Dermatoscopy in general practice

Clinical techniques in veterinary dermatology: Dermoscopy

Dermoscopy is a noninvasive, painless, easy-to-perform technique used in human and veterinary medicine for rapid and magnified in vivo observation of dermatological lesions and disease. Dermoscopy can lead to a swifter diagnosis and may eliminate the need to perform more invasive diagnostic testing such as skin biopsies. To perform dermoscopy, the clinician needs a dermoscope and a software program equipped with image capture for pattern identification. Two techniques exist for dermoscopy: standard contact, where the dermoscope is applied directly to the patient's skin with the use of a liquid interface, or noncontact, where there is no direct contact between the skin and the dermoscope. The most important criteria to be considered when using dermoscopy are the morphology/arrangement of vascular structures, scaling patterns, colours, follicular abnormalities and specific disease features. Application of dermoscopic findings should always be correlated with the patient's history, clinical signs and the morphology of the skin lesions. Dermoscopy does require an initial financial and time investment by the clinician, yet this technique can quickly and easily help to identify patterns of disease that correlate with clinical diagnosis of dermatological disease.

"Extraction Dermoscopy": Expanding the Utility of Epiluminescence Microscopy

INTRODUCTION

Many dermatological conditions require extraction of material from the lesion followed by visualization under a microscope. However, visualization of the extracted material can be done using a dermoscope instead. We propose "extraction dermoscopy" as an addition to the already existing treasury that dermoscopy holds.

METHODS

After approval from the institutional ethics committee, a cross-sectional study was carried out in a tertiary care hospital. Polarized and non-polarized versions of in vivo dermoscopy, as well as extraction dermoscopy, were performed on a total of 77 lesions, including 5 eruptive vellus hair cysts, 2 cilia incarnata externum, 10 trichostasis spinulosa, 20 keratosis pilaris, 20 molluscum contagiosum, and 20 lesions of milia. Heine Delta 20T and Dino-Lite Premier AM4113T were employed for dermoscopic examination.

RESULTS

A total of 77 lesions were selected, including 5 eruptive vellus hair cysts, 2 cilia incarnata externum, 10 trichostasis spinulosa, 20 keratosis pilaris, 20 molluscum contagiosum, and 20 lesions of milia. Extraction dermoscopy of the eruptive vellus cysts revealed skin color to brownish colored cysts with a bunch of pigmented hair. Similarly, findings of all other lesions were described and recorded post-extraction.

CONCLUSION

Extraction dermoscopy helps confirm the diagnosis without visualization under a microscope. Its application in recent times makes the explanation of the nature of many disorders to patients easier, and demonstration of extracted lesions may further improve doctor-patient communication.

Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia

Importance

International literature has shown that teledermoscopy referral may be a viable method for skin cancer referral; however, no economic investigations have occurred in Australia.

Objective

To assess the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia.

Design, Setting, and Participants

Cost-effectiveness analysis using a decision-analytic model of Australian primary care, informed by publicly available data.

Interventions

We compared the costs of teledermoscopy referral (electronic referral containing digital dermoscopic images) vs usual care (a written referral letter) for specialist dermatologist review of a suspected skin cancer.

Main Outcomes and Measures

Cost and time in days to clinical resolution, where clinical resolution was defined as diagnosis by a dermatologist or excision by a general practitioner. Probabilistic sensitivity analysis was performed to examine the uncertainty of the main results.

Results

Findings from the decision-analytic model showed that the mean time to clinical resolution was 9 days (range, 1-50 days) with teledermoscopy referral compared with 35 days (range, 0-138 days) with usual care alone (difference, 26 days; 95% credible interval [CrI], 13-38 days). The estimated mean cost difference between teledermoscopy referral (A$318.39) vs usual care (A$263.75) was A$54.64 (95% CrI, A$22.69-A$97.35) per person. The incremental cost per day saved to clinical resolution was A$2.10 (95% CrI, A$0.87-A$5.29).

Conclusions and Relevance

Using teledermoscopy for skin cancer referral and triage in Australia would cost A$54.64 extra per case on average but would result in clinical resolution 26 days sooner than usual care. Implementation recommendations depend on the preferences of the Australian health system decision makers for either lower cost or expedited clinical resolution. Further research around the clinical significance of expedited clinical resolution and its importance for patients could inform implementation recommendations for the Australian setting.