Using dermoscopy to diagnose skin lesions

NICE guidance recommends that GPs seeing skin lesions regularly should be trained in dermoscopy. Drs Veronique Bataille, Josep Malvehy and Susana Puig explains how dermoscopy can increase diagnostic accuracy.

An early invasive superficial malignant melanoma, see case study below
An early invasive superficial malignant melanoma, see case study below

The diagnosis of skin lesions is an important part of a GP’s work. Unfortunately, it is well recognised that training in dermatology during medical school is very short and does not prepare GPs for the large volume of skin lesions or conditions they may encounter in their practice.

However, it is clear that for dermatology trainees, the recognition of skin lesions is learned by seeing a lot of cases and using dermoscopy routinely. This skill can be acquired by any health worker who sees skin lesions on a regular basis as they can build a knowledge of dermoscopy features for common lesions such as benign naevi, seborrhoeic keratoses, dermatofibroma and haemangioma.

Skin Cancer Detection and Dermoscopy Course for GPs

The Skin Cancer Detection and Dermoscopy Course for GPs is a course organised by world leaders in skin cancer recognition. The two-day course in London and Barcelona at four weeks’ interval will also include online dermosocopy tutorials with feedback from the lecturers. The course has been approved for CPD at a European level. Click here for more details.

This article has been provided by the Skin Cancer Detection and Dermoscopy Course for GPs for GP Connect

Once benign lesions become familiar to the clinician, the recognition of atypical skin lesions such as early melanoma and basal cell carcinoma with dermoscopy is much easier.

Dermoscopy increases diagnostic accuracy and will help in selecting lesions most appropriate for referrals using the two-week wait referral route.1,2 The use of an attachment for photography with most dermoscopy devices also enables GPs to keep files of lesions seen and ask advice from dermatology colleagues where teledermatology is in use.

For dermatologists, the use of dermoscopy for teledermatology referral is also crucial for diagnostic accuracy.

NICE guidance

The recently updated NICE guidelines recommend that all GPs seeing skin lesions regularly be trained in dermoscopy.3

Some GPs may be put off using dermoscopy because they believe it takes a long time to train and the diagnostic features using dermoscopy are too complex. However, there are basic dermoscopy learning tools, which help most health workers to improve their diagnosis skills - advanced dermoscopy course are not necessary for GPs at an early stage of their learning curve.

A practical dermoscopy course with face-to-face and online tutorials, based on many cases of benign and malignant skin lesions, such as the one described in the box above, will help GPs improve their knowledge in skin cancer and their skills in identifying suspicious skin lesions.

Case study

A 29-year-old female presented with a pigmented lesion on her right upper back which had enlarged over the last 9 months.

Clinical examination: Skin type 3. Palpable lesion on the upper back with dark shades of brown showing sharp borders and asymmetry (figure 1, below). Diameter 11mm.

Figure 1

Dermoscopy: reticular global pattern, asymmetry in two axes, colours: black, dark brown, light brown and blue-grey. Atypical pigment network, atypical black dots and blue veil (figures 2 and 3, below).

Figure 2

Figure 3

Pathology: Early invasive superficial malignant melanoma (Breslow 0.6mm) arising in a benign melanocytic naevus. No mitoses present. No ulceration.

Management: Wide surgical excision with 1cm margin.

Comments: Some early superficial malignant melanomas may be misdiagnosed due to a nevus like appearance. The clinical history of the patient with changes in an acquired melanocytic tumour which is large a presentation (11mm in diameter) has to raise an index of suspicion. Dermoscopy confirms the diagnosis of melanoma with the presence of asymmetry, multiple colours including blue, black and grey and an atypical pigment network and dots. In addition a blue hue is seen in some areas of the tumour.

  • Dr Bataille is a dermatologist at West Herts NHS Trust & Kings College, London; Dr Malvehy is a dermatologist and director of the Melanoma Unit, Hospital Clínic of Barcelona; Dr Puig is a dematologist and director of the dermatology service, Hospital Clínic of Barcelona


  1. Marghoob et al. Dermoscopy for the family physician. Am FamPhysician 2013; 88: 441-50
  2. Chappuis et al. Dermoscopy. A useful tool for general practitioners in melanoma screening. A nationwide survey. Brit J Dermatol 2016 Feb 23. doi: 10.1111/bjd.14495. [Epub ahead of print]
  3. NICE. Melanoma. NG14. London, NICE, July 2015.

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