Ultraviolet-Induced Fluorescence Dermoscopy: Game Changers

Ultraviolet-induced fluorescence dermoscopy (UVFD) is a novel diagnostic and visualization technique that enhances visualization of skin dermatoses with ultraviolet (UV) light. UVFD has been used to diagnose dermatoses including bacterial and fungal infections, pigmentary disorders, and skin neoplasms. We present five cases-pitted keratolysis, porokeratosis, molluscum, biopsy site identification, and lentigo maligna-where UVFD alone, compared to traditional polarized dermoscopy (PD) or the unaided clinical exam, served as a "game-changer" in diagnosis and management. Polarized and UV images were captured using a DL5 dermatoscope coupled to a smartphone. In the cases of pitted keratolysis, porokeratosis, and molluscum, we highlight distinct patterns of fluorescence that were readily visualized with UVFD and aided efficient diagnosis, in contrast with more subtle features that were seen under PD. We also demonstrate the utility of UVFD in identification and confirmation of a prior biopsy site in a patient who presented for excision of a skin cancer. Finally, we describe the advantage of UVFD in presurgical margin delineation in a patient with lentigo maligna. In these cases, we show that UVFD facilitates prompt and accurate diagnosis, streamlines appropriate treatment, and has the capacity to reduce the need for unnecessary biopsies. Given the convenience and practicality of a dermatoscope equipped with a UV light, we propose that clinicians would benefit from the use of UVFD as a supplementary tool alongside conventional dermoscopy, rather than as a substitute.