Dermoscopy – a New Diagnostic Approach of Pigmented Skin Lesions

Dermoscopy is a noninvasive diagnostic method, which is becoming increasingly reliable and, as a consequence, increasingly popular among dermatologists and patients. Especially in the field of pigmented skin lesions (PSLs), dermoscopy may add useful information to the clinical constellation, improving the diagnostic performance for early diagnosis of melanoma and for differentiating various melanocytic and nonmelanocytic pigmented lesions. This method has various other potential applications besides diagnosis, including lesion’s selection for biopsy, determination of appropriate therapeutic modalities, verification of treatment efficacy, and decision of surgical margins. What is dermoscopy ? The introduction of dermoscopy into the clinical practice of dermatology has disclosed a new and fascinating morphologic dimension of pigmented skin lesions (PSLs). Dermoscopy is a noninvasive, simple, and cheap diagnostic technique that permits the visualization of morphologic features that are not visible to the naked eye, thus forming a link between macroscopic clinical dermatology and microscopic dermatopathology. This submacroscopic observation of PSLs enriches the available clinical diagnostic tools by providing new morphologic criteria for the differentiation of melanoma from other melanocytic and nonmelanocytic PSLs. Over the past years, dermoscopy has been known by a variety of names, including skin surface microscopy, epiluminescence microscopy, incident-light microscopy, dermatoscopy, and video-dermatoscopy. The term “dermoscopy,” however, first used by Friedman et al. (1) in 1991, currently enjoys the greatest international consensus (2). Dermoscopy involves covering the skin lesion with mineral oil, alcohol, or even water and then inspecting the lesion with a hand-held lens, a hand-held scope (also called a dermatoscope), a stereomicroscope, a camera, or a digital imaging system. Magnifications of these various instruments range from x 6 to x 40 and even up to x 100. The widely used dermatoscope has a 10-fold magnification that is sufficient for routine assessment of PSLs. The fluid placed on the lesion eliminates surface reflection and renders the cornified layer translucent, thus allowing better visualization of pigmented structures within the epidermis, the dermal–epidermal junction, and New hand-held dermatoscopes are now available on the market that are provided with polarized light, rendering the fluid placed on the lesion unnecessary for inspecting pigmented skin structures. The current practice in the diagnosis of melanoma In the last 2 decades, a rising incidence of melanoma has been observed. Because of the lack of adequate therapies for metastatic melanoma, the best treatment currently is still early diagnosis and prompt surgical excision of the primary tumor. The current practice in the diagnosis of melanoma is based on the ABCD rule, which