Page 28 - Noninvasive Diagnostic Techniques for the Detection of Skin Cancers
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               dermatologist who developed tonic pupil (Adie’s pupil) after intensive use of a dermoscope.
               There has been some concerns that dermoscope could serve as a potential source of nosocomial
               infection because Staphylococcus aureus had been isolated from dermoscopes that used mineral
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               oil as immersion fluid;  although another group of investigators felt that the potential risk of
               nosocomial infection related to the routine use of dermoscopes in an outpatient setting was
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               small.  Disinfecting dermocopes with 70-percent isopropyl alcohol  or using alcohol-based
               antibacterial gel as immersion fluid were reportedly effective in reducing or eradicating potential
               pathogens. 63,64  One key informant informed us that most dermatologists today who practice
               dermoscopy use alcohol as an immersion fluid.
                   Binder and colleagues, in a 1999 letter, cautioned the use of standard immersion oil for use in
               contact dermoscopy because it may contain chlorinated paraffin and dibutyl phthalate, both of
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               which could be teratogenic and carcinogenic.  The authors suggested the use of olive oil,
               glycerin, or ultrasonic conduction gel instead.

               Variations of Technique
                                                                                   ®
                   •  Dermoscopy without image capture features.  14,66  The Dermlite  handheld dermoscopic
                       device is comparatively inexpensive ($300-$1000). Test accuracy varies depending on a
                       user’s experience. This device does not identify “featureless” or very early melanomas.
                   •  Dermoscopy with image capture features.  14,66  These devices are equipped with a digital
                       camera that captures dermoscopic images, and can store the digital images of pigmented
                       lesions and identify changes over time.
                   •  Dermoscopy with image capture features and analytical capability. 14,66,67  These devices
                       are equipped with both a digital camera and computer software. They can extract and
                       save clinical and dermoscopic information. Purported advantages are that these devices
                       can be used by nonexperts, and they provide objective and reproducible results. Some of
                       the systems provide computerized diagnostic results.


               Clinical Context of Use
                   Dermoscopy may have different intended purposes depending on the clinical setting. In a
               primary care setting, dermoscopy could be used primarily to help a clinician decide whether to
               refer a patient’s suspicious skin lesion(s) for dermatology consultation. In a dermatology setting,
               dermoscopy could be primarily used to help improve the diagnosis of melanocytic and non-
               melanocytic nevi and help monitor patients with multiple nevi.
                   Clinical settings in the abstracts reviewed were almost all based in dermatology offices or
               pigmented lesion clinics. Of the 400 plus abstracts, only seven were based in primary care
               settings.
                   A 2009 survey reported that 48 percent of U.S. dermatologists (1555/3209) are dermoscopy
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               users (n=1555), while 52 percent are nonusers (n=1654).  Among 1555 dermoscopy users, the
               types of dermoscopy used are: polarized light noncontact dermatoscope (54.7 percent),
               nonpolarized light immersion dermatoscopes (30.0 percent), and polarized light contact
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               dermatoscopes (21.8 percent).  Dermoscopy was principally used in the assessment of patients
               with pigmented lesions (70.7 percent of patients); the remainder of patients had nonpigmented
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               lesions (28.6 percent ) or papulosquamous conditions (8.8 percent).  Another 2009 survey
               reported that 88 percent (81/92) of dermatology residents were using dermoscopy and the
               authors concluded that the use of dermoscopy has increased significantly during the last
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               decade.  One cohort study suggests that a dermoscopic followup program, tailored to the



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