Dermoscopy

Dermoscopy (aka dermatoscopy, epiluminescence microscopy, reflected light microscopy, skin surface microscopy) is a non invasive diagnostic technique, based on an optical instrument  (dematoscope), wich enables the visualization of morphologic criteria of the skin surface, not otherwise distinguishable by the naked eye.

The differential diagnosis of pigmented skin lesions represents a challenge for the clinician, but dermoscopy allows a detailed assessment of pigmented lesions improving the diagnostic efficacy and the detection of melanoma and other suspected malignant skin lesions.

This technique, though rudimentary, was already known in the second half of 19th century.

A first radical improvement of  in vivo skin microscopy was operated in 1949  by Leon Goldman who created a hand held microscope with a 10 fold magnification lens and an incandescent wire lamp to enlight the skin surface in epiluminescence.

In 1980, Peter Fisher's work team gave a substantial boost to the technique, describing, for the first time, the pigmented network.

Later, in 1987, austrian authors Hubert Pehamberger, Andreas Steiner and Klaus Wolff  introduced the term “epiluminescence microscopy .”

On a revision of more than 3.000 cases of pigmented skin lesions, they developed the pattern analysis method for the diagnosis of lesions, posing the diagnostical criteria to distinguish between a malignant and a benign lesion.

Over the last 10 years, this technique has been further implemented, thanks to the design of more precise and sensitive instruments and, reviewed in numerous scientific pubblications, eventually gaining a full reliability in the diagnosis of melanoma.

Recently, a number of statistical studies demonstrated the greater diagnostic accuracy when performing a dermoscopic exam in the detection of malignant pigmented skin lesions.

In the last few years, starting from a sperimental technique performed only in few centers, dermoscopy has become a standard day hospital exam  for oncologists, first care doctors and other specialists dealing with pigmented skin lesions and early recognition of melanoma.

Dermoscopy allows the differential diagnosis of suspected skin lesions, enables clinicians to detect 20% more melanoma cases than in the past and  is extremely useful when deciding to excise a suspected naevus.