Frequently Asked Questions About Dermoscopy

Frequently Asked Questions About Dermoscopy

Which dermatoscopes are polarized?

All dermatoscopes sold on our website are polarized. However, some of the Dermlite and Lumio dermatoscopes do not offer the option of “non-polarization” light mode. For example, the DL100, DL200 HR, and the Dermlite GL are “polarized only” dermatoscopes. On the other hand, the Carbon, DL200 Hybrid, Handyscope, DL3N, DL4, DL4W, DL5, Lumio S, Lumio 2, and (original) Lumio all offer both polarized and non-polarized lighting.

Which dermatoscope can be used to take pictures?

Any of the Dermlite dermatoscopes which are "MagnetiConnect-compatible" can be used to take pictures. However, there are no Dermlite dermatoscopes which directly take pictures and/or store images within the dermatoscope. That is, the dermatoscope allows smartphones, tablets, etc. the ability to view lesions much more closely, under polarized lighting, etc., but the actual "picture" can only be taken on the smartphone's (or tablet's) camera (which, in turn, is stored on that smartphone or tablet and/or uploaded from that smartphone/tablet to a computer).

Can non-Magneticonnect-compatible dermatoscopes take pictures?

Yes, photos can be taken with non-MagnetiConnect-compatible dermatoscopes, but only by manually holding the camera (or smartphone or tablet) up to the eyepiece of the dermatoscope and taking pictures without the benefit of direct “MagnetiConnect” connection.

Which dermatoscope is the newest?

The newest model in the Dermlite lineup is the Dermlite DL5, which was introduced in late 2022. The DL5 is generally considered the "best" dermatoscope available, at least with respect to available features. However, the main drawback to the DL5, at least for some, is its size and weight. Some clinicians find it to be a bit too large to carry throughout the day, which could help explain why the DL4 remains a very popular option.

Why is polarization important when performing dermoscopy?

Polarization is important when performing dermoscopy because it allows for the visualization of deeper structures in the skin, such as blood vessels and collagen, which are not as visible with nonpolarized dermatoscopes. Polarized light can penetrate deeper into the skin and capture backscattered light from the dermal layers, enhancing the visualization of the DEJ and dermal structures. Nonpolarized dermatoscopes are better for visualizing superficial structures in the epidermis, such as milia-like cysts. Familiarity with both nonpolarized and polarized dermoscopy is crucial for understanding the pertinent applications of each modality in the evaluation of pigmented and nonpigmented skin lesions.

Is dermoscopy possible without polarization?

Yes, dermoscopy is possible without polarization. Nonpolarized dermoscopy is another modality of dermoscopy that provides additional information beyond that gleaned by evaluating the lesion through a simple magnifying lens. It requires the use of a liquid interface and direct contact with the skin. For most pigmented and nonpigmented skin lesions, polarized and nonpolarized dermoscopy offer overall similar images. However, some dermatoscopes provide higher-quality visualization of dermoscopic structures and colors when used with immersion fluid and direct skin contact. Hybrid dermatoscopes have also been developed that allow the user to toggle between polarized and nonpolarized modes, but they should be applied using direct skin contact with a liquid interface. If this is not done, then the user will see dermoscopic structures only in the polarized mode, and no dermoscopic structures will be discernible with the nonpolarized mode; instead, the observer will simply see a magnified clinical (not dermoscopic) image of the surface of the lesion.

Is liquid always necessary when performing contact dermoscopy?

No, liquid is not always necessary when performing contact dermoscopy. While some dermatoscopes require the use of immersion fluid and direct skin contact for higher-quality visualization of dermoscopic structures and colors, other devices, such as those using cross-polarization, do not mandate the use of a liquid interface and do not require direct contact with the skin. However, it is important to note that PD typically requires stronger LED lighting to compensate for the photons blocked by cross-polarization.

Is dermoscopy only helpful for evaluation of pigmented lesions?

No, dermoscopy is helpful for the evaluation of both pigmented and nonpigmented skin lesions. Significant progress has been made in defining benign and malignant dermoscopic structures and patterns of both types of lesions, making dermoscopy a valuable clinical tool for the noninvasive, in vivo evaluation and diagnosis of cutaneous lesions. Familiarity with both nonpolarized and polarized dermoscopy is crucial to understanding pertinent applications of each modality in the evaluation of pigmented and nonpigmented skin lesions. Dermoscopy can also aid in the detection of pigmented structures that are not visible to the naked eye, helping to select appropriate treatments for nonpigmented basal cell carcinomas (BCCs) and detect residual/recurrent BCC after noninvasive treatments.

What’s the typical magnification used in dermoscopy?

Dermoscopy can be performed with the use of a handheld dermatoscope with 10-fold magnification. However, digital dermatoscopes ranging from 20- to 1000-fold magnification have the additional benefit of allowing more precise measurements of the visualized structures, making them suitable for monitoring disease severity.

To what degree does dermoscopy enhance the accuracy of diagnosis?

Dermoscopy significantly improves the specificity and sensitivity for the detection of skin cancer, including melanoma. Studies have shown that the use of dermoscopy alone can result in potential diagnostic pitfalls, so a more integrative approach to diagnosis is recommended to further improve diagnostic accuracy. Sensitivity measures the proportion of melanomas that are correctly diagnosed as suspicious and surgically removed, while specificity measures the proportion of benign lesions that are correctly diagnosed as benign and spared from unnecessary biopsies. Dermoscopy combined with sequential digital dermoscopy imaging (SDDI) has been shown to double the sensitivity for melanoma and reduce the excision or referral rate of benign lesions by more than 50%. The use of both techniques in a "multimodal approach" can increase melanoma diagnostic accuracy. Knowledge of histopathological correlates can also be helpful in accurately interpreting clinical and dermoscopic information.

What's the lightest dermatoscope currently available?

The Dermlite DL1 is currently the smallest, lightest, and most compact dermatoscope available.

Does insurance generally reimburse for dermoscopy?

Insurance coverage for dermoscopy varies depending on the specific insurance plan and provider. Some insurance plans may cover dermoscopy as a diagnostic tool for skin cancer screening, while others may not. It is recommended to check with your insurance provider to determine if dermoscopy is covered under your plan. Additionally, some dermatology clinics may offer dermoscopy as a self-pay service for patients without insurance coverage.

Which dermatoscopes offer UV light?

The Dermlite DL5 and the Lumio offer a UV light setting.

How is UV (Woods) lighting beneficial with respect to performing skin exams?

Fluorescence: Certain substances, such as skin cells infected with fungi or bacteria, will fluoresce when exposed to UV light. This means that they will emit light of a different color than the UV light that is shining on them. This can help doctors to identify and diagnose skin infections.
Differentiation of skin types: UV light can also be used to differentiate between different skin types. For example, fair-skinned people will have a more pronounced red or pink fluorescence than dark-skinned people. This can be helpful for doctors when making diagnoses and determining the best course of treatment.

The Dermlite DL5 is currently the only handheld dermatoscope which offers UV lighting as an option. 

The Lumio UV and the Lumio 2 both offer a UV light mode, but due to their size and lower magnification, they're better classified as "screening devices" rather than dermatoscopes.

Which dermoscopic signs are most specific for melanoma?

Asymmetry in the distribution of colors and structures within a lesion is considered the best predictor of malignancy, followed by blue-white structures and atypical network. Lesions with a total score of two or three points are considered positive, and a skin biopsy or referral is recommended. The three-point checklist has a sensitivity of 79% to 91% and a specificity of 71–72% for the diagnosis of melanoma and BCC. It is recommended that any pigmented lesion with focal adherent keratin or a rough texture that reveals an asymmetric dermoscopic pattern be considered suspicious so as to avoid missing the diagnosis of malignancy.

Can you describe the 3-point checklist?

The 3-point checklist is a skin cancer screening tool that has a high sensitivity for pigmented skin cancers, including pigmented BCC and melanoma. It includes three dermoscopic features: asymmetry of pattern and structures, blue-white structures, and atypical network. Asymmetry is defined as asymmetry in the distribution of dermoscopic color and/or structures in one or two perpendicular axes. Blue-white structures are defined as blue-white veil and/or white scarlike depigmentation and/or blue pepper-like granules. Atypical network is defined as pigment network with thick lines and irregular-sized holes.

What are some of the more common mistakes made when performing dermoscopy?

Some common mistakes made when performing dermoscopy include false positive and false negative diagnoses, which can result in unnecessary excisions of benign lesions or delays in detecting malignant tumors. Collision tumors, featureless lesions, and lesions presenting with structures characteristic of other diagnoses are also prone to misdiagnosis. It is important for dermoscopists to correctly assign weight to clues and avoid overvaluing unreliable or misleading clues. Experience and training are essential for mastering dermoscopy.

Can dermoscopy assist in the diagnosis of actinic keratoses?

Dermoscopy cannot always reliably differentiate pigmented actinic keratosis from lentigo maligna, but it may help guide the best location to biopsy. Biopsying areas revealing the most suspicious features, such as annular-granular structures, asymmetric follicular openings, dots within the ostial openings, or rhomboidal structures, may provide the pathologist with the most diagnostically relevant tissue to examine. However, caution should be exercised when not performing a complete biopsy of any lesion to exclude or confirm melanoma.

How does squamous cell carcinoma present in dermoscopy?

Squamous cell carcinoma can present in dermoscopy with atypical network and regression structures. Invasive SCC arising in pigmented Bowen's disease may show dermoscopic features of the latter, such as a dermoscopic blue and white structureless area as well as white circles. When evaluating nonpigmented tumors, dermatoscopists should consider clinical features, dermoscopic keratin clues, dermoscopic morphology of vascular structures, architectural arrangement and distribution of vessels seen under dermatoscopy, and additional dermoscopic criteria such as the rosette sign or strawberry pattern. Experienced dermoscopists are usually able to make a diagnosis in a few seconds, as the vast majority of skin neoplasms exhibit repetitive morphologic characteristics that are easily recalled and recognized. It is recommended to perform a total body skin examination on patients with a history of skin cancer, patients with a family history of melanoma, patients under the age of 50 years who present with more than 20 nevi on the arms, and patients over the age of 50 years who present with evidence of chronic solar damage.

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