BehindTheMedspeak: Dermoscopy — Non-Invasive Melanoma Detection

In the August 16 New York Times Kate Murphy wrote about a revolution in dermatology currently underway in the United States.

We're a little bit behind the curve here: the technique is widely used in Europe, particularly in Germany and Austria, where it was developed in the 1980s.

It's called dermoscopy.

Only 23% of American dermatologists use it in their clinical practices.

Murphy wrote, "The technique, which involves using a specialized hand–held microscope called a dermoscope (below),

allows doctors to more accurately assess the likelihood that a mole or other skin growth is cancerous and therefore reduces the need for surgical excisions."

Why isn't it more widely used in the U.S.?

Duh: follow the money.

You can't bill very much for a look–see through a dermoscope.

Bring out the biopsy punch and scalpel, though, and the cash register starts to go crazy.

A paper published this year in the Journal of the American Academy of Dematology showed that dermoscopy improved doctors' accuracy by as much as 30% over clinical visual inspection.

Using the dermoscope reduces the number of moles that need to be removed by 20% to 50%.

That's a lot of green.

Fact: Only about 1 in 100 biopsies turns out to be melanoma.

That's a lot of extra surgery, not to mention the anxiety caused by a diagnosis of "possible melanoma."

And even if the biopsy turns out negative, insurance companies can — and do — deny coverage on the basis of a biopsy having been performed at all.