Benefits and Limitations of Dermatoscopy in the Diagnosis of Skin Malignancies in the Practice of a Family Doctor

Abstract

Topicality: Traditionally, dermatoscopy has been used exclusively by dermatologist. However, it is now gaining popularity in other fields of medicine such as family medicine. Family doctors (FD) are often the first ones to encounter and manage skin lesions. It has been shown that especially with some training also family physicians can improve their diagnostic accuracy and triaging abilities of skin lesions by using a dermatoscope. Consequently, the amount of unnecessary skin biopsy is decreased as well as the referrals and the pressure on secondary health care. Thus, dermatoscopy can be seen to be cost effective. Lately applications of teledermatology have also emerged. Why is dermatoscopy then not implied to all family care practices and more widely used?

Aim: The aim of this literature review is to show that dermatoscopy in family medicine is helpful and profitable and should be more widely used. It is emphasized that application of telemedicine would make FD work easier.

Methodology: Articles were selected from PubMed database by using the PRISMA approach. Using Mendeley reference a total of 217 articles were reviewed. After applying the exclusion criteria, 34 primary articles were included in this study.

Results and discussion: The skin malignancy sensitivity increases from 40-54% with naked eye examination alone up to 61% with dermatoscope application. Dermatoscopy is favourable, with 14 out of 16 studies displaying beneficial effects. Dermatoscopy enhances patient care by increasing the number of referrals for melanoma lesions, simultaneously decreasing those of benign lesions. This reduces costs and the burden for physical visits. A decrease of anxiety for both the patient and the physician by e.g., making definitive diagnosis faster is seen. In studies considering limitations, the need of dermatoscopic training is stressed.

Conclusion: This literature review supports the use of dermatoscopy in primary care, with evidence of improving the diagnostic accuracy as well as damping the burden on health care.

Topicality: Traditionally, dermatoscopy has been used exclusively by dermatologist. However, it is now gaining popularity in other fields of medicine such as family medicine. Family doctors (FD) are often the first ones to encounter and manage skin lesions. It has been shown that especially with some training also family physicians can improve their diagnostic accuracy and triaging abilities of skin lesions by using a dermatoscope. Consequently, the amount of unnecessary skin biopsy is decreased as well as the referrals and the pressure on secondary health care. Thus, dermatoscopy can be seen to be cost effective. Lately applications of teledermatology have also emerged. Why is dermatoscopy then not implied to all family care practices and more widely used?

Aim: The aim of this literature review is to show that dermatoscopy in family medicine is helpful and profitable and should be more widely used. It is emphasized that application of telemedicine would make FD work easier.

Methodology: Articles were selected from PubMed database by using the PRISMA approach. Using Mendeley reference a total of 217 articles were reviewed. After applying the exclusion criteria, 34 primary articles were included in this study.

Results and discussion: The skin malignancy sensitivity increases from 40-54% with naked eye examination alone up to 61% with dermatoscope application. Dermatoscopy is favourable, with 14 out of 16 studies displaying beneficial effects. Dermatoscopy enhances patient care by increasing the number of referrals for melanoma lesions, simultaneously decreasing those of benign lesions. This reduces costs and the burden for physical visits. A decrease of anxiety for both the patient and the physician by e.g., making definitive diagnosis faster is seen. In studies considering limitations, the need of dermatoscopic training is stressed.

Conclusion: This literature review supports the use of dermatoscopy in primary care, with evidence of improving the diagnostic accuracy as well as damping the burden on health care.