What Goes Into a Valuable Dermoscopy

The prevalence of skin cancer has emerged as an increasingly concerning trend in dermatology, during an era of increased climate change-related health issues and stagnant patient pursuit of diagnoses and screening. One clinician recently told HCPLive there is additionally a need for improved monitoring by deramtologists among higher-risk patients, including the elderly.

“If we watch them just a little bit closer, if we do manage them a little bit more aggressively, then I feel like we’re doing our due diligence to try and catch these patients that are eventually going to go on to develop a high-level skin cancer in the future,” the clinician said earlier this summer.¹

There is also an increasing emphasis on screening methodology, fortunately.

Ashfaq A. Marghoob, MD, director of clinical dermatology at Memorial Sloan Kettering Hauppauge, recently presented a workshop on adequate dermoscopy strategies during the Maui Derm 2023 NP + PA Summer Conference in Colorado Springs in June.²

In an interview with HCPLive, Marghoob reviewed his workshop presentation and the components and virtues of an adequate dermoscopy in an era of increasing skin cancer concerns.

HCPLive: Can you review the 2-step dermoscopy algorithm and pattern analysis used to detect skin cancers?

Marghoob: The 2-step dermoscopy algorithm is based on a top-down process of thinking. In the first step, we evaluate benign lesions including nevi (in context), dermatofibromas, seborrheic keratosis, angiomas, sebaceous hyperplasia and a few other less common benign lesions.

In the second step we evaluate for cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Skin cancers tend to display a disorganized pattern. This is all nicely explained in dermoscopedia.com or in a chapter we wrote in UpToDate.³

HCPLive: What is the value of early skin cancer diagnosis, and who are the stakeholders in facilitating a timely dermoscopy?

Marghoob: The value of early diagnosis includes lower morbidity and mortality! The stakeholders are patients, physicians and companies that produce products and services for early diagnosis.

HCPLive: Relative to the influx of available therapies to treat skin cancer, what more benefit can prescribing clinicians get from a dermoscopy?

Marghoob: Systemic therapies for melanoma and SCC are expensive, with significant side effects. Dermoscopy can assist in early diagnose and thereby circumvent the need for systemic therapies with money saved. In addition, dermoscopy helps decrease the excessive removal of benign lesions that clinically mimic skin cancer.

HCPLive: What is the biggest hurdle impeding patients from seeking a screening for possible skin cancer?

Marghoob: There are currently 3: lack of patient knowledge, lack of available time, and lack of endorsed clinician recommendations for screening.

The transcript of this interview was edited for clarity.

References

1. ^{Kunzmann K. Matt Reynolds, PA-C: Identifying, Preventing Skin Cancer Risks. HCPLive. Published June 11, 2023. https://www.hcplive.com/view/identifying-preventing-skin-cancer-risks}
2. ^{Maui Derm NP+PA Summer 2023 Program. Maui Derm. Accessed August 27, 2023. https://mauiderm.com/maui-derm-nppa-summer-2023-program.}
3. ^{Marghoob AA, Jaimes N. Dermoscopic evaluation of skin lesions. UpToDate. Published July 5, 2023. https://www.uptodate.com/contents/dermoscopic-evaluation-of-skin-lesions/print}