While a biopsy is still the most accurate diagnostic method for confirming or excluding a diagnosis of skin cancer, a handheld microscope-like device called a "Dermoscope" can help Dermoscopists evaluate areas of concern. Used to evaluate melanomas and other skin lesions, the Dermoscope magnifies a pigmented lesion and allows the Dermoscopist to see through the stratum corneum (bottom of the outermost layer of skin), which permits a detailed view of structures within the skin that are usually invisible to the unaided eye.

Studies have shown that Dermoscopy, also referred to as "surface microscopy" and "epiluminescence microscopy," can help determine:

• Whether or not the pattern of pigmentation in a lesion indicates cancer, which improves accuracy in determining which skin lesions should be biopsied
• If the pigmented section of a lesion is wider than the portion visible to the unaided eye, which helps ensure that the entire lesion and the right amount of unaffected skin is removed during treatment
• If change is occurring in an atypical mole which aids in early detection of melanomas

What can be seen without and with a Dermoscope
To give you an idea of the visible differences that a dermoscope provides, the following photographs show the same lesion viewed without and then with a dermoscope.

WITHOUT a dermoscope, this lesion resembles just a small freckle 

WITH a dermoscope, abnormal pigment network is visible which suggests a potential melanoma. A biopsy confirmed the lesion was an early melanoma.

Most often using a Dermoscope we are able to reassure patients that a mole does not need to be removed. At other times, a Dermoscope helps us diagnose moles which are dangerous skin cancers or melanomas at an earlier stage. It is also possible to photograph our Dermoscopic images if necessary.

Dr. Sharad P Paul is a Member of the International Dermoscopic Society.

Dr Sharad P Paul convened and taught at the Skin Cancer Surgery and Dermoscopy course which was held alongside the NZ Melanoma Summit in Wellington in March 2011.

In August 2011, he presented on Skin Cancer and Dermoscopy at the Rodney Surgical Centre CME programme.