Hand-held dermatoscope or videodermatoscope: Which one to buy?

Dermatoscopy is increasingly being used for diagnosis, prognosis as well as treatment follow-up in the field of dermatology. However, there are still many dermatologists, especially residents, who grapple with the question: ‘Which device should they start working with?’ The lack of formal training in dermatoscopy in teaching departments, as well as the lack of a greater understanding granted by standard textbooks of dermatology has led to further confusion and indecision. Through this article, we wish to highlight important features of different types of devices, so that dermatologists new to this technique can make an informed decision.

Broadly, there are two types of dermatoscopes: hand-held dermatoscopes and videodermatoscopes.^1,2 The practice of dermatoscopy started off with the hand held dermatoscopes, which offered a magnification of 10x. Most of the initial work in dermatoscopy was done with these devices. The initial handheld devices used non-polarized light. This would limit the visualization of structures and patterns to the papillary dermis. To overcome this issue, immersion/contact fluids were used to enhance light penetration. With the advent of devices with polarization, the applications and acceptability of dermatoscopes increased tremendously. The algorithms developed for pigmentary disorders, especially melanocytic nevi are based on pattern recognition with polarized light at 10x magnification.

Soon enough, it was realized that just as a 10x magnification offered a new perspective on skin diseases, higher magnification (20-200x) can further enhance diagnostic utility by enhancing/elaborating more features.^3,4 This degree of magnification was afforded by videodermatoscopes. Universal serial bus (USB) dermatoscopes, which are marketed as ‘digital microscopes’, fall under this category. Over recent years, there has been an increasing trend of utility for these devices.^3-6 Even in this category, there are a range of magnifications, brands and special features available. The higher magnification afforded by these devices helps delineate additional details, especially vascular structures. Table 1 summarizes the major differences between these two types of devices including their features and their utility for various indications. Table 2 summarizes the common brands available in the market.

For a beginner, especially a post-graduate student, buying an expensive instrument like a dermatoscope is an important investment to make. With limited knowledge and several choices, it is not always easy to make the right decision. This uncertainty prompts many to buy a cheaper dermatoscope in the initial phase of their learning. However, poor resolution and picture quality fail to do justice to dermatoscopy, and may dampen one’s interest. Therefore, it is advisable to research available instruments and invest in the best one possible.

The best dermatoscope to buy is the one which best suits the user’s personal needs in terms of the type of skin lesion to be visualized commonly. This is further based on the type of practice, time available and the ease of carrying accessory equipment for image capture and storage [Figures 1 and 2]. Hand-held dermatoscopes offer low magnification but excellent optical resolution and images, but most devices need to be in contact with the area to be examined, which may limit their use, especially in the current pandemic era. Other advantages of hand-held dermatoscope include ease of use and easy connectivity to the smartphones. For daily practical needs, a hand-held scope might be as good as video one or even better given the practicality of use, while for research purposes, a videodermoscope might be better. Videodermatoscopes are more versatile devices which allow visualization of odd sites like nail, eye and mucosae with ease.^6-9 Features like magnification, resolution, ultraviolet light, pigment boost, measurement and calibration add to the versatility of these dermatoscopes. The availability of cross-polarization should always be ensured in the device bought. It is recommended to hold and use the device before investing a major amount, so that individual comfort and ergonomics with the procedure are ensured. Whatever type of dermatoscope one starts off with, there always exists the possibility of switching to another type to discern more features or to capture better images.

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Figure 1:

A hand-held dermatoscope with the accompanying requirements for capturing and storing images

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Figure 2:

A universal serial bus dermatoscope with accompanying requirements for capturing and storing images

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