Quality statement 4: Dermoscopy
People with pigmented skin lesions undergoing a specialist assessment have the lesions examined using dermoscopy.
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.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Evidence of local arrangements and clinical protocols to ensure that people undergoing specialist assessment of pigmented skin lesions are examined using dermoscopy.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations such as in local service specifications.
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: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
a) Pigmented skin lesions not selected for biopsy that are subsequently confirmed as melanoma.
Data source: National Cancer Registration and Analysis Service CancerStats2 tool and local data collection.
b) Proportion of melanoma diagnosed at stage 1 or 2.
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 (NHS England and integrated care systems) ensure that the specialist services they commission have trained specialists who use dermoscopy to examine pigmented skin lesions.
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.
Melanoma: assessment and management. NICE guideline NG14 (2015, updated 2022), recommendation 1.3.1
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)]