Giuseppe Argenziano, MD, PhD, presented his seven rules for detecting the earliest signs of melanoma during his lecture “Dermoscopy: Tips for the Practicing Clinician” at the Aug. 1 European Academy of Dermatology and Venereology/American Academy of Dermatology Joint Symposium.
“Today we know there is the possibility to diagnose 20 percent more melanomas if we use dermoscopy,” said Dr. Argenziano, professor of dermatology and head of the Skin Cancer Research Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy. “Those 20 percent of melanomas are not looking like melanomas to the naked eye. They are looking like common lesions from a clinical point of view. By using dermoscopy, we are able to catch those melanomas and therefore excise them.”
He recommends that dermatologists join him in following seven key rules in applying dermoscopy:
1. View all lesions with a dermatoscope. Then also check the skin surface of the entire body in a patient presenting with suspicious lesions. The goal is to detect, or rule out, the presence of melanoma elsewhere on the patient.
“The point is that in the past, dermoscopy was used only as a second-level procedure that was applied for lesions that were clinically suspicious,” Dr. Argenziano said. “Today, dermoscopy provides such a great advantage because we are now able to recognize 20 percent additional melanomas.”
2. Perform full-body skin examinations on high-risk patients. “As a general rule, we should do these comprehensive examinations on all patients with visibly sun-damaged skin, or with more than 20 nevi on the arms,” he said. “We often forget to check the entire body, but today, we know that especially older patients with visibly sun-damaged skin have an increased risk of having melanoma.”
3. Apply the 10-second rule. Look at the lesion for just 10 seconds. If the lesion is completely benign looking in the rapid time frame, send the patient home. If there is any suspicion whatsoever, excise it.
4. In patients with many moles, monitor them with dermoscopic inspection on an ongoing basis. “We should avoid excising too many lesions in patients with multiple nevi,” he said, “Often, we are able to catch melanoma only over time because the melanoma is changing but the nevi are not changing.”
5. Excise any doubtful nodular lesions. “If it is a suspicious lesion, we have to excise it immediately because we may be dealing with a nodular melanoma, which is the most aggressive type,” Dr. Argenziano said.
6. Combine clinical and dermoscopic criteria. “Even using a dermatoscope, we must always remember that patient history is important,” he said. “Has the lesion just been growing in the last few months? Is it located on the leg? Is it located on a 55-year-old patient? These clinical criteria must be considered while examining the lesion with the dermatoscope.”
7. Combine clinical and histopathologic criteria. When the histopathology report comes back, double-check the pathologist’s diagnosis with what we can see by the clinical and dermoscopic examination, Dr. Argenziano said. If there is no correlation with what is visualized clinically and dermascopically with what the pathologist found looking at the slide, then call the pathologist to make sure the proper cut of the specimen was performed. A second opinion from another pathologist may be required.
“As a major conclusion, I would say that today, skin cancer screening is not possible for the dermatologist without using a dermatoscope,” he said. “In addition to recognizing 20 percent additional melanomas with it, we are also able to spare patients from unnecessary biopsies of many benign lesions. The dermatoscope is an instrument that all dermatologists should use in their everyday clinical screening.”