Clarity and accuracy for the ages
Dermoscopy emerges as key tool in early detection and treatment of skin cancer.
U004 – Dermoscopy to the Rescue! Maximizing the Power of the Dermatoscope for Diagnostic and Management Challenges in Your Patients With Skin Cancer
7:30-8:30 a.m. | Friday, March 27
Room 301
A growing body of clinical expertise is shining new light on the power of dermoscopy — the noninvasive diagnostic technique that is transforming the early detection and management of keratinocyte cancers.
Long used to evaluate pigmented lesions, dermoscopy is proving equally valuable in identifying actinic keratosis (AK), squamous cell carcinoma in situ (SCCis), invasive squamous cell carcinoma (iSCC), and a range of basal cell carcinoma (BCC) subtypes. Its ability to reveal subsurface vascular and structural patterns that are invisible to the naked eye is driving earlier diagnoses and more precise treatment choices. It’s also the focus of the upcoming Annual Meeting session, U004 – Dermoscopy to the Rescue! Maximizing the Power of the Dermatoscope for Diagnostic and Management Challenges in Your Patients With Skin Cancer.
Drew Emge, MD, MSc, FAAD, is among the panelists sharing insights on dermoscopy, including its aid in the early identification of high-risk features, such as polymorphous vessels, ulceration, and white structureless areas. Dr. Emge is an assistant professor of dermatology at the University of Kansas Medical Center in Kansas City, Kansas.
“It is a useful tool, in combination with a physical exam, to guide the choice between lesion-directed and field-directed therapies, including surgery, topical and intralesional agents, and photodynamic therapy based on lesion morphology, extent, and patient factors,” Dr. Emge said. “It also supports monitoring treatment response and detecting recurrence, thereby optimizing outcomes in both isolated lesions and field cancerization.”
Dr. Emge said dermoscopy provides sharper diagnostic accuracy, resulting in fewer unnecessary biopsies, and significantly increases sensitivity and specificity when evaluating suspicious keratinocytic lesions. This allows clinicians to better differentiate between benign lesions, early AK, and higher-risk variants of SCC by identifying‑risk variants of SCC by identifying hallmark patterns, such as:
- Polymorphous vessels
- Ulceration
- White structureless areas
- Shiny white structures and circles
- Yellow-orange keratin masses
According to fellow session panelist Elizabeth V. Seiverling, MD, FAAD, dermoscopy’s expanding role in classifying basal cell carcinoma subtypes is accelerating clinical decision‑making. Dr. Seiverling is an associate professor of dermatology at Tufts University School of Medicine in Boston.
“The ability to determine the BCC subtype allows for expedited, even same-day treatment in some cases,” Dr. Seiverling said. “In this forum, we will review the dermoscopic features of superficial basal cell carcinoma in contrast to more aggressive subtypes and highlight the emerging role of ultraviolet-induced fluorescence dermoscopy in BCC subtyping.”
Dermoscopy is increasingly guiding therapeutic decisions across a spectrum of treatment strategies, Dr. Emge said, including:
- Lesion‑directed therapies: These include cryotherapy, curettage, electrodessication, and topical agents like 5‑fluorouracil and imiquimod.
- Field‑directed therapies: For patients with multiple AKs or field cancerization, dermoscopy helps uncover subclinical lesions, enabling more complete treatment using topical agents or photodynamic therapy.
- Surgical planning: For lesions suspicious for invasive SCC, dermoscopy helps define tumor margins, improving the precision of excisions or Mohs surgery.
Clinicians are also using dermoscopy to monitor treatment response and detect early recurrence, he said, particularly in patients with chronic sun damage or prior SCC.
Although dermoscopy provides unprecedented clarity, Dr. Emge cautioned that it remains:
- Operator‑dependent, requiring training and continued practice.
- Susceptible to lesion overlap, as some SCCs can mimic BCC or melanoma.
- Limited in assessing deeper features, such as tumor thickness or perineural invasion.
The technology plays a vital role in a host of other diagnostic strategies as well as in detecting early disease progression, said session presenter Kelly Nelson, MD, FAAD, professor of dermatology at the University of Texas MD Anderson Cancer Center in Houston.
“Dermoscopy can help distinguish between blue nevi and cutaneous melanoma metastases, which can help identify early disease progression, even before progression is detectable on restaging CT or MRI scans,” Dr. Nelson said. “Dermoscopy can also distinguish between BCC and amelanotic melanoma, which can help guide biopsy technique to minimize the risk of tumor transection.”
Drs. Emge, Nelson, and Seiverling agree that dermoscopy is becoming indispensable for dermatologists aiming to improve diagnostic accuracy, reduce clinic inefficiencies, and achieve better long-term outcomes for patients with melanoma, BCC, and SCC.
