Dermoscopy at an Inflection Point: Sharper Criteria, New Optics, and the Arrival of Artificial Intelligence
5 affiliations
- 1Orlando College of Osteopathic Medicine, Winter Garden, FL 34787, USA
- 2Reveal Research Institute, Dallas, TX 75235, USA
- 3Texas Health Dallas, Dallas, TX 75231, USA
- 4The Departments of Dermatology and Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- 5Lake Granbury Medical Center, Dallas, TX 75235, USA
Abstract
Dermoscopy improves the diagnosis of melanoma and keratinocyte carcinoma, but its value depends on the observer, the lesion mix, the anatomic site, and the action taken after the examination. Recent reviews have mainly focused on one modality or image-classification accuracy. This narrative review follows the clinical pathway and compares five linked areas: defined diagnostic criteria, sequential digital monitoring, site- and skin-tone-specific interpretation, multimodal imaging, and artificial intelligence (AI). Melanoma and keratinocyte carcinoma are discussed separately because their criteria, diagnostic problems, imaging needs, and management differ. Meta-analyses support dermoscopy over naked-eye examination, although accuracy remains closely related to clinician experience. A randomized trial of three-dimensional total-body photography with sequential dermoscopy led to more procedures and higher costs without finding more malignant tumors over two years. Reflectance confocal microscopy can improve specificity in selected equivocal lesions, while optical coherence technologies add architectural and depth information that is most relevant to keratinocyte carcinoma. AI has moved from retrospective benchmarks to prospective multicenter studies, but false-positive burden, dataset shift, underrepresentation of darker skin tones, limited explainability, and uncertain workflow effects remain. The review also considers foundation models, regulation, and patient-facing tools and uses a SWOT analysis to define research priorities. The field is at an inflection point in evidence, not image quality. Progress should be judged by effects on biopsy decisions, missed-cancer rates, timeliness, cost, access, and patient outcomes in defined populations.
Related
- Pigmented Orocutaneous Fistula: A Diagnostic Dilemma Unmasked by Dermoscopy.
- Secondary Syphilis Mimicking Annular Lichen Planus: A Case Report and Brief Narrative Review of Dermoscopy in Differential Diagnosis
- Smartphone acquisition as an inflection point in early adolescence digital exposome: relevance to mental health
- A focused PubMed artificial intelligence search program creates better literature reviews than general purpose artificial intelligence and is comparable to trainees in shoulder and elbow surgery
- Generative Artificial Intelligence Models in Breast Cancer Diagnosis: A Systematic Review
BibTeX
@article{pham2026dermoscopy,
title = {{Dermoscopy at an Inflection Point: Sharper Criteria, New Optics, and the Arrival of Artificial Intelligence}},
author = {Dana N. Pham and Warren H. Chan and Jade Conway and Iman Ali and Clay J. Cockerell},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203277},
url = {https://www.mdpi.com/2072-6694/18/20/3277},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Dermoscopy at an Inflection Point: Sharper Criteria, New Optics, and the Arrival of Artificial Intelligence
AU - Dana N. Pham
AU - Warren H. Chan
AU - Jade Conway
AU - Iman Ali
AU - Clay J. Cockerell
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203277
UR - https://www.mdpi.com/2072-6694/18/20/3277
AB - Dermoscopy improves the diagnosis of melanoma and keratinocyte carcinoma, but its value depends on the observer, the lesion mix, the anatomic site, and the action taken after the examination. Recent reviews have mainly focused on one modality or image-classification accuracy. This narrative review follows the clinical pathway and compares five linked areas: defined diagnostic criteria, sequential digital monitoring, site- and skin-tone-specific interpretation, multimodal imaging, and artificial intelligence (AI). Melanoma and keratinocyte carcinoma are discussed separately because their criteria, diagnostic problems, imaging needs, and management differ. Meta-analyses support dermoscopy over naked-eye examination, although accuracy remains closely related to clinician experience. A randomized trial of three-dimensional total-body photography with sequential dermoscopy led to more procedures and higher costs without finding more malignant tumors over two years. Reflectance confocal microscopy can improve specificity in selected equivocal lesions, while optical coherence technologies add architectural and depth information that is most relevant to keratinocyte carcinoma. AI has moved from retrospective benchmarks to prospective multicenter studies, but false-positive burden, dataset shift, underrepresentation of darker skin tones, limited explainability, and uncertain workflow effects remain. The review also considers foundation models, regulation, and patient-facing tools and uses a SWOT analysis to define research priorities. The field is at an inflection point in evidence, not image quality. Progress should be judged by effects on biopsy decisions, missed-cancer rates, timeliness, cost, access, and patient outcomes in defined populations.
SN - 2072-6694
ER -