09 October 2015

EADV Congress - “We are beginning to move away from clinicopathological diagnosis to an era of clinico-imaging diagnosis”

Copenhagen, 9 October 2015. When asked about what’s new in dermoscopy, Assoc. Prof. Giuseppe Argenziano, MD (Naples, Italy) answered, “We are beginning to move away from clinicopathological diagnosis to an era of clinico-imaging diagnosis.”

The dermatoscope, he pointed out, is now the dermatologist’s stethoscope and his most important diagnostic tool. Why is that? It is not only because dermoscopy reveals a new and fascinating morphological dimension of pigmented and non-pigmented skin tumours, but also because it improves recognition of a growing number of skin symptoms in general dermatology that are very useful in diagnosing many inflammatory and infectious skin diseases.

Melanoma detection is still the most important purpose of dermoscopy, however. In melanoma screening, the aim of dermoscopy is to maximise early detection while minimising the unnecessary excision of benign skin tumours. In the last few years, various studies have shown that dermoscopy is superior to naked eye examination alone. Dermoscopy in the hands of experts has been shown to have a significantly greater sensitivity. This is due to at least three factors:

  • Firstly, pearly malignancy signs become visible in melanoma much earlier in dermoscopy than “classical features” are seen by the naked eye. This allows early detection.
  • Secondly, spots on the skin often look benign when examined by the naked eye, but suspicious under the dermatoscope. This has increased the willingness of clinicians to check clinically banal-looking lesions with this screening method.
  • Thirdly, clinicians routinely monitor their patients with this technique nowadays, thus improving the recognition of melanoma in patients with multiple moles.

Argenziano has argued that better strategies need to be found in order to reduce the number of benign lesions that are unnecessarily excised and to lower melanoma mortality rates. “Dermoscopy allows early and highly reliable non-invasive clinico-imaging diagnosis. This is the future!”

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