Dermoscopy (and photography) - an overview

This section is split into four parts:

  • Introduction
  • Training
  • Choosing a dermatoscope
  • Taking photographs - clinical and dermoscopic

Acknowledgements: I would like to thank Dr Chin Whybrew who has done much to develop this section of the website, as well as Dr Kash Bhatti who runs the PCDS Facebook Dermoscopy Group.


Introducing dermoscopy 

Basic skin lesion recognition

  • The first step in lesion recognition involves having a good understanding of the history and naked-eye examination. The PCDS run day courses (ED1) part of which include skin lesion recognition
  • As the next step it is worth considering the use of 10-LED Scale Loupe Magnification devices that help better identify common benign non-melanocytic lesions such as seborrhoeic keratoses, dermatofibroma and angioma. The attached document provides an introduction in to this technique and how it can be used to help reduce referrals. Such devices are not recommended for more intermediate-advanced skin lesion recognition for example in the assessment of melanocytic lesions when dermatoscopes along with specific dermoscopy learning is required

Dermoscopy introduction

  • In the right hands dermoscopy can help with the recognition of both non-melanocytic and melanocytic skin lesions, both benign and cancerous. As with the above it must not be used in isolation but instead combined with a good history and naked eye examination

Who can perform dermoscopy?

  • Dermoscopy interpretation can be performed by dermatologists, GPwERs and GPs who have undertaken appropriate training in the technique. In an ideal world one GP per practice should be upskilled in this technique. The taking of photos through a dermatoscope may be done by a suitably trained member of the team, including medical photographers, nurses, HCAs, or allied health professionals. However, if taking photos for someone else to interpret, more information may be needed, and services need to be carefully planned.

Which lesions are suitable for dermoscopy?

  • The main role of dermoscopy in Primary Care is to help identify benign lesions. The majority of seborrhoeic keratoses, angioma, dermatofibroma and blue naevi can be readily identified with a dermatoscope. This can help reduce referrals / unnecessary skin surgery
  • Dermoscopy can be used to diagnose some melanomas
  • Dermoscopy can also aid in the diagnosis of pre-cancerous lesions such as actinic keratoses and Bowen's disease, as well as basal cell carcinoma
  • Considerable experience is often required to differentiate between some benign melanocytic naevi, atypical naevi and melanoma, indeed some cases of melanoma have very subtle dermoscopic features. Accordingly, all melanocytic lesions suspicious of melanoma in terms of the history and naked-eye examination should be referred urgently to Secondary Care as a 2 Week Rule, regardless of their dermoscopic appearance
  • Dermoscopy can be used to aid in the diagnosis of general dermatology inflammatory dermatoses and rashes, infections such as scabies and lice, and hair and nail disorders

Training needed for dermoscopy

​Recognised conferences 

Use this website

  • The PCDS Facebook Dermoscopy Group - PCDS membership required 
  • The clinical chapters incorporate both clinical and dermoscopic images

Hands on experience

  • Arrange to sit in on local dermatology clinics
  • Once you start using the dermatoscope use it for every lesion, even if you know the lesion is benign

Dermoscopy blogs

These are a great way to learn about dermoscopy. The more recently developed blogs tend to use modern dermoscopic terminology. There are many blogs including:

  • Dr Tim Cunliffe - the dermoscopy blog can be found on the first column of this website. The layout of this site enables you to use a dermoscopic algorithm to work through each case
  • Dr Stephen Hayes of the PCDS has produced his own high quality dermoscopy website
  • Dr Eric Ehrsam's dermoscopy website

Online resources

Courses


Choosing a dermatoscope 

Dr Chin Whybrew has produced excellent information detailing different dermatoscopes:


Taking photographs - clinical and dermoscopic


Troubleshooting tips for taking images on (newer) phones

Which camera lens to use

    • One of the lenses will be the macro one - if you try the scope over each lens in turn, you should be able to work out which one it is 
    • However, if it keeps switching between lenses, you can also hold your finger a few cm away from the lens, and get the phone to focus on your finger. By moving your finger between the different lenses you can check which lens the camera is using 

    Phone keeps switching between camera lenses

    • If the phone keeps switching between camera lenses, once you have attached the scope (and you have checked which camera it wants to use for the dermoscopy), you may need to change the settings
    • Under camera settings, you need to find “macro control” and make sure it is turned ON
    • If you don’t have “macro control” but you do have “auto macro”, then you need to make sure “auto macro” is turned OFF

    Total whiteout

      • For some phones, the light from the scope is so bright that the camera simply shows whiteout, and you can’t see anything at all. This should be simple to fix, by switching to “portrait mode”

      The phone keeps changing settings each time you turn it on 

        • In camera settings, you can set it to “preserve settings” – this will keep it on the same settings as when it was last used
        • If you have used the camera for something else then you will need to reset