|Year : 2021 | Volume
| Issue : 1 | Page : 30-32
The use of dermoscopy among dermatologists in Riyadh, Saudi Arabia: A cross-sectional study
Nouf N Alqahtani1, Faten A AlBukhari2
1 Department of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
2 Department of Dermatology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
|Date of Submission||01-Jun-2020|
|Date of Acceptance||12-Aug-2020|
|Date of Web Publication||04-May-2021|
Dr. Nouf N Alqahtani
Department of Dermatology, King Abdulaziz Medical City, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Dermoscopy aids in visualizing skin and has been used commonly by dermatologists around the world. Purpose: The purpose was to estimate the prevalence of dermoscopy usage in Saudi Arabia (SA), to identify the determinants of its use, and to assess the desire of dermatologists to learn more about it. Methods: One hundred questionnaires were distributed to dermatologists practicing in Riyadh; 65 were answered and returned. Results: About 56.9% own a dermatoscope or find it available in their clinics, and 36.9% of them use it regularly. About 67.7% report knowing how to use it, whereas 32.3% do not. The majority (41.5%) learned how to use it clinically by spending time with senior expert dermatologists. About 93.8% find it helpful in diagnosing melanoma and pigmented skin lesions; 81% believe that it is more accurate than the naked eye examination alone. On the other hand, 41.5% find it ineffective mostly because it requires extensive training.Comparing the postgraduate training place of the respondents. Showed no difference in terms of dermoscopy availability P = 0.09, use P = 0.51, or specialized training P = 0.09 between dermatologists currently training or did their training in SA and other dermatologists who trained outside SA. About 8.3% of dermatologists practicing for more than 10 years are using it regularly, in comparison to 91.4% of those who have been practicing for 10 years or less. Conclusion: Age, postgraduate training place, years of practice, and clinical experience are the main factors affecting the use of dermoscopy in SA. The majority of the respondents expressed their desire to expand their knowledge and improve their skills to use dermoscopy more efficiently.
Keywords: Dermatology, dermatoscopy, dermoscopy, questionnaire, Saudi Arabia, skin
|How to cite this article:|
Alqahtani NN, AlBukhari FA. The use of dermoscopy among dermatologists in Riyadh, Saudi Arabia: A cross-sectional study. J Dermatol Dermatol Surg 2021;25:30-2
|How to cite this URL:|
Alqahtani NN, AlBukhari FA. The use of dermoscopy among dermatologists in Riyadh, Saudi Arabia: A cross-sectional study. J Dermatol Dermatol Surg [serial online] 2021 [cited 2021 Jun 14];25:30-2. Available from: https://www.jddsjournal.org/text.asp?2021/25/1/30/315331
| Introduction|| |
Dermoscopy or epiluminescence microscopy is a noninvasive approach that uses a handheld device to observe aspects of the skin that cannot be visualized by the naked eye alone. The history of this technique dates to the 17th century when Kohlhaus observed the vessels of the nail matrix using a microscope. Dermoscopy was not commonly used by physicians until the 20th century when Goldman developed a portable microscope. Expansions over the decades resulted in the polarized dermatoscope used today which magnifies up to 10 times in comparison to the naked eye alone.,,,,,
The primary use of dermoscopy was initially limited to cutaneous hyperpigmented lesions. Currently, dermoscopy is also used in diagnosing nonpigmented skin lesions, malignancies, cutaneous inflammatory, and infectious conditions, and it also helps in studying treatment effectiveness and side effects. The International Dermoscopy Society, founded back in 2003, currently has more than 16,000 members from 168 countries around the world, demonstrating the widespread uptake of this method (http://www.dermoscopy-ids.org).,,,,
This study aims to assess the prevalence of dermoscopy use among dermatologists in SA, to identify the determinants of its use, including the level of experience and the frequency of diagnosing conditions using dermoscopy, and finally to assess respondents desire to learn more about it.
| Methods|| |
This is a quantitative cross-sectional study conducted over 4 months in Riyadh city, Saudi Arabia (SA). We surveyed a convenience nonprobability sample of board-certified dermatologists from governmental and private sectors and residents training in the Saudi Board of Dermatology. The study approved by the Research and Ethical Committee at Princess Nourah Bint Abdulrahman University. Dermatologists practicing in Riyadh city were included with no exclusion criteria, regardless of the years of experience or training level. The study power was based on an expected prevalence of dermoscopy use of 10% with a margin of error of 10% using a level of confidence of 95% (alpha = 0.05) and a power of 80% (beta = 0.20).
Participants completed a self-administered questionnaire with 14 items on demographic data and factors impacting the pattern of use, dermoscopy availability in the clinic, frequency of use, years of practice and level of training, postgraduate training place, general knowledge about the indications, and effectiveness in making a diagnosis. Participation was voluntary, participants informed about the nature of the research, and their privacy was insured. The data were coded and analyzed using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, NY) and evaluated using frequency and multivariability analysis (Chi-square test and Fisher's exact test). P < 0.05 is considered statistically significant.
| Results|| |
Out of 100 self-administered questionnaires, 65 were answered and returned. The majority of the respondents were female (58.5%), 66.2% were between 25 and 35 years of age, and 38.5% have been practicing dermatology for 5 years or less [Table 1]. Thirty-seven of the respondents (56.9%) own a dermatoscope or find it available in their clinics; 36.9% of them use it on regular bases, whereas the rest (20%) use it sometimes [Table 2].
About 67.7% (n = 44) reported knowing how to use dermoscopy properly, whereas the rest do not (32.3%) (n = 21). Clinical training with senior experts in dermoscopy is the most common learning method used by the respondents; other methods include theoretical reading from various recourses and attending live lectures and seminars [Figure 1].
|Figure 1: The methods of learning used by the participants to use dermoscopy|
Click here to view
Respondents find dermoscopy mostly helpful in diagnosing the following conditions: melanoma and pigmented skin lesions 93.8% (n = 61), nonmelanoma skin cancers 33.8% (n = 22), hair disorders 76% (n = 50), and inflammatory skin lesions 20% (n = 13). They believe in the importance of using dermoscopy clinically for the following reasons: more accurate than the naked eye examination alone 81% (n = 53), for early detection of melanoma 44.6% (n = 29), it reduces the need of skin biopsy 36.9% (n = 24), essential for documentation purposes 29.2% (n = 19), and to reduce the patient anxiety 10.8% (n = 7).
Others find it less useful for the following reasons: it requires extensive training 41.5% (n = 27), the equipment is too expensive 32.3% (n = 21), melanoma is uncommon in SA 27.7% (n = 18), time-consuming 15.4% (n = 10), and 7.7% (n = 5) believe that it could affect the accuracy of skin biopsy result.
The respondents were asked to estimate the frequency of diagnosing skin cancer in their clinics. the majority (52.3%) (n = 34) diagnose it once a year, 16.9% (n = 11) once every 6 months, 13.8% (n = 9) once a month, 12.3% (n = 8) once every 3 months, and 4.6% (n = 3) diagnose it once a week.
About 73.8% did their training or are currently training in SA, and 26.2% trained abroad (in the United States, Canada, or Egypt). Insignificant correlations noticed between the two groups in terms of dermoscopy availability and its regular use clinically (P = 0.09 and P = 0.51, respectively). Among the abroad group, 52.9% (n = 15) received specialized training to use dermoscopy in comparison to 31.3% (n = 15) of the SA group (P = 0.9) [Table 3].
|Table 3: Comparison between the respondents in terms of the postgraduate training place|
Click here to view
Dermatologists who have been practicing for 10 years or less use dermoscopy more than those practicing for more than 10 years, 91.4% (n = 22) and 8.3% (n = 2), respectively, (P = 0.01). The majority of participating dermatologists believe in the clinical importance of dermoscopy (68%) (n = 45%) and wish to expand their knowledge to use it (95.4%) (n = 62). In comparison, 4.6% (n = 3) think that it is less important in the skin of color patients.
| Discussion|| |
Dermoscopy is becoming a more widely used tool for diagnosing a variety of dermatological conditions and not only pigmented lesions. Many previous studies have been conducted around the world on its use. Dermoscopy is used in SA more than in the United States and less than in Europe (48% and 89%, respectively)., Dermatologists who trained with a pigmented lesions' specialist are more confident than those who trained with others. Similarly, in SA, dermatologists report knowing to use it mostly by clinical practice under the supervision of senior experts. About 41.5% find dermoscopy less useful because it requires extensive training. This finding could explain the low rate of its daily use (19.2%), as the lack of training is reported to be the most common factor limiting the use of dermoscopy.,
A cross-sectional study conducted in Germany noticed a significant increase in the sensitivity for diagnosing melanoma by dermatologists who use dermoscopy daily. In this study, half of the respondents see a case of melanoma or nonmelanoma skin cancer about once a year. Therefore, the rarity of diagnosing skin cancer in SA might also be an explanation of the low rate of daily use.
Young age dermatologists in SA are using it more often than the older ones. This is consistent with the findings reported in the literature, demonstrating a higher rate of use among the younger generation., This finding reflects the expanding clinical uses of dermoscopy and the willingness of the younger generation to adopt new technology.
| Conclusion|| |
Age, postgraduate training place, years of practice, and clinical experience are the main factors affecting the use of dermoscopy in SA. The majority of the respondents expressed their desire to expand their knowledge and improve their dermoscopy skills.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Garg A, Levin N, Bernhard J. Structure of skin lesions and fundamentals of clinical diagnosis. In: Goldsmith LA, Katz MS, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in General Medicine. 8th
ed. The McGraw-Hill Medical; 2012. p. 28.
Marghoob AA, Swindle LD, Moricz CZ, Sanchez Negron FA, Slue B, Halpern AC, et al
. Instruments and new technologies for the in vivo
diagnosis of melanoma. J Am Acad Dermatol 2003;49:777-97.
Menzies SW, Ingvar C, McCarthy WH. A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma. Melanoma Res 1996;6:55-62.
Argenziano G, Soyer HP. Dermoscopy of pigmented skin lesions--a valuable tool for early diagnosis of melanoma. Lancet Oncol 2001;2:443-9.
Campos-do-Carmo G, Ramos-e-Silva M. Dermoscopy: Basic concepts. Int J Dermatol 2008;47:712-9.
Vázquez-López F, Marghoob AA. Dermoscopic assessment of long-term topical therapies with potent steroids in chronic psoriasis. J Am Acad Dermatol 2004;51:811-3.
Wu TP, Newlove T, Smith L, Vuong CH, Stein JA, Polsky D. The importance of dedicated dermoscopy training during residency: A survey of US dermatology chief residents. J Am Acad Dermatol 2013;68:1000-5.
Argenziano G, Ferrara G, Francione S, Di Nola K, Martino A, Zalaudek I. Dermoscopy--the ultimate tool for melanoma diagnosis. Semin Cutan Med Surg 2009;28:142-8.
Engasser HC, Warshaw EM. Dermatoscopy use by US dermatologists: A cross-sectional survey. J Am Acad Dermatol 2010;63:412-9, 419.e1-2.
Forsea AM, Tschandl P, Del Marmol V, Zalaudek I, Soyer HP, Eurodermoscopy Working Group, et al
. Factors driving the use of dermoscopy in Europe: A pan-European survey. Br J Dermatol 2016;175:1329-37.
Blum A, Kreusch J, Stolz W, Argenziano G, Forsea AM, Marmol VD, et al
. The status of dermoscopy in Germany – Results of the cross-sectional Pan-Euro-dermoscopy study. J Dtsch Dermatol Ges 2018;16:174-81.
[Table 1], [Table 2], [Table 3]