Dermoscopy (epiluminescent microscopy)

Dermoscopy (epiluminescent microscopy) is a technique of examining the skin with a lighted microscope. In this technique, the lighted lens of a microscope is placed directly on a lesion to be examined. A small amount of fluid is placed between the lens and the skin. Under normal conditions, the top layer of the skin (stratum corneum) prevents the eye from seeing the underlying skin structures. With dermoscopy, the stratum corneum is “eliminated”, because the interaction of the liquid and lens renders it translucent. Thus, the physician is able to see what lies beneath the top layer of skin. The advent of epiluminescent microscopy has allowed dermatologists to examine suspicious spots for skin cancer with a new level of precision. The method has increased the chances of melanoma detection by about 10 to 27%. Additionally, dermoscopy reduces the number of unnecessary biopsies.

It is incredible that with all the benefits of dermoscopy in detecting skin cancer, only a small minority of dermatologists is familiar with the method. Even a smaller number use it in their practice regularly. There are multiple reasons for this. First, the technology is relatively new. It takes a while for members of the medical community to accept new methods. Second, dermoscopy is not easy to learn. Training in dermoscopy is required. The American Academy of Dermatology provides physicians with courses where the method is taught. Some residency programs have started introducing epiluminescent microscopy into their training. Additionally, many months or years are needed after the initial training until the novice physician becomes fully experienced with dermoscopy. There is no doubt that dermoscopy has a significant learning curve for physicians.

Unfortunately, dermoscopy is not yet the standard of dermatologic care in the United States. In Europe, on the other hand, this method is universally accepted. In fact, many patients there will refuse to see a dermatologist who does not use dermoscopy. I feel that dermoscopy often allows me to detect skin cancer at a much earlier stage than would an examination using the naked eye. It has transformed my practice of dermatology.

Alexander Doctoroff, D.O., F.A.O.C.D.
Assistant Chief of Dermatology, Veterans Administration Medical Center
East Orange, New Jersey
Assistant Clinical Professor of Medicine,
University of Medicine and Dentistry of New Jersey.