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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