Digital dermatoscopy and photographic monitoring of skin lesions
Table of contents
Digital dermoscopy enables moles and other skin lesions to be examined in detail using a dermoscope, and allows identified images to be saved for comparison during subsequent check-ups. In selected individuals, it can be combined with photographs of large areas of the body to identify new lesions or detect changes. It does not provide an automatic diagnosis, nor does it replace a biopsy when a lesion exhibits suspicious characteristics.
What is digital dermatoscopy and what information does it provide?
Dermatoscopy uses an optical instrument called a dermatoscope, which allows the colours, structures and patterns of a lesion to be observed that are not always distinguishable to the naked eye. When these images are captured, identified and stored for later review or comparison, this is referred to as digital dermatoscopy.
The technique can be used to document a lesion during a specific consultation or to monitor its progression. Some systems include tools to help organise or compare the images, but the interpretation is the responsibility of the dermatologist.
Dermatoscopy enhances the clinical assessment of the skin. Where there is sufficient suspicion of melanoma or another skin tumour, diagnosis may require a biopsy and subsequent analysis of the tissue.
Keeping images taken in a similar manner during different visits enables the dermatologist to assess the progression of a lesion and identify changes that may be difficult to detect by relying solely on visual memory.
Would you like more information about digital dermatoscopy?
The team can advise you on how the examination is carried out, when photographic monitoring may be useful, and what happens if a lesion requires further assessment.
Digital dermatoscopy, mole mapping and body photography
Although these terms are related, they do not describe exactly the same thing. A digital dermatoscopic image is a magnified photograph of a specific lesion, which allows its pattern to be studied and recorded. Sequential dermatoscopic monitoring involves repeating these images at different times to assess whether any significant changes occur.
Full-body photography records large areas of the skin using standardised photographs. Its main purpose is to facilitate the detection of new lesions or to identify general changes between check-ups.
In some people, both strategies are combined. This approach may be referred to as digital body mapping or digital mole mapping, although this does not necessarily mean that every mole is photographed individually using a dermatoscope.
When digital dermoscopy may be indicated
The technique may be useful when comparing images over time could influence a clinical decision. It may be considered in people with numerous moles, multiple atypical lesions, a personal history of melanoma, or certain family or genetic histories that increase the risk.
It can also be used to monitor a specific lesion when its appearance does not warrant an immediate biopsy, but nor does it allow the lesion to be classified with sufficient confidence in a single consultation.
Not everyone with moles requires digital monitoring. Whether it is indicated depends on the overall risk and on whether having comparable images can provide clinically useful information.
Monitoring of pigmented lesions
A new or changing lesion is not necessarily malignant. Changes may be related to age, growth, sun exposure, pregnancy, inflammation or trauma. Similarly, a stable lesion cannot be considered benign simply because it has not changed.
The dermatologist interprets the change over time alongside the current appearance, age, location, medical history and the pattern of the other lesions.
Surveillance in people at increased risk of melanoma
Full-body photography and sequential digital dermoscopy may form part of the monitoring of certain individuals at high risk. The decision does not depend on the number of moles alone, but on the overall medical history and clinical characteristics.
A lesion that already shows sufficiently suspicious signs should not be monitored solely through photographic follow-up whilst waiting to see if it changes.
How to prepare for a digital dermatoscopy
Preparation depends on the areas to be examined and the type of imaging required. You may be advised to attend with no make-up, self-tanner or thick products on the areas to be photographed, as these can alter the colour or affect the quality of the images.
If your nails are to be examined, you may need to remove any nail varnish. To examine the scalp, it is best if your hair can be parted easily. It may also be helpful to:
Wearing clothes that can be easily removed and put back on.
Mention any new lesions or any that have changed.
Point out any areas of concern.
Bringing any previous images or reports if they are from another centre.
It is not usually necessary to fast or to change your medication.
How digital dermatoscopy and photographic monitoring are carried out
The dermatologist begins by reviewing the reason for the consultation, the patient’s medical history, risk factors and, where applicable, previous check-ups. They then examine the skin and decide which lesions or areas should be documented. Not all consultations require a full-body photograph or a dermatoscopic record of all moles.
Full-body photography
When a full-body photograph is taken, the patient assumes different positions in front of a camera to capture various areas of the skin. The aim is to obtain reproducible images that can be compared during subsequent visits. It may be necessary to expose large areas of the body for short periods.
Before beginning, the team should explain which areas are to be photographed and how privacy will be protected.
Digital dermatoscopy
The dermatoscope is placed on top of the lesion or very close to it. Some devices come into contact with the skin and may use a liquid or gel; others operate using polarised light without direct contact. Magnified images of the selected lesions are obtained and recorded so that they can be located later.
No recovery time is required. Once the examination is complete, the dermatologist assesses which lesions do not require immediate action, which should be monitored, and which require a biopsy or further assessment.
What you might feel during digital dermatoscopy
The procedure does not involve needles, radiation or contrast agents. You may feel a slight pressure when the dermatoscope comes into contact with the skin, or a cooling sensation if gel is used.
Full-body photography may cause some discomfort due to the need to expose areas of skin or hold certain positions for a few seconds. The procedure can be adapted in cases of pain, instability or reduced mobility.
The duration depends on the scope of the examination. Documenting a single lesion takes less time than carrying out an initial assessment involving full-body photography and recording numerous lesions.
Privacy and protection of dermatological images
Body photographs may cover large areas and, on occasion, sensitive areas. Before taking them, the team must explain which areas need to be documented and for what purpose. The patient may raise any queries and express any concerns regarding the taking of images.
Photographs used for follow-up form part of the clinical record and contain particularly sensitive health information. Their storage and access must be managed in accordance with the centre’s procedures and applicable regulations.
Any potential educational, scientific or informational uses of an image must be distinguished from its use in patient care.
How to interpret the results of a digital dermatoscopy
Digital dermatoscopy does not simply provide a positive or negative result. The dermatologist takes into account the current appearance of the lesion, its dermatoscopic characteristics, a comparison with previous images, the patient’s medical history and an examination of the rest of the skin.
No immediate action is required
When the clinical and dermatoscopic findings do not warrant a biopsy or specific follow-up, it may be recommended to continue with routine monitoring. This does not guarantee that the lesion will never change or that new ones will not appear.
A follow-up appointment is arranged
Some lesions present a degree of uncertainty that does not warrant an immediate biopsy, but does warrant a further assessment. The follow-up interval depends on the characteristics of the lesion, the individual’s risk and the protocol used. The usefulness of this strategy depends on the scheduled check-ups being carried out.
A biopsy or excision is recommended
A new, changing or suspicious lesion may require histopathological examination. The decision does not depend solely on whether a change has occurred. The current appearance, location, symptoms, age and medical history are also taken into account.
Images are not comparable
Changes in lighting, orientation, magnification, device pressure or the imaging system may make comparison difficult. When images do not allow the progression to be assessed with sufficient confidence, the decision is based on the current examination and may require further imaging, follow-up or a biopsy.
Limitations of digital dermoscopy and mole mapping
Digital monitoring facilitates comparison, but does not provide comprehensive or infallible surveillance. A benign lesion may change and ultimately require a biopsy. At the same time, a malignant lesion may initially show few signs, appear between check-ups, or lie outside the areas photographed.
Hair, skin folds, certain postures or clothing can conceal lesions. Some areas, such as the scalp, nails, soles of the feet, the spaces between the toes or intimate areas, may require specific examination.
The quality of follow-up also depends on the images being comparable and correctly labelled. Automated systems can help to organise or analyse images, but should not be used as a standalone diagnostic tool.
A follow-up with no concerning findings does not guarantee the absence of disease, nor does it replace the assessment of a new lesion or a significant change that may arise between appointments.
Risks and potential drawbacks of digital dermoscopy
The direct physical risk associated with the technique is low. There may be slight pressure on the skin, a cold sensation from the gel, or discomfort when maintaining certain positions.
Follow-up may also lead to biopsies being taken of lesions that ultimately prove to be benign. This is one of the limitations of a strategy designed to ensure that significant lesions are not overlooked.
Full-body photography may cause discomfort related to privacy; therefore, providing information in advance and taking care whilst capturing the images are particularly important.
Digital dermatoscopy and skin biopsy
Digital dermatoscopy examines and compares images. A biopsy involves taking a tissue sample for examination under a microscope. These are complementary techniques.
Dermatoscopy can help to identify which lesions can be monitored and which require histopathological examination. Where there is sufficient clinical suspicion of melanoma or another tumour, photographic monitoring should not be used to delay a biopsy that is indicated.
Digital dermatoscopy in special circumstances
During pregnancy, changes may occur in some moles, but these should not automatically be attributed to this circumstance. Any concerning lesion requires dermatological assessment. In children and adolescents, some nevi may change as they grow. Their progression should be interpreted taking into account the patient’s age and clinical context.
If there is reduced mobility, the angles and scope of the photographic record can be adapted. Hard-to-reach areas may require a targeted examination and are not always adequately captured in a standard full-body photograph.
Specialists in digital dermatoscopy at Memorial Publio Cordón
At Memorial Publio Cordón Hospital, digital dermatoscopy forms part of the Dermatology and Venereology department, within the Dermo Centre. The department is headed by Dr Javier Pedraz Muñoz.
The department is organised into various clinical units, including the General Dermatology Unit and the Dermatological Surgery Unit, which are involved in the assessment and management of pigmented lesions, precancerous lesions and skin tumours.
Digital dermatoscopy is integrated with dermatological examination and, when a lesion requires confirmation via tissue analysis, with skin biopsy and histopathological examination.
Medical information for general guidance
This factsheet aims to help you understand what digital dermoscopy is, how it differs from body photography and mole mapping, how lesions are monitored, and in which situations a biopsy may be necessary.
The Publio Cordón Memorial Hospital promotes accurate, understandable and useful medical information, linked to specialist care, research, scientific dissemination and advances in medicine.
The indication for digital dermoscopy, the scope of the photographic record and the frequency of check-ups must be tailored to the individual’s risk profile and characteristics. A stable image does not provide absolute confirmation of benignity, and any new or concerning lesion must be clinically assessed, even if regular follow-up is already in place.