Everything you need to know about digital dermoscopy

Dermoscopy is a commonly used technique in dermatology consultations. Dr. Villalón, an expert in dermatology, talks about this test as a diagnostic tool for tumors.

What does digital dermoscopy consist of?

Digital dermoscopy consists of applying to the skin a device consisting of a magnifying glass of different magnifications, illuminated with polarized light, i.e. the photons of its light are all oriented in the same direction. This device is called a dermatoscope or, simply, dermoscope.

The application of the dermatoscope on the skin makes it possible to visualize structures in the cutaneous subsurface that would not be visible with normal optics. This fact has allowed more powerful dermoscopes to be developed since the 1970s and over the years to describe dermoscopic structures and patterns that we did not know before and that can be related to the histologic diagnosis, i.e., to the biopsy result. In this way it has been possible to develop a series of diagnostic algorithms that are useful in the routine consultation of any dermatologist. Thus, by means of this technique, we can obtain a first diagnostic approximation of the structure we are analyzing, generally moles, without having to resort to their removal and study in the laboratory.

Dermoscopy has developed in recent years. The computerization of medical practices has also made it possible to record the images obtained and archive them by digitizing them. This is how digital dermoscopy was born.

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Pathologies that can be diagnosed by digital dermoscopy

Digital dermoscopy allows the diagnosis of any tumor, in the skin and in any other organ, is always histologic. However, dermoscopy is very useful in deciding whether moles, which are the structures most frequently studied by this technique, are at greater risk of degenerating or of already being a de facto melanoma. This makes it possible to decide whether the mole should be removed, whether it can be left and checked, or whether it simply poses no more risk than the surrounding healthy skin.

It is in this group of moles, those that we can say have a biological evolution of low risk of giving problems in the long term, where digitizing the dermatoscope images is useful.

Advantages of digital dermoscopy over other tests

Digital dermoscopy makes it possible to avoid surgery in low-risk lesions (if they are high-risk it is advisable to remove them), to save the images and to follow them up. This is important to avoid unwanted aesthetic sequelae, especially in visible regions such as the face and décolleté or those that tend to heal poorly (keloids). In addition, files can be shared with other professionals and teledermatology can be performed.

How do I know if I should undergo digital dermoscopy?

There are a series of clinical and dermoscopic criteria that make it possible to stratify the risk of the mole. In principle, all persons who have moles or skin spots that are large, of different colors, irregular shapes or have undergone changes in shape or size should be inspected by a dermatologist. Not always when these criteria are met does it indicate that the lesions are malignant, but they should be evaluated and generally with a dermatoscope. In turn, patients with risk factors: many moles, family history of skin cancer, having had significant sunburns in childhood or adolescence, moles since the first year of life, etc. should also be evaluated in consultation.

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The decision to perform follow-up or digital dermoscopy is based on several criteria according to the morphology and count of these moles as well as the relative cumulative risk of the patient in question.