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March 1, 2011 / molehunter

Dermoscopy evidence on Wikipedia

Nobody can oppose ‘evidence’ any more than they can oppose breastfeeding, but some mothers can’t breastfeed despite their best efforts and sometimes, quite often actually, you ‘know’ something is true but lack evidence. You’ve seen it work, you know it works, but you don’t have a meta analysis of randomised controlled trials at hand to ‘prove’ it. Those of us who have been using dermoscopy for a number of years know it works but have at times had difficulty persuading sceptical colleagues. However, the situation has changed recently with a lot of good published trials showing the benefits of surface microscopy of skin lesions. Training is required. 

A handy item on wikipedia http://en.wikipedia.org/wiki/Dermatoscopy gives a brief overview of dermoscopy and looks at a few papers, inlcuding the meta analysis by Vestergaard et al in the British Journal of Dermatology as mentioned here

 Vestergaard, ME; Macaskill, P; Holt, PE; Menzies, SW (2008). “Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting”. British Journal of Dermatology 159 (3): 669–76. doi:10.1111/j.1365-2133.2008.08713.x. PMID 18616769

Obvious really, all dermoscopy does is allow a bit more clinical information to be collected from the patient (from whom the clinician has already taken a history and given their skin lesion an eyeballing). This is just the same as we do with stethoscopes, auriscopes, ophthalmoscopes etc. It stands to reason that, given the right training and experience, this extra information should put the examining doctor in  better position to get the right diagnosis. That’s my story and I’m sticking to it!  But its nice to have good, solid clinical trial evidence to back up what you can see is true with your own eyes. and now we have.

Something I believe but can’t (yet) prove is that when (hopefully) dermoscopy becomes established practice in NHS surgeries through the land, this will make it easier for anyone worried about a funny looking or changing mole to get it properly checked without fuss or expense.  This might lead to more melanomas being detected at a thinner stage, when they are more curable. We don’t yet have evidence to prove this, but then neither did they when the cervical smear test was rolled out, and that worked very well. Different cancer, same principle (early case finding through use of best available diagnostic technology). Sometimes you have to go with the best evidence you have and act in good faith. This is my opinion, and I am selling a course so I’m biased, but do check the Wikipedia stuff and the Vestergaard paper.

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