Twenty-five practical recommendations in primary care dermoscopy

Dermoscopy in primary care enhances clinical diagnoses and allows for risk stratifications. We have compiled 25 recommendations from our experience of dermoscopy in a wide range of clinical settings. The aim of this study is to enhance the application of dermoscopy by primary care clinicians. For primary care physicians commencing dermoscopy, we recommend understanding the aims of dermoscopy, having adequate training, purchasing dermoscopes with polarised and unpolarised views, performing regular maintenance on the equipment, seeking consent, applying contact and close non-contact dermoscopy, maintaining sterility, knowing one algorithm well and learning the rules for special regions such as the face, acral regions and nails. For clinicians already applying dermoscopy, we recommend establishing a platform for storing and retrieving clinical and dermoscopic images; shooting as uncompressed files; applying high magnifications and in-camera improvisations; explaining dermoscopic images to patients and their families; applying toggling; applying scopes with small probes for obscured lesions and lesions in body creases; applying far, non-contact dermoscopy; performing skin manipulations before and during dermoscopy; practising selective dermoscopy if experienced enough; and being aware of compound lesions. For clinicians in academic practice for whom dermatology and dermoscopy are special interests, we recommend acquiring the best hardware available with separate setups for clinical photography and dermoscopy; obtaining oral or written consent from patients for taking and publishing recognisable images; applying extremely high magnifications in search of novel dermoscopic features that are clinically important; applying dermoscopy immediately after local anaesthesia; and further augmenting images to incorporate messages beyond words to readers.