Dermatology Times

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B Y R EBECCA B RYANT S TAFF C ORRESPONDENT Miami Beach 4 Only 23 percent of U.S.dermatologists are evaluating lesions with tools and techniques col- lectively described as cdermoscopy. d Given that it 9s the standard ofcare in Europe and other countries,this is inexcusable,says Robert H.Johr, M.D.,a clinical professor ofderma- tology and pediatrics at the University ofMiami School of Medicine. The instruments for dermoscopy are inexpensive 4 $200 to $300 for a DermLite,a small device that fits in a pocket.Experienced users can study a lesion analysis in 10 to 15 seconds. And dermoscopy considerably improves a physician 9s performance by copening up a world ofcolor and structure that can 9t be seen with the naked eye, dDr.Johr says.

Why the lag? So why are American doctors so far behind their international colleagues? According to Dr.Johr,it 9s because they either haven 9t read the literature or they 9ve misplaced their priorities.

And a lot ofbalking,he fears,is due to the second factor. He says, cMy colleagues are flock- ing to meetings to learn how to do Botox,fillers and resurfacing.Doing cosmetic work is fine but not at the expense oflearning to use a tech- nique that saves patients 9lives.With one person dying each hour ... more. less.

from melanoma,every physician who sees patients with pigmented skin lesions should be checking them out with a dermoscope. d Invest in basics In the past,dermoscopy required use ofan oil or fluid on the lesion to eliminate surface light reflection and illuminate the stratum corneum. Today,that 9s not necessary. Hand-held instruments combine polarizing filters,LED lighting and magnifying lenses to reveal the epi- dermis,the dermo-epidermal junc- tion and the papillary dermis.A sig- nificant learning curve comes into play because the colors and structures that show up are different from those seen with the naked eye. Dermoscopy means better doctors, happier patients Photo 1:A pigmented skin lesion that does not demonstrate the clinical ABCDs suspicious for melanoma. A busy clinician could easily pass this off as being benign. Photo 2:Clinically and with dermoscopy this melanocytic lesion was suspicious and it was excised. The histopathologic report came back as a dysplastic nevus. Photo 3:Clinical examination demonstrates a dark lesion that is asymmetrical with irregular borders. The clinical diagnosis includes melanoma. Photo 4: If you examine the same lesion with dermoscopy, the benign vascular nature becomes obvious. A biopsy is not indicated and the patient can be assured that the lesion is non-cancerous. Photos: Robert H. Johr, M.D. 1 2 3 4 Crusader calls derms to higher standard of care with minimal investment Dermatology Times The Leading Newsmagazine for Dermatologists www.dermatologytimes.com Vol. 26, No. 3 March 2005 Cutaneous Oncology Says Dr.Johr, cIt takes three to six hours to learn the basics,but then it 9s necessary to practice.There aren 9t enough meetings on dermoscopy in the U.S.,but there are CDs and books. d Determined to encourage der- moscopy adoption in the U.S.,Dr. Johr co-authored one ofthose books, Dermoscopy: The Essentials (Elsevier Health,2004). Through the book,as well as arti- cles and lectures,he argues that doc- tors should learn dermoscopy because it helps to:differentiate melanocytic lesions from non- melanocytic and malignant lesions from nonmalignant;diagnose melanoma at an earlier stage;avoid unnecessary surgery,which is espe- cially important in pediatric popula- tions;and better plan surgery for high risk lesions. Other benefits That 9s not all.Physicians in a PPO or HMO environment can use der- moscopy to bolster their case for exci- sion and protect themselves and patients from less-experienced pathologists.The technique pin- points dysplastic moles that need long-term follow-up.And,finally,it reassures patients who are concerned about getting a thorough skin exami- nation. The literature cThere are several important articles that demonstrate the efficacy ofthe technique, dDr.Johr says. cOne was an article in Lancet Oncology in 2002 from a group ofdermatologists in Vienna.They did a meta analysis of 27 studies published between 1987 and 2000 and concluded that the diagnostic accuracy ofdermoscopy is significantly better than the use ofthe naked eye by up to 49 percent 4 depending on the experience ofthe examiner. d In 2004,Italian dermatologists published a report in the British Journal ofDermatology ,comparing the efficacy ofdermoscopy versus nondermoscopy in 3,053 consecu- tively excised lesions.Two ofthe physicians used dermoscopy and four did not.All were experienced doctors with 10 or more years ofpractice. At the start ofthe study in 1977, non-user practitioners removed 12 benign lesions for every melanoma. By the end ofthe study in 2001,they were removing 15 benign lesions for each cancerous one. Doctors using dermoscopy,on the other hand,showed a dramatic improvement in performance. Initially,they excised 18 benign lesions for each melanoma.At the end ofthe study,they were only excis- ing four benign lesions to each malig- nant one. DT Disclosure: Dr. Johr reports no financial interest in dermoscopic equipment. 3Gen, LLC Detect Skin Cancer- Early 23801 Salvador Bay Dana Point, CA 92629 Tel: 949-481-6384 Fax: 949-240-7492 www.dermlite.com info@3genllc.com © Reprinted from DERMATOLOGY TIMES, March 2005 Printed in U.S.A. Copyright Notice Copyright by Advanstar Communications Inc. Advanstar Communications Inc. retains all rights to this article. This article may only be viewed or printed (1) for personal use. User may not actively save any text or graphics/photos to local hard drives or duplicate this article in whole or in part, in any medium. Ad vanstar Communications Inc. home page is located at http://www.advanstar.com.

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