida, and H. Uhara, Key point in dermoscopic differentiation between early nail apparatus melanoma and benign longitudinal melanonychia. The Journal of Dermatology, 2011. 38(1): p. 45-52.