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Not too infrequently, customers will directly ask, โwhich 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 ๐ถ๐'๐ ๐ฎ๐ฐ๐๐๐ฎ๐น๐น๐ ๐๐ต๐ฒ ๐ฑ๐ฒ๐ฟ๐บ๐ผ๐๐ฐ๐ผ๐ฝ๐ถ๐๐ (๐ฎ๐ป๐ฑ ๐๐ต๐ฒ๐ถ๐ฟ ๐๐ธ๐ถ๐น๐น ๐น๐ฒ๐๐ฒ๐น) ๐๐ต๐ถ๐ฐ๐ต ๐บ๐ฎ๐ธ๐ฒ๐ ๐๐ต๐ฒ ๐ด๐ฟ๐ฒ๐ฎ๐๐ฒ๐๐ ๐ฑ๐ถ๐ณ๐ณ๐ฒ๐ฟ๐ฒ๐ป๐ฐ๐ฒ.
That being said, there are some general "rules of thumb" that those who are new to dermoscopy should consider:
Larger is (Arguably) Better
๐๐ฎ๐ฟ๐ด๐ฒ๐ฟ-๐น๐ฒ๐ป๐๐ฒ๐ฑ ๐ฑ๐ฒ๐ฟ๐บ๐ฎ๐๐ผ๐๐ฐ๐ผ๐ฝ๐ฒ๐ ๐ฎ๐ฟ๐ฒ ๐บ๐ผ๐ฟ๐ฒ ๐น๐ถ๐ธ๐ฒ๐น๐ ๐๐ผ ๐ถ๐ป๐ฐ๐น๐๐ฑ๐ฒ ๐๐ต๐ฒ ๐ฒ๐ป๐๐ถ๐ฟ๐ฒ ๐น๐ฒ๐๐ถ๐ผ๐ป ๐๐ถ๐๐ต๐ถ๐ป ๐๐ต๐ฒ ๐ณ๐ถ๐ฒ๐น๐ฑ ๐ผ๐ณ ๐๐ถ๐ฒ๐ (๐๐ข๐ฉ). 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 ๐ฎ๐ด๐ป๐ถ๐ณ๐ถ๐ฐ๐ฎ๐๐ถ๐ผ๐ป ๐ผ๐ณ ๐ญ๐ฌ๐ ๐ถ๐ ๐ฐ๐ผ๐ป๐๐ถ๐ฑ๐ฒ๐ฟ๐ฒ๐ฑ ๐๐ต๐ฒ "๐๐๐ฎ๐ป๐ฑ๐ฎ๐ฟ๐ฑ" ๐ณ๐ผ๐ฟ ๐ฝ๐ถ๐ด๐บ๐ฒ๐ป๐๐ฒ๐ฑ ๐น๐ฒ๐๐ถ๐ผ๐ป ๐ฒ๐๐ฎ๐น๐๐ฎ๐๐ถ๐ผ๐ป.
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 -โshiny white lines" (aka, โshiny 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.