Dermlite DL5 showing the question, "Which dermatoscope is best for diagnosing melanoma?"

"Which dermatoscope is best for diagnosing melanoma?"

Not too infrequently, customers will directly ask, โ€œwhich dermatoscope is best for diagnosing melanoma?โ€

Those of you who are truly into dermoscopy understand that there's no single answer to that question. Dermatoscopes do vary in their features, but most would agree that ๐—ถ๐˜'๐˜€ ๐—ฎ๐—ฐ๐˜๐˜‚๐—ฎ๐—น๐—น๐˜† ๐˜๐—ต๐—ฒ ๐—ฑ๐—ฒ๐—ฟ๐—บ๐—ผ๐˜€๐—ฐ๐—ผ๐—ฝ๐—ถ๐˜€๐˜ (๐—ฎ๐—ป๐—ฑ ๐˜๐—ต๐—ฒ๐—ถ๐—ฟ ๐˜€๐—ธ๐—ถ๐—น๐—น ๐—น๐—ฒ๐˜ƒ๐—ฒ๐—น) ๐˜„๐—ต๐—ถ๐—ฐ๐—ต ๐—บ๐—ฎ๐—ธ๐—ฒ๐˜€ ๐˜๐—ต๐—ฒ ๐—ด๐—ฟ๐—ฒ๐—ฎ๐˜๐—ฒ๐˜€๐˜ ๐—ฑ๐—ถ๐—ณ๐—ณ๐—ฒ๐—ฟ๐—ฒ๐—ป๐—ฐ๐—ฒ.

That being said, there are some general "rules of thumb" that those who are new to dermoscopy should consider:

Larger is (Arguably) Better

๐—Ÿ๐—ฎ๐—ฟ๐—ด๐—ฒ๐—ฟ-๐—น๐—ฒ๐—ป๐˜€๐—ฒ๐—ฑ ๐—ฑ๐—ฒ๐—ฟ๐—บ๐—ฎ๐˜๐—ผ๐˜€๐—ฐ๐—ผ๐—ฝ๐—ฒ๐˜€ ๐—ฎ๐—ฟ๐—ฒ ๐—บ๐—ผ๐—ฟ๐—ฒ ๐—น๐—ถ๐—ธ๐—ฒ๐—น๐˜† ๐˜๐—ผ ๐—ถ๐—ป๐—ฐ๐—น๐˜‚๐—ฑ๐—ฒ ๐˜๐—ต๐—ฒ ๐—ฒ๐—ป๐˜๐—ถ๐—ฟ๐—ฒ ๐—น๐—ฒ๐˜€๐—ถ๐—ผ๐—ป ๐˜„๐—ถ๐˜๐—ต๐—ถ๐—ป ๐˜๐—ต๐—ฒ ๐—ณ๐—ถ๐—ฒ๐—น๐—ฑ ๐—ผ๐—ณ ๐˜ƒ๐—ถ๐—ฒ๐˜„ (๐—™๐—ข๐—ฉ). Some dermatoscopes, like the DL100, Carbon, and DL1 have lenses which are relativelyย small at only 15mm in diameter.ย 

Most "serious" dermoscopists tend to buy dermatoscopes which have lenses that are twice as large (or more). For example, the DL5's lens measures 32mm in diameter, the DL4's lens measures 30mm, and the DL200ย line measures 25mm.

When you're dealing with a large lesion that doesn't "fit" within the FOV, one could argue that not seeing the entire lesion at once could potentially increase the likelihood of something being missed. But this is just speculation, as there's really no evidence that smaller lenses result in increased errors.ย 

One thing is for sure though, which is that larger lenses are more convenient and comfortable to use - no shifting, moving around, scanning in "sections" is needed.

Magnification of 10x

๐— ๐—ฎ๐—ด๐—ป๐—ถ๐—ณ๐—ถ๐—ฐ๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—ผ๐—ณ ๐Ÿญ๐Ÿฌ๐˜… ๐—ถ๐˜€ ๐—ฐ๐—ผ๐—ป๐˜€๐—ถ๐—ฑ๐—ฒ๐—ฟ๐—ฒ๐—ฑ ๐˜๐—ต๐—ฒ "๐˜€๐˜๐—ฎ๐—ป๐—ฑ๐—ฎ๐—ฟ๐—ฑ" ๐—ณ๐—ผ๐—ฟ ๐—ฝ๐—ถ๐—ด๐—บ๐—ฒ๐—ป๐˜๐—ฒ๐—ฑ ๐—น๐—ฒ๐˜€๐—ถ๐—ผ๐—ป ๐—ฒ๐˜ƒ๐—ฎ๐—น๐˜‚๐—ฎ๐˜๐—ถ๐—ผ๐—ป.

Nearly all dermatoscopes we offer provide 10x magnification, but some don't.ย 

For example, theย Lumio S is 4x. The Dermlite GL has two lenses, the strongest of which is 6x.ย 

All magnification levels will enhance your diagnostic accuracy, but in order to see some of the very subtle details, colors and structures that are most associated with melanoma, 10x is ideal.

Polarization is Non-Negotiable

All Dermlite and Lumio devices offer at least polarized lighting. Some devices will additionallyย offer non-polarized (or "linear-polarized") lighting, which allows for enhancement of surface features.ย 

But when it comes to pigmented lesions, nearly all visual clues to melanoma are found beneath the glare of the stratum corneum.ย In fact, one of theย most significantย dermoscopic signs of melanoma -โ€œshiny white lines" (aka, โ€œshiny white streaksโ€) - can only be seen under polarized light!

The "X-Factor" (Which No One Likes to Admit)

The largest lens and highest magnification won't make a difference if the dermatoscope itself isn't being used.ย 

This is one of the reasons why, for some docs, owning two dermatoscopes would actually be the ideal setup.ย 

For those who don't carry their dermatoscope with them into every examination, the question is, "why?'

"I don't like to carry anything too bulky or heavy."

For those who feel this way, a smaller/lighter dermatoscope like the GL or DL1 would be a great "carry around" dermatoscope. The limitations of either could be offset by also owning a higher magnification and/or larger-lensed dermatoscope (such as the DL200, DL4, or DL5) which could be pulled out "only as needed" for closer exam when a more unusual lesion warrants doing so.

"I don't like squinting through a dermatoscope all day long."

For those who don't like to squint, a larger-lensed dermatoscope like the Lumio S would be a great "carry around" dermatoscope. Its magnification limits could be offset by also owning a 10x dermatoscope which could be used "here and there" when particularly suspicious lesions need a closer examination.

The Verdict

The verdict is thatย there is no single best dermatoscope for diagnosing melanoma.

If regardless of the size, weight, or shape of a dermatoscope, youย knowย that you'll use it consistently during all skin exams, then go for the largest-lensed, 10x Dermlite dermatoscope you can afford.

However, if other factors play an important role in your comfort (and willingness to use the dermatoscope regularly), there's nothing wrong with admitting that! Just be honest with yourself, and purchase whichever dermatoscope is light enough, large enough, or small enough that it motivates you to carry and use it regularly during all skin exams.

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