Quality standard

Quality statement 3: Dermoscopy

Quality statement 3: Dermoscopy

Quality statement

People with suspected melanoma undergoing a specialist assessment have the lesion examined using dermoscopy. [2016, updated 2024]

Rationale

Dermoscopy done by suitably trained specialists may more accurately distinguish between benign and malignant 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

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.

Process

Proportion of people with suspected melanoma undergoing a specialist assessment who have the lesion examined using dermoscopy.

Numerator – the number in the denominator who have the lesion examined using dermoscopy.

Denominator – the number of people with suspected melanoma undergoing a specialist assessment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) Proportion of suspected melanomas not selected for biopsy that are subsequently confirmed as melanoma.

Numerator – the number in the denominator subsequently confirmed as melanoma.

Denominator – the number of suspected melanomas not selected for biopsy.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

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

Numerator – the number in the denominator diagnosed at stage 1 or 2.

Denominator – the number of melanomas diagnosed.

Data source: NHS Digital's Cancer registration statistics, England reports annual counts, age-specific and directly age-standardised rates of cancer incidence by ICD-10 codes including melanoma of the skin and stage at diagnosis.

What the quality statement means for different audiences

Service providers (such as local hospital multidisciplinary teams and specialist multidisciplinary teams) ensure that systems are in place for using dermoscopy during a specialist assessment of suspected melanoma. Service providers should also ensure that those using dermoscopy have formal training.

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

Commissioners ensure that the specialist services they commission have trained specialists who use dermoscopy to examine lesions that suggest melanoma.

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

Source guidance

Definitions of terms used in this quality statement

Specialist assessment

An assessment carried out by a clinician trained in the diagnosis of skin malignancy 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), and expert opinion]

Dermoscopy

Skin scoping or observing the skin directly using a special hand-held microscope, called a dermatoscope, usually performed on a mole or suspicious lesion on living skin. Dermatoscopes can be adapted to allow a camera or smartphone to take static images of a skin lesion to assist in referral, assessment and triage of suspected skin cancer (teledermoscopy). [Adapted from NICE's guideline on improving outcomes for people with skin tumours including melanoma, glossary of terms; dermatoscope and dermatoscopy, and expert opinion]