Following the recent Royal College of Podiatry Conference last month in Liverpool, I decided to try and answer the most asked question during the dermatology sessions - which dermatoscope should I buy?
This is a common question I get asked by those wishing to dive into the fascinating world of skin lesion examination but there is no straight answer - it's a bit like saying should I buy a Ford or a Ferrari? They are both cars that would get you from A to B but what you choose depends on your individual needs. In this blog, I will offer some tips on how to select the best device for your practice.
1. Buy the one you want, from the start. There is always a temptation when starting out to get a cheaper or “beginners” model for whatever hobby you may be taking up. In dermoscopy, I don't think there is actually a “beginners” dermatoscope. You only really need to ever buy one device runsunless it's lost or broken so it should last you for your career. You only buy one once so invest in the one you really want.
2. Cheapest is not always the best. You only get what you pay for and I will stick my neck out and say if you are moving into this field a budget of £800 - £1300 will get you a quality device. Yes, you can find devices labelled as dermatoscopes from £25 online, but as you can probably guess, they may not be up to the job. Of course, you may find a second-hand quality model. These will be cheaper but will still hold their prices well into the £100’s.
3. Buy from a retailer with longevity and an aftercare service. Occasionally things can go wrong and it's good to know that the company you purchased from is still in business and happy to replace a battery and answer any queries you may have.
4. It's always best to try before you buy. Any reputable dealer will have a range of devices and exhibit at conferences so it's a good time to try before you buy. How does it feel in your hands? How big is the viewing area? Do you like the feel or design? They are all slightly different and so it's good to try them out to see what you like best. Also, you can find out about accessories. For example, most recharge their batteries via a USB port but some come with desk chargers. Also, what cases do they come with?
5. Get some training! It's important to understand the basics of dermoscopy to get the best from it. The basic training is roughly around 4-5 hours. Remember it's good CPD but also important if you are serious about using your dermatoscope. A range of courses are available across the UK. I run live training online (2 consecutive evenings) for a maximum of five people at a time, focussing on foot and ankle dermoscopy (Click here to learn more), whilst the Primary Care Dermatology Society also run courses open to podiatrists (click here to learn more).
Basic Requirements
Contact, non-contact functionality or both? Dermatoscopes can be used to visualise lesions by holding them slightly away from a lesion (non-contact dermoscopy) or by placing them onto the skin lesion directly (contact dermoscopy). Solely non-contact devices are better suited when surveying skin with lots of lesions, allowing rapid scanning of a patient with lots of moles for example. In podiatry, we are probably only going to be looking at a few and they are best viewed by using a contact dermatoscope. Most professional devices offer both modes, but in podiatry, contact devices are much more useful.
Check if your device offers both polarised and non-polarised light settings. This is standard for modern devices, but cheaper or older devices may be lacking a polarised setting meaning their functionality is limited. Most newer devices use LEDs to generate light, older (and cheaper) designs use traditional bulbs which also have a shorter lifespan and reduced luminescence.
Magnification. 10X should be seen as the standard level of magnification required for dermoscopy although some do offer slightly higher magnification.
Can you attach your smartphone or camera to it to take pictures? A picture is an ideal way to capture a lesion and serves as a comparator if you are comparing a lesion for change over time. Most modern devices are perfectly capable of doing this, usually through the use of an adaptor, special phone case or phone case attachment. Check with your retailer that this is part of the package. You can manually hold a smartphone lens over the scope and take images. Although cost saving it can be fiddly, without one.
Can it reach the places that you need it to? What do I mean? Well, between the toes. A patient with an interdigital naevus can be tricky for a dermatoscope with a large head to reach so most come with a small lesion plate that fits onto the head and allows visualisation in tight spots. Not all devices have a small lesion plate available, and for the ones that do, it may be an added extra so it's good to check first.
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Example of a small lesion plate
Cleaning you device
The head of the dermatoscope and lens is the only part that comes into contact with the patient. When using the device on lesions, after use of an alcohol wipe or hypochlorous solution is recommended as a standard procedure to decontaminate it. A number of devices have disposable plastic caps as covers but some devices have detachable autoclavable lenses.
Additional Features
Measuring made easy. Some devices have a measurement scale (or graticule) on the plate itself which means that when you look down the ‘scope, there is a convenient ruler with which to measure the lesion.
Dermatoscopic image showing the measurement scale (graticule) in mm.
Software Apps. Some of the newer devices come with smartphone apps that can be used to help store any images and patient details. Not always essential but a nice touch.
Where should I buy one from in the UK?
A search of the internet will bring up many companies that sell devices. Many just do online sales, but it is worth doing your research and finding companies that allow you to contact them by phone and ask questions. Companies which have smaller catalogues or specialise in this field are usually more knowledgeable about the products they stock and responsive to queries.
In the UK, Stephen Knobel at Surgisol offers a range of dermatoscopes and is happy to chat with podiatrists via the phone or e-mail to discuss their needs. He be can be contacted via his website: www.surgisol.com.
Other retailers can also be found online.
Where can I see reviews of devices?
The PCDS has a Youtube channel where Dr. Chin Whybrew demonstrates a range of devices.
The BAD produces a document that outlines a range of devices that are available along with their features.
Which Brands?
Over the years, I have used a range of devices in the podiatry clinic. Below I included two leading manufacturers of quality dermatoscopes and suggest models which may be useful for podiatry.
Heine
(https://www.heine.com/en_US/products/dermatoscopes-and-digital-documentation/dermatoscopes)
A long-established German company that makes a range of devices including the newer Heine Delta One and Delta 30 devices. These offer all the essential features plus 3 levels of brightness and quality optics. Phone adaptors ensure you can easily capture images from them. You can read my reviews of the Delta One and Delta 30 devices.
Heine Delta One Dermatoscope
3GEN / Dermlite (https://dermlite.com/)
This American company makes a range of quality devices including the Dermlite DL4, DL3 and DL200 models. All offer polarised and non-polarised settings. The devices are portable and fit modern smartphones. My video review of the DL4 can be found here.
Dermlite DL4 Dermatoscope
As they always say on TV, other device manufacturers are available!
Please note. This article is based on my personal opinions with no financial incentives from any company involved in the manufacture or distribution of dermatoscopes.