NAPLES, FLA. Several new technologies are becoming available to follow and visualize melanomas, but practicing dermatologists will be best served if they focus on learning dermoscopy, Harold S. Rabinovitz, M.D., said at the annual meeting of the Florida Society for Dermatology and Dermatologic Surgery.
Current estimates are that about 15% of U.S. dermatologists use dermoscopy, said Dr. Rabinovitz, of the department of dermatology at the University of Miami.
Even experienced dermatologists are not perfect at differentiating between malignant melanoma and benign melanocytic nevi, he said. Studies have found the overall diagnostic accuracy of dermatologists to be about 65%. Dermoscopy improves diagnostic accuracy over visual inspection by about 15%, Dr. Rabinovitz said.
Once dermoscopy technique is learned, it does not take much extra time to do, which makes it convenient and practical. The obstacle is learning to do dermoscopy well, he added.
"There is a steep learning curve," he said. "In dermoscopy, a little knowledge is worse than no knowledge. It is only a diagnostic aid, as pathology is the reference standard."
The other melanoma-diagnosing technologies that are available or in development, he said, are impractical or their future is uncertain.
For instance, total-body photography, even with today's digital photography and computer software, requires too much time to take and review the photographs. When Dr. Rabinovitz does total-body photography for appropriate, high-risk patients, he says he gives patients CD copies of the digital photos. When they have a concern about a particular nevus, they can compare it to the photographic record. "Full-body photography, in my opinion, is for the patients."
Confocal imaging, like dermoscopy, allows visualization of structures below the surface, but on the horizontal plane. This imaging system is being used in several studies, including one on tracking imiquimod treatment of in situ melanoma. But confocal imaging is a research tool and probably will remain one, he said, because dermoscopy is available, and because biopsy will remain the standard of diagnosis.
Image-analyzing computer programs for use with dermoscopy and photography are in development, and could have great promise because the computer might be able to pick up things the eye may miss, he said. But their introduction into the market is probably at least a few years away, even if problems in analyzing some histologic features can be worked out.
"My advice to you is to learn dermoscopy," Dr. Rabinovitz said. "Over the years, I believe this will be an important tool and aid for dermatologists in the management of their patients."
Dr. Rabinovitz said he knows of four companies that sell dermoscopy equipment. He did not recommend any one product, but he did advise that the best course of action is to buy the latest model of equipment.