ABSTRACT
Dermoscopy is a noninvasive diagnostic investigation based on magnification, illumination and obliteration of light scatter on the skin surface allowing better visualization of structures beneath the stratum corneum. We aimed to assess image quality of lesions evaluated at a skin cancer clinic using three different handheld dermatoscopes;the Heine Delta 20T (contact) with an iPad;the MoleScope II (noncontact) with a Samsung 7 smartphone;and the Dino-Lite Edge with direct download to a MacBook laptop (noncontact). The Heine Delta 20T and iPad is the current standard used. The MoleScope is a mobile smartphone-attachable dermatoscope. The Dino-Lite is a handheld digital microscope that connects directly to the computer via a USB port. The cost of the Heine Delta 20T is roughly 1100, the MoleScope II 260 and the Dino-Lite 600. Twenty-three lesions were imaged with each device;15 were pigmented. A total of 69 images were downloaded and transferred to Microsoft PowerPoint for review in random order. The images were scored by four consultant dermatologists, one general practitioner with a special interest and one associate specialist, blinded to the diagnoses. A score of 1-5 (poor- excellent) was attributed to each category: (i) detail/dermoscopic features;(ii) colour discrimination;(iii) magnification. Each assessor recorded whether - based on the image alone - they could make a diagnosis. The lesions were basal cell carcinoma (n = 6), seborrhoeic keratosis (n = 4), lichenoid keratosis (n = 1), benign naevi (n = 4), dysplastic naevi (n = 2), melanoma (n = 1), blue naevus (n = 1), sebaceous gland hyperplasia (n = 1), ruptured cyst (n = 1), pyogenic granuloma (n = 1) and dermatofibroma (n = 1). The mean score for each device and category was calculated as follows. (i) Heine: detail = 3.2, colour = 3 3, magnification = 3 2 (overall score = 3 2);46 2% felt able to make a diagnosis. (ii) MoleScope: detail = 2 5, colour = 2 7, magnification 2 5 (overall score = 2 6);43 5% felt able to make a diagnosis. (iii) Dino-Lite: detail = 3 2, colour = 3 2, magnification = 3 6 (overall score = 3 3);57 2% felt able to make a diagnosis. Analysis on a PC screen allowed greater magnification than is generally employed in clinic, which may have affected assessors. The Heine is not primarily designed for digital dermoscopy. It requires two operators for image capture, whereas the other systems require only one. The MoleScope remains the most 'mobile', whereas the Dino-Lite is attached to a laptop/PC. Both the MoleScope and Dino-Lite can be used as noncontact dermatoscopes, avoiding contact medium use. Considering the current COVID-19 pandemic, these devices are less time consuming, more convenient and easier to clean. Overall, the Dino-Lite produced the best images. Despite the MoleScope scoring lower, it was comparable for diagnostic ability. It is proposed that the MoleScope and Dino-Lite systems may be optimal for use in teledermatology to facilitate virtual clinics.