Quality statement 4: Dermoscopy

Quality statement

People with pigmented skin lesions undergoing a specialist assessment have the lesions examined using dermoscopy.

Rationale

Dermoscopy performed by suitably trained specialists is more sensitive and more specific in classifying skin lesions than clinical examination with the naked eye. It lessens the chance of missing a diagnosis of melanoma and reduces the number of unnecessary surgical procedures to remove benign lesions.

Quality measures

Structure

Evidence of local arrangements and clinical protocols to ensure that people undergoing specialist assessment of pigmented skin lesions are examined using dermoscopy.

Data source: Local data collection.

Process

Proportion of pigmented skin lesions undergoing specialist assessment that are examined using dermoscopy.

Numerator – number in the denominator examined using dermoscopy.

Denominator – number of pigmented skin lesions undergoing specialist assessment.

Data source: Local data collection.

Outcome

a) Pigmented skin lesions not selected for biopsy that are subsequently confirmed as melanoma

Data source : Public Health England Cancer stats tool and local data collection.

b) Proportion of melanoma diagnosed at stage 1 or 2.

Data source: Public Health England, National Cancer Registration and Analysis Service.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (local hospital skin cancer multidisciplinary teams and specialist skin cancer multidisciplinary teams) ensure that systems are in place for using dermoscopy during specialist assessment of pigmented skin lesions. Service providers should also ensure that those using dermoscopy have formal training.

Healthcare professionals (members of local hospital skin cancer multidisciplinary teams or specialist skin cancer multidisciplinary teams) undertaking specialist assessment of pigmented skin lesions ensure that they examine the lesions using dermoscopy. They should include formal training as part of their continuing professional development.

Commissioners (clinical commissioning groups and NHS England) ensure that the specialist services they commission have trained specialists who use dermoscopy to examine pigmented skin lesions.

What the quality statement means for patients and carers

People with skin lesions (such as damaged or injured patches of skin or new, large, changing or unusual looking moles) that are being assessed by a specialist have the lesions examined using a magnifying tool called a dermatoscope, which gives a more accurate view of the lesion.

Source guidance

Definitions of terms used in this quality statement

Specialist assessment

An assessment carried out by a doctor trained in the diagnosis of skin malignancy, normally a dermatologist, who is a member of either a local hospital skin cancer multidisciplinary team or a specialist skin cancer multidisciplinary team.

[Adapted from NICE's guideline on improving outcomes for people with skin tumours including melanoma, key recommendations (page 8)]