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Year : 2017  |  Volume : 15  |  Issue : 4  |  Page : 203-209

Dermoscopy versus skin biopsy in diagnosis of suspicious skin lesions

1 Department of Dermatology, Venereology and Andrology, Qena Faculty of Medicine, South Valley University, Egypt
2 Department of Dermatology, Venereology and Andrology, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt
3 Department of Pathology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
4 Department of Dermatology, Qena General Hospital, Qena, Egypt
5 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt

Correspondence Address:
Hassan Ibrahim
Department of Dermatology, Venereology and Andrology, Quena Faculty of Medicine, South Valley University, 83523 Qena
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AZMJ.AZMJ_67_17

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Background Dermoscopy is a simple and inexpensive diagnostic technique that permits the visualization of morphologic features that are not visible to the naked eye, forming a link between clinical dermatology and microscopic dermatopathology. For many years, skin biopsy was considered the only definite diagnostic tool that confirms or excludes the clinical diagnosis. Skin biopsies are invasive and have many adverse effects and precautions. Objective To evaluate the accuracy of dermoscope in diagnosis of skin tumors and its correlation with clinical and pathological diagnosis. Patients and methods Thirty-four patients who attended Dermatology Clinic at Qena University Hospital from January 2013 to December 2014 were recruited in a nonrandomized prospective study. The inclusion criteria were reported through the following: full history taking, such as (a) name, age, sex, duration of the lesion, onset, progress, and symptoms; (b) previous history of similar lesions or skin cancer; (c) family history of similar lesion or skin cancer; and (d) any recognized changes in the lesion in the past year such as change in size, consistency, hair growth, or bleeding; dermatologic examination, such as (I) type, site, size, shape, color, surface, and border of lesion have been also detected and reported by using of the three-point checklist as a method for differentiation between benign and suspicious lesions and (II) any specific manifestations as tenderness, bleeding, and recurrence have been detected; (III) digital photography has been performed using digital camera (Sony cyber-shot 16.1 mega pixels); dermoscopic findings by using dermoscope (HEINE BETA DELTA 20), and histopathological examination. Results There was an excellent diagnostic reliability of dermoscopy compared with skin biopsy with interrater κ value of 0.859 (confidence interval: 0.734–0.984, P<0.001). The overall agreement between dermoscopical and histopathological diagnosis was recorded in 27/33 (81.8%) cases. The ability of dermoscopy to differentiate lesion categories was investigated. Nine of the 10 neoplastic lesions and 22 of the 23 non-neoplastic lesions were identified by dermoscopy [χ2(1)=24.2, P<0.001] with sensitivity and specificity rates of 90 and 95.7%, respectively, and positive and negative predictive values of 90 and 95.7%, respectively. Regarding differentiation benign from malignant skin lesions, dermoscopy identified 25 of the 26 benign lesions and identified all malignant skin lesions [χ2(1)=27.8, P<0.001]. The specificity and sensitivity were 96.2 and 100%, respectively, and the positive and negative predictive values were 100 and 87.5%, respectively. Conclusion There was a good agreement between the dermoscopy and clinical diagnosis and also a good agreement between the dermoscopy and pathological diagnosis. So dermoscopy can be introduced as a routine diagnostic tool in dermatological examination and will be of a great aid in the accurate diagnosis of suspicious skin lesions before invasive skin biopsy. However, further studies with large sample size are needed later on.

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