Data to support its use in primary care are limited; however, it may assist in triaging suspicious lesions for urgent referral when employed by suitably trained clinicians. Formal algorithms may be of most use for dermoscopy training purposes and for less expert observers; however, reliable data is lacking.

Dinnes, J., Deeks, J. J., Chuchu, N., Ferrante di Ruffano, L., Matin, R. N., Thomson, D. R., Wong, K. Y., Aldridge, R. B., Abbott, R., Fawzy, M., Bayliss, S. E., Grainge, M. J., Takwoingi, Y., Davenport, C., Godfrey, K., Walter, F. M., & Williams, H. C. (2018). Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database of Systematic Reviews, 2018(12), CD011902–CD011902. https://doi.org/10.1002/14651858.CD011902.pub2

Vestergaard, M. E., Macaskill, P., Holt, P. E., & Menzies, S. W. (2008). Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. British Journal of Dermatology (1951), 159(3), 669–676. https://doi.org/10.1111/j.1365-2133.2008.08713.x

Some melanomas may lack discernible clinical and dermoscopic features, making them challenging to diagnose with one dermoscopic exam. Ongoing dermoscopy surveillance may help identify atypical featureless melanomas.

Kittler, H., Guitera, P., Riedl, E., Avramidis, M., Teban, L., Fiebiger, M., Weger, R. A., Dawid, M., & Menzies, S. (2006). Identification of Clinically Featureless Incipient Melanoma Using Sequential Dermoscopy Imaging. Archives of Dermatology (1960), 142(9), 1113–1119. https://doi.org/10.1001/archderm.142.9.1113

This prospective RCT showed adding dermoscopy reduced the number of pigmented skin lesions excised for diagnosis by 42% (p = 0.01). 

Carli, P., de Giorgi, V., Chiarugi, A., Nardini, P., Weinstock, M. A., Crocetti, E., Stante, M., & Giannotti, B. (2004). Addition of dermoscopy to conventional naked-eye examination in melanoma screening: a randomized study. Journal of the American Academy of Dermatology, 50(5), 683–689. https://doi.org/10.1016/j.jaad.2003.09.009

In a retrospective study over five years among two dermatologists,  the ratio of benign/malignant pigmented lesions that were excised significantly decreased from 18:1 to 4:1(p = 0.037) with the addition of dermoscopy.

Carli, P., De Giorgi, V., Crocetti, E., Mannone, F., Massi, D., Chiarugi, A., & Giannotti, B. (2004). Improvement of malignant/benign ratio in excised melanocytic lesions in the “dermoscopy era”: a retrospective study 1997-2001. British Journal of Dermatology (1951), 150(4), 687–692. https://doi.org/10.1111/j.0007-0963.2004.05860.x

Analysis by a clinician trained in dermoscopy or an AI neural network‐trained computer can improve the diagnostic accuracy of melanoma compared with that of an inexperienced clinician. Computer diagnosis might represent a useful tool for screening melanoma, particularly at centres that are not experienced in dermoscopy. A dermoscopic image is a requisite!

Piccolo, D., Ferrari, A., Peris, K., Daidone, R., Ruggeri, B., & Chimenti, S. (2002). Dermoscopic diagnosis by a trained clinician vs. a clinician with minimal dermoscopy training vs. computer-aided diagnosis of 341 pigmented skin lesions: a comparative study. British Journal of Dermatology (1951), 147(3), 481–486. https://doi.org/10.1046/j.1365-2133.2002.04978.x

Four out of nine studies showed that the beneficial estimates apply to specialists as well as generalists trained in dermoscopy.

Marchetti, M. A., & Marghoob, A. A. (2014). Dermoscopy. Canadian Medical Association Journal (CMAJ), 186(15), 1167–1167. https://doi.org/10.1503/cmaj.140008

Argenziano, G., Puig, S., Zalaudek, I., Sera, F., Corona, R., Alsina, M., Barbato, F., Carrera, C., Ferrara, G., Guilabert, A., Massi, D., Moreno-Romero, J. A., Muñoz-Santos, C., Petrillo, G., Segura, S., Soyer, H. P., Zanchini, R., & Malvehy, J. (2006). Dermoscopy Improves Accuracy of Primary Care Physicians to Triage Lesions Suggestive of Skin Cancer. Journal of Clinical Oncology, 24(12), 1877–1882. https://doi.org/10.1200/JCO.2005.05.0864

 A study of Dutch general practices found that the probability of a correct diagnosis was 1.25 times higher when dermoscopy was used to evaluate suspicious skin lesions, and the incremental cost-effectiveness ratio was €89 (95% CI −€60 to €598).

Koelink, C. J. L., Vermeulen, K. M., Kollen, B. J., de Bock, G. H., Dekker, J. H., Jonkman, M. F., & van der Heide, W. K. (2014). Diagnostic accuracy and cost-effectiveness of dermoscopy in primary care: a cluster randomized clinical trial. Journal of the European Academy of Dermatology and Venereology, 28(11), 1442–1449. https://doi.org/10.1111/jdv.12306

Early detection is crucial in managing skin cancers. However, many family doctors need more training and tools to use dermoscopy effectively, relying on visual inspection alone. Proper education and training on dermoscopy are necessary for family physicians to incorporate it into their practice.

Fee, J. A., McGrady, F. P., Rosendahl, C., & Hart, N. D. (2019). Dermoscopy Use in Primary Care: A Scoping Review. Dermatology Practical & Conceptual, 9(2), 98–104. https://doi.org/10.5826/dpc.0902a04