Twenty-five practical recommendations in primary care dermoscopy
Antonio Chuh 1 2 3 8 , Vijay Zawar 3 4 , Regina Fölster-Holst 3 5 , Gabriel Sciallis 3 6 , Thomas Rosemann 3 71 Department of Family Medicine and Primary Care, The University of Hong Kong and Queen Mary Hospital, Pokfulam, Hong Kong.
2 JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong.
3 The Hong Kong Society of Primary Care Dermoscopy, Hong Kong.
4 Department of Dermatology, Godavari Foundation Medical College and Research Center, Dr Vasantrao Pawar Medical College, Nashik, India.
5 Universitätsklinikum Schleswig-Holstein, Campus Kiel, Dermatologie, Venerologie und Allergologie, Germany.
6 Emeritus, Department of Dermatology, Mayo Medical School, Minnesota, USA.
7 Institute of Primary Care, University of Zürich, Zurich, Switzerland.
8 Corresponding author. Email: antonio.chuh@yahoo.com.hk
Journal of Primary Health Care 12(1) 10-20 https://doi.org/10.1071/HC19057
Published: 15 January 2020
Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
Dermoscopy in primary care enhances clinical diagnoses and allows for risk stratifications. We have compiled 25 recommendations from our experience of dermoscopy in a wide range of clinical settings. The aim of this study is to enhance the application of dermoscopy by primary care clinicians. For primary care physicians commencing dermoscopy, we recommend understanding the aims of dermoscopy, having adequate training, purchasing dermoscopes with polarised and unpolarised views, performing regular maintenance on the equipment, seeking consent, applying contact and close non-contact dermoscopy, maintaining sterility, knowing one algorithm well and learning the rules for special regions such as the face, acral regions and nails. For clinicians already applying dermoscopy, we recommend establishing a platform for storing and retrieving clinical and dermoscopic images; shooting as uncompressed files; applying high magnifications and in-camera improvisations; explaining dermoscopic images to patients and their families; applying toggling; applying scopes with small probes for obscured lesions and lesions in body creases; applying far, non-contact dermoscopy; performing skin manipulations before and during dermoscopy; practising selective dermoscopy if experienced enough; and being aware of compound lesions. For clinicians in academic practice for whom dermatology and dermoscopy are special interests, we recommend acquiring the best hardware available with separate setups for clinical photography and dermoscopy; obtaining oral or written consent from patients for taking and publishing recognisable images; applying extremely high magnifications in search of novel dermoscopic features that are clinically important; applying dermoscopy immediately after local anaesthesia; and further augmenting images to incorporate messages beyond words to readers.
KEYwords: Basal cell carcinoma; epiluminescence; melanoma; skin cancer; skin microscopy; squamous cell carcinoma
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