J Korean Med Assoc.  2018 Nov;61(11):649-654. 10.5124/jkma.2018.61.11.649.

Role of dermoscopy and biopsy in the diagnosis of skin cancer: it takes two to tango

• Li K

• KMID: 2426474
• DOI: http://doi.org/10.5124/jkma.2018.61.11.649

Abstract

Although the dermoscopy had very long history since its introduction in 17th century, only recently it has been possible to see the widespread application of dermoscopy in the dermatology clinic. One of the most promising areas where the dermoscopy can be applied is the diagnosis of skin cancer, especially malignant melanoma. Due to its inherent limitation to obtain in-depth information"”literally, from more than skin-deep and more importantly, from microscopic structures"”of skin cancers, dermoscopy cannot replace the present gold-standard "˜biopsy' in the diagnosis of skin cancer. However, several advantages of dermoscopy over biopsy merit further considerations. For example, as a non-invasive tool, dermoscopy is best suited for the follow-up of suspicious skin lesions, and as an all-at-a-glance tool, dermoscopy can aid the selection of the best biopsy-site to obtain the most meaningful pathological information from the minimal tissue specimen. There goes a saying that "˜it takes two to tango,' similarly, we might need the two (biopsy and dermoscopy) to cope rhythmically with the varying tempos of ever-progressing skin tumorigenesis and to reveal the true face of skin cancers usually hidden in various disguises.

Keyword

Biopsy; Dermoscopy; Skin neoplasms; Diagnosis

MeSH Terms

Biopsy*
Carcinogenesis
Dermatology
Dermoscopy*
Diagnosis*
Follow-Up Studies
Melanoma
Skin Neoplasms*
Skin*

Figure

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  Figure 1 Overview on the dermoscopy. (1st row) Skin lesions are usually approached in two ways. One is horizontal plane (orange), and the other is vertical plane (blue). (2nd row, A-C; 3rd row, D-F) Clinical photo (D), dermoscopic photo (E), and photomicroscope (F) of basal cell carcinoma on the nose of 67-year-old man. Human eye (A), the most elementary examining tool of the dermatologists, evaluates the skin lesion on horizontal plane. Dermoscope (B) also reveals horizontal characteristics of skin lesion, with more magnified and clarified view. In contrast, biopsy and subsequent processes in the pathology department (C) provide glass-slide showing vertical section of the skin. White-dotted cylinder on the 2nd row (C) represents the tissue removed by punch, a versatile apparatus for skin biopsy. Inset in the photomicroscope on the 3rd row (F) corresponds to the punch-biopsy specimen after H&E stain. (4th row) Clinico-dermoscopic-pathologic correlation (CDPC) and schematic presentation of dermoscopic findings and corresponding microscopic structures for basal cell carcinoma. Clinic-pathologic correlation (CPC) has long been emphasized in the interpretation of biopsy result. Different approaches taken by clinical (horizontal) and pathologic (vertical) evaluation should be incorporated to obtain maximal information from the biopsy specimen. Revealing structures unobserved by naked eye, which corresponds to the characteristic microscopic structures in the pathologic specimen, dermoscope can provide additional informations for CPC, thus making CDPC possible.

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