Elsevier

The Lancet Oncology

Volume 2, Issue 7, July 2001, Pages 443-449
The Lancet Oncology

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Dermoscopy of pigmented skin lesions – a valuable tool for early

https://doi.org/10.1016/S1470-2045(00)00422-8Get rights and content

Summary

The clinical use of dermoscopy has uncovered a new and fascinating morphological dimension of pigmented skin lesions. Dermoscopy is a noninvasive diagnostic technique that links clinical dermatology and dermatopathology by enabling the visualisation of morphological features not seen by the naked eye. Close examination of pigmented skin lesions in this way increases the effectiveness of clinical diagnostic tools by providing new morphological criteria for distinguishing melanoma from other melanocytic and non-melanocytic pigmented skin lesions.

Section snippets

Current practice in the diagnosis of melanoma

During the past two decades, the frequency of melanoma has been increasing. Owing to the lack of adequate therapies for metastatic melanoma, the best treatment is still early diagnosis (Figure 1) and prompt surgical excision of the primary tumour.

In the 1960s and 1970s, the clinical diagnosis of melanoma was based on observable symptoms such as bleeding, itching, and ulceration, and the presence all of these at the time of diagnosis was associated with poor prognosis. In the 1980s, the ABCD

Classical pattern analysis

Dermoscopy has advanced from being an experimental method used in only a few highly specialised centres to become part of the normal practice for screening pigmented skin lesions in many outpatient clinics worldwide. This is mainly because of the simple diagnostic techniques involved. However, before dermoscopy can be more widely used in routine practice, it must become easier to do and more reliable. For this to happen, the diagnostic criteria must be standardised and simplified, and a more

Other diagnostic methods

There are three other approaches in addition to classical pattern analysis. The first attempt at simplifying the dermoscopic diagnosis of melanocytic skin lesions was a modification of the ABCD rule, which was introduced by Stolz and coworkers in 1994.9 This semiquantitative diagnostic method uses a scoring system to assess just four dermoscopic criteria. Nachbar and colleagues showed that this method was reproducible in a prospective study, and that it has specificity of 90% and sensitivity of

Integration of clinical and dermoscopic examinations

The greatest advantage of dermoscopy lies in increasing the preoperative diagnosis of melanoma. Although clinical examination allows a correct diagnosis in 65–80% of melanomas, depending on the examiner's experience,4 the proportion of correct diagnoses based on dermoscopic observation ranges from 70–95%.16, 17, 18, 19, 20, 21 Nevertheless, individually, neither method enables the correct diagnosis of all melanomas. Great progress has been made recently in integrating dermoscopic examinations

Dermoscopic follow-up of pigmented skin lesions

There are two reasons why a patient must be examined over time. First, some patients run a high risk of developing melanoma (eg patients with a personal or family history of melanoma, a high number of naevi, or skin phototype I or II), so should be monitored periodically. Second, morphological changes eventually occur in melanocytic naevi, and objective, long-term observation is necessary to monitor those changes.25 This approach is even more important for monitoring patients who have many

Teledermoscopy

When family doctors in rural areas, without access to specialised equipment or knowledge, have doubts about diagnosing and treating certain pigmented skin lesions, they are obliged to refer their patients to consultants in larger specialist centres. This procedure is time-consuming and costly for both the patient and the health service involved.

Recent advances in information technology have permitted the introduction of a revolutionary diagnostic system known as telemedicine, which enables

Automatic diagnosis

Another exciting and fascinating approach in the diagnosis of pigmented skin lesions is the automatic analysis of dermoscopic images, which seeks to increase the reliability of melanoma diagnosis carried out by non-expert clinicians. These new developments initially concentrated on the study of the clinical features of melanoma and are now moving rapidly in the direction of the digital analysis of dermoscopic images. Table 2 summarises the diagnostic effectiveness of different automatic

Future considerations

Several problems in the diagnosis of pigmented skin lesions remain unresolved. The most urgent problem is the need for standardisation of diagnostic criteria and methods. A virtual Consensus Net Meeting which was held between July and October last year aimed to provide such a standard. Participants in the meeting included experts in dermoscopy, who tested the reproducibility of the dermoscopic variables, together with the repeatability and reliability of various diagnostic algorithms.

Conclusions

Developments in dermoscopic diagnostic methods, the integration of dermoscopic and clinical examinations, the new possibilities offered by digital instruments for follow-up examination of pigmented lesions, teledermoscopy and the automatic diagnostic systems all reflect the direction in which dermoscopic research is heading. Over the past few years, several research groups have helped to perfect the diagnostic criteria for the application of dermoscopy, enabling the precise characterisation of

Search strategy and selection criteria

Published data up to 2000 were available to us for this review. Publications were identified through PubMed and our own database of dermoscopy publications. Papers submitted on the same topic by the same group of investigators to several journals were reviewed to identify one that was representative of the results. Case reports and (in most cases) preliminary results were excluded, and larger studies were selected instead.

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