Digital epiluminescence dermoscopy for pigmented cutaneous lesions, primary care physicians, and telediagnosis: a useful tool?

J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):1054-8. doi: 10.1016/j.bjps.2008.01.011. Epub 2008 Jun 10.


Background: Digital epiluminescence dermoscopy is a relatively recent tool, based on the acquisition of high-definition digital images, for the diagnosis of pigmented cutaneous lesions.

Purpose: To verify the usefulness of digital dermoscopy in detecting pigmented lesions with features which may lead to suspicion of malignancy, when the examination is carried out by primary care physicians (PCP), not expert in that kind of diagnosis. Another target was an appraisal of the effectiveness and safety of telediagnosis based on epiluminescence digital dermoscopy on pigmented lesions.

Methods: Digital images from some peripheral centres (235 lesions) have been forwarded in real time to the reference centre (Unit of Plastic Surgery, University of Siena, Italy), with a double judgement by each primary care physician ('benign' or 'suspicious of malignancy') on the basis of anamnesis and clinical examination at first step, and dermoscopy as second step. The image analysis carried out from the reference centre identified every lesion examined as 'to be controlled' (219 lesions) or 'to be removed' (16 lesions).

Results: Regarding the patients with dermoscopic examination (197 subjects, 235 lesions), the investigation reduced the number of lesions suspected of malignancy from 68 to 29 after the first dermoscopy, and from 29 to 16 after the re-examination of the image by the central unit researchers. Fourteen lesions suspected of malignancy when examined in the peripheral centres were then evaluated as benign by the central unit researchers, while one lesion, judged as benign at first (always labelled as 'benign' by the PCP), was then revealed as a dysplastic naevus.

Conclusion: Digital dermoscopy can be enhanced by telediagnosis, which provides a better control of cutaneous pigmented lesions in the peripheral areas, thus reducing the number of consultations in specialised centres.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dermoscopy / instrumentation*
  • Dermoscopy / methods
  • Dysplastic Nevus Syndrome / diagnosis*
  • Dysplastic Nevus Syndrome / pathology
  • Early Detection of Cancer
  • Female
  • Humans
  • Male
  • Melanoma / diagnosis*
  • Melanoma / pathology
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / pathology
  • Telepathology / methods*