Journal of Plastic, Reconstructive & Aesthetic Surgery
Correspondence and CommunicationsDermoscopy – time for plastic surgeons to embrace a new diagnostic tool?☆
Introduction
Dermoscopy is a non-invasive technique that can improve diagnostic accuracy of skin lesions.1 The technique is performed as an adjunct to clinical examination and involves use of a magnifying device with an integral light source applied to the skin with either a liquid interface or polarised light to visualise dermal and epidermal structures. Characteristic features of pigmented and non-pigmented lesions can be seen that are not evident to the naked eye.2
Early diagnosis with surgical excision delivers the best prognosis in patients with melanoma and limits morbidity in other cutaneous malignancies such as basal cell carcinoma.3 Dermoscopy can improve the management of skin tumours by enabling early diagnosis and excision of lesions (fewer false negatives) and excision of proportionately fewer benign lesions (fewer false positives).
Plastic surgeons are at the forefront of skin malignancy management, being involved in the local and specialist skin multidisciplinary team (LSMDT, SSMDT), development of guidelines and delivery of all aspects of primary tumour and nodal disease treatment. However, dermoscopy is not widely practiced. We set out to assess the potential of training in dermoscopy to improve diagnostic accuracy amongst a group of plastic surgeons.
Section snippets
Methods
We conducted a prospective paired cohort study to determine the effect of dermoscopy on diagnostic accuracy of skin lesions. Clinicians attending the First International Dermoscopy for Plastic Surgeons, Oxford, reviewed clinical photographs of 30 skin lesions (20 benign, 10 malignant) at the beginning of the course. The selection of images reflected a typical clinic case load with a mix of pigmented and non-pigmented lesions. Based on pure naked eye assessment, attendees were asked to mark each
Results
Thirty clinicians attended the course and completed the pre-course test. Twenty nine completed the post-course test. The accuracy of diagnosing malignant skin lesions by dermoscopy (sensitivity 64%, specificity 64%) was greater (relative odds ratio 5.2) than naked eye examination (56%, 44%, p < 0.05).
Dermoscopy also enabled surgeons to be more confident and accurate in leaving benign lesions. Specifically, the number of benign-leave lesions nearly doubled from 5.6 ± 0.6 to 9.7 ± 0.6
Discussion
Increasing public awareness has led to improved outcomes in patients with skin tumours, especially malignant melanoma.4 Early detection and surgical excision remains the most effective treatment but an overcautious approach to surgical diagnosis could rapidly swamp a tumour service and cause unnecessary morbidity. Differentiating lesions that warrant excision from those that can be managed expectantly has become an increasingly important skill.
Dermoscopy is a handheld investigative tool, used
Conflicts of interest
None.
Funding
None.
References (5)
- et al.
Revised UK guidelines for the management of cutaneous melanoma 2010
J Plast Reconstr Aesthet Surg
(2010 Sep) - et al.
Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting
Br J Dermatol
(2008 Sep)
Cited by (8)
Assessing exposure to dermoscopy in plastic surgery training programs
2021, JPRAS OpenCitation Excerpt :Indeed, a retrospective review involving three plastic surgery trainees with dermoscopy training found their diagnostic accuracy to be comparable to dermatologists.9 Moreover, among plastic surgeons who attended a one-day dermoscopy training course, the sensitivity of diagnosing malignant skin lesions increased from 56% to 64%, with the specificity increasing from 44% to 64%.4 Notwithstanding these results, dermoscopy is a tool with a steep learning curve, and proper use likely requires formal training with sustained exposure.8,10
Response to the comment made on the article “The diagnostic effectiveness of dermoscopy performed by plastic surgery registrars trained in melanoma diagnosis”
2020, Journal of Plastic, Reconstructive and Aesthetic SurgeryDiagnostic effectiveness of dermoscopy performed by plastic surgery registrars trained in melanoma diagnosis
2020, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :For patients who already had previous consultation at the service with photos of lesions saved in the medical records, a sequential dermoscopy comparison could be made. Previous reports underline the lack of formal training in dermoscopy for UK plastic surgery trainees and improvement of the accuracy of diagnosis by dermoscopy after specific training for plastic surgeons.11,12 In this study, the authors aim to determine the impact of specific training on the diagnostic effectiveness of dermoscopy performed by plastic surgeon registrars.
The management of malignant skin cancers
2017, Surgery (United Kingdom)Citation Excerpt :Dermatoscopy is a simple tool used to assess the dermal and epidermal structures of lesions that are not commonly seen by the naked eye. It consists of a magnifying device with an integrated light, used with a liquid interface or polarized light.12 An improved accuracy has been demonstrated in detecting melanomas with a dermatoscope, when compared to the naked eye examinations.13
The use of dermatoscopy amongst plastic surgery trainees in the United Kingdom
2015, Journal of Plastic, Reconstructive and Aesthetic SurgeryLetter in response to: 'Estimating the positive predictive value and sensitivity of the clinical diagnosis of basal cell carcinoma'
2014, Journal of Plastic, Reconstructive and Aesthetic Surgery
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This work will in part be presented at the Summer BAPRAS meeting in Oxford (July 2011).