Box 1: Dermatoscopy

Dermatoscopy (also known as skin surface microscopy, epiluminescence microscopy, incident light microscopy and dermoscopy) is a method of visualising the pigmented anatomical structures of the epidermis, dermoepidermal junction and superficial papillary dermis.^4,5

The technique uses microscopy with

• Oil applied to the skin to eliminate surface reflection caused by the refractive-index mismatch between air and skin. This renders the stratum corneum more translucent, revealing skin structures not visible by simple magnification (e.g., the pigment network, black dots, white veil, radial streaming and pseudopods). Many features seen in pigmented lesions have been assessed for their sensitivity and specificity for melanoma.⁶

• A dermatoscope -- a hand-held instrument, similar to the otoscope, with a tubular body containing an achromatic lens at the top. This lens is focused on a glass footplate, providing a skin surface magnification of about x10. Halogen illumination at an angle of 20 degrees is used. Dermatoscopes include those manufactured by Heine Instruments, and the Episcope (Welch Allyn). Skin surface microscopy can be performed with other instruments, such as the binocular stereomicroscope, but these are generally confined to research and not used in general clinical practice.

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