|What is the difference between epiluminescence microscopy, dermatoscopy and dermoscopy?
There is no difference at all --- just different names for the same technique. There are also some other terms still used for dermoscopy: surface microscopy, direct skin microscopy, incident light microscopy and skin videomicroscopy, just to name the most common ones. We consequently are using the term dermoscopy in order to escape from this "dermobabel"!
Why should a dermatologist start doing dermoscopy?
This question is easy to answer. Because she/he will increase her/his diagnostic accuracy for pigmented skin lesions in general and early invasive melanoma, including melanoma in situ in particular.
Why should a dermatologist buy digital equipment for dermoscopic examination?
With the various instruments already available, digital follow-up examinations of melanocytic skin lesions can easily be performed and so any change of a given lesion will be noticed resulting in a more accurate diagnosis. Unnecessary excisions of melanocytic nevi can therefore be reduced without increasing the risk of overlooking melanomas. We infer that the management procedure of pigmented skin lesions will change completely in the next years and new standards of care will replace the traditional management system.
Should dermoscopic examinations only be performed by experts?
This is a rhetorical question. Of course, experts will do better than non-experts. But the same is true for every field. We suggest that colleagues beginning with dermoscopy should rely as usual on their clinical judgement for the first months. Also, they should start to use dermoscopy for unequivocal lesions. In this way their knowledge and expertise in dermoscopy will gradually increase.
Will the automated diagnosis of pigmented skin lesions substitute for diagnosis by an experienced dermatologist?
We understand these concerns very well, but we do not think that machines will replace physicians. However, computer-aided or computer-assisted diagnosis of pigmented skin lesions will be helpful in decision-making for the clinical management of individuals with numerous melanocytic nevi. From an epidemiological point of view these new developments may be very helpful in decreasing the "melanoma epidemic."
Do we still need histopathology when performing dermoscopy?
Dermoscopy is a non-invasive clinical method that is currently used to supplement the traditional clinical diagnosis. With dermoscopy, morphologic features are visible that cannot be detected by the naked eye alone. Therefore, dermoscopy opens up a new dimension of clinical morphology that can be regarded as the missing link between clinical morphology and histopathology. Nevertheless, when a pigmented skin tumor is excised, conventional histopathologic examination is still the standard.
What are the limits of dermoscopy?
Dermoscopy allows visualization of the horizontal plane of a given skin lesion only to the level of the papillary dermis. Pathologic structures situated in the reticular dermis cannot be visualized at all (like with the naked eye). Moreover, heavily pigmented skin lesions are sometimes very difficult to diagnose dermoscopically. Amelanotic melanoma represents a particular diagnostic pitfall.
What type of immersion oil is best used for the dermoscopic examination?
Just normal immersion oil is fine, but also alcohol and even water can be used. Most of the digital instruments work with polarized lenses and there is no need for immersion oil.
What magnification is the best used for dermoscopy?
In our estimation, a 10-fold magnification works well for diagnosing pigmented skin lesions. For special purposes, such as the examination of the vasculature of a given skin tumor, higher magnifications up to 50-fold may be helpful.