Rationale (4 line justifying the need of using the solution)

A dermatoscope is a hand-held visual aid device a professional can use to examine and diagnose skin lesions and diseases, such as melanoma, Blau syndrome, Actinic prurigo, Peeling skin syndrome, Argyria, Erythropoietic protoporphyria, Lamellar ichthyosis, Harlequin ichthyosis… It can also help a professional examine the scalp, hair, and nails. Dermoscopy is a noninvasive, in vivo technique primarily used for the examination of cutaneous lesions. Dermatoscopy, epiluminescence, microscopy, incident light microscopy, and skin-surface microscopy are synonyms. Dermoscopy is performed with a handheld instrument called a dermatoscope.

Features of the solution (how the solution works)

Dermatoscopes uses light and magnification to help a dermatologist see how a person’s skin looks in more detail. Dermatoscopes help show details in the outer layer of skin that would not be visible to the naked eye. A dermatoscope functionally simulates a magnifying lens, with the added features of much higher magnification, and an adjustable inbuilt illuminating system. A hand-lens, even with in-built illumination, cannot allow visualization beyond the surface of the skin because of the reflection and scattering of light from the stratum corneum. A dermatoscope can assess structures to the depth of reticular dermis, and record images for future comparison. The basic principle of dermoscopy is transillumination of a lesion in order to study it with high magnification to visualize subtle features. Light incident on a surface like the skin may be reflected, refracted, diffracted and/or absorbed. The physical properties of the skin influence these phenomena. Most light incident on dry, scaly skin is reflected, but smooth, oily skin allows light to pass through to reach the deeper dermis. Application of a linkage or immersion fluid (like mineral oil, liquid paraffin, ultrasound gel, or 70% alcohol-based commercial solutions) over the skin, enhances translucency and improves visibility of subsurface skin structures of the lesion under investigation. The essential components of a dermatoscope include: 1) a set of achromatic lenses with magnification starting from 10× up to 200× or even higher, 2) an inbuilt illuminating system composed of halogen lamps placed within the handheld piece, and 3) a source of power supply such as rechargeable or replaceable batteries or rechargeable handles.

The newest generation of dermatoscopes includes inbuilt crossed-polarizers, which filter out scattered light from the periphery, reduce glare, and permit visualization of substratal structures without the need of a linkage fluid. Some dermatoscopes have an inbuilt photography system with supporting software for the capture and storage of images. For those dermatoscopes without inbuilt systems, special adapters are available to connect to digital cameras. Advanced devices have whole body mapping systems for detailed analysis and follow up of skin lesions over time. Newer handheld units can attach to smart-phones for easier image capture and documentation.

Dermatoscopes may be with or without an in-built image capturing facilities. A simple hand-held dermatoscope looks like a broader version of an otoscope and lacks an inbuilt camera. Image-capture dermatoscopes have a special lens, which mounts onto a conventional or a digital camera. United serial bus (USB) video-dermatoscopes have a high-resolution camera fitted to the handpiece that allows visualization of the image on the computer screen as well as capturing videos. Advanced dermatoscopes have an analytical capability in addition to image-capture.

Dermoscopy is performable by either the non-contact or the contact technique. In the contact technique, the glass plate of the instrument touches the lesion through the linkage fluid. In the non-contact technique, the cross-polarized lens absorbs all the scattered light and hence allows only light in a single plane to pass through it without contact of the lens with the skin. The contact technique gives better illumination and resolution. The advantage of the non-contact technique is the prevention of inter-patient infections.  Avoidance of cross-infection in the case of contact dermoscopy is by using a barrier like a cling film or adhesive tape over the lesional skin.

Although the advent of high-quality dermatoscopes with polarizers has rendered the use of linkage fluids and contact dermoscopy almost redundant; it is worthwhile to be cognizant of the concept. The linkage fluid enhances the translucency of stratum corneum facilitating imaging of deeper structures. Many substances can function in this capacity including mineral oil, ethanol, liquid paraffin, and ECG/USG gel. The latter remains the most commonly used linkage fluid in the current era, especially for onychoscopy.

The recent improvements in the manufacturing of dermatoscopes include – reduction in dimensions and bulk of the device, wi-fi connectivity for USB dermatoscopes, digital image analysis, and attempts to incorporate artificial intelligence to create an automated diagnostic unit.

Benefits of the solution

The dermascope allows the visualization of subsurface skin structures not visible to the naked eye. The dermoscopic images may be photographed or recorded digitally for storage or sequential monitoring for change. It can help identify lesions and differentiate melanocytic lesions from dysplastic lesions, melanomas, or non-melanoma skin cancers such as basal cell carcinoma or squamous cell carcinoma. Furthermore, over the past several years, the use of dermoscopy has expanded to include utilization for diagnosis of dermatological disorders including inflammatory dermatosis, pigmentary dermatosis, infectious dermatosis, and disorders of the hair, scalp, and nails. As the utility of dermoscopy continues to expand, practitioners in almost all specialties should be familiar with this simple, non-invasive and high-yield diagnostic technique. This activity reviews the various uses for dermoscopy across multiple specialties and stresses the role of team-based interprofessional care.

The usage of a dermascope may result in confirmation of clinical diagnosis, often avoiding the need for a skin biopsy. Although a skin biopsy and clinicopathological correlation (CPC) remain the gold standard for cutaneous diagnosis, dermoscopy often helps tilt the clinical differential in instances where it identifies a distinct pattern. Its use has been most popular for differentiation between melanocytic nevi and melanomas. However, the indications of dermoscopy are continually expanding and include an evaluation of hair disorders, general pigmentary disorders, appendageal tumors, inflammatory disorders like psoriasis and lichen planus, and for pre- and post-evaluation of therapeutic procedures. In the current scheme of things, we are gradually moving from CPC to clinico-dermoscopic-pathological correlation (CDPC).

Skills requirements (to use the solutions by healthcare and social care employees)

Dermoscopy is not only for dermatologists, rather the skill should be acquired and customized by other specialists too, especially general practitioners/family physicians, pediatricians, and dermatosurgeons. Pediatricians in particular must get acquainted with dermoscopy as the non-invasive and visually engaging property of dermoscopy and its images make paediatricians’ interaction with an anxious child much more convenient.

The use of dermoscopy by general physicians is very low. The impact of subspecialisation and dermatoscopy use have a big impact on the accuracy of melanoma diagnosis among primary care doctors worldwide. Regrettably, many barriers have resulted in extremely low usage of dermoscopy by general/family physicians. Some of these barriers include – costs of dermoscopy—both the equipment cost and the relatively inadequate reimbursement for its use in practice, the need for dermoscopy training, lack of information about learning resources and the unwillingness to invest time, both for training and to use dermoscopy in practice.

In order to use a dermascope a professional must acquire specific imagery skills, beside the basic knowledge about how to use a computer/laptop, basic knowledge about internet connection and a basic level of technology proficiency.