Dermoscopy for a suspected actinic keratosis

The examination uses a handheld dermatoscope with magnification and controlled light. It helps the clinician assess surface scale, colour, follicle openings and blood-vessel patterns while comparing the patch with nearby skin. Dermoscopy supports clinical judgement; it does not provide a tissue diagnosis.

The clinician places the dermatoscope on or just above the lesion, sometimes using a contact liquid. The assessment is usually brief and does not cut the skin. Images may be stored so that a later examination can be compared with the same area.

Features can support an impression of actinic keratosis or point toward a different diagnosis. Heavy scale can obscure structures, and some AK changes overlap with squamous cell carcinoma or other lesions. If the patch is thick, ulcerated, tender, growing or visually uncertain, biopsy may be more informative than observation alone.

Leave the area free of makeup, tinted sunscreen or thick ointment if practical, unless a clinician has told you to keep a dressing in place. Mention previous treatment, bleeding, pain and the pace of change. Older photographs can help establish whether the lesion has evolved.

After the examination, make sure you understand whether the plan is treatment, photography and monitoring, or biopsy. If monitoring is chosen, note the intended review point and avoid picking scale from the lesion, since repeated trauma can alter its appearance. Continue ultraviolet protection for all exposed skin.

Seek an earlier assessment when the spot rapidly enlarges, becomes firm or painful, bleeds repeatedly, develops an open sore, or changes noticeably after it was photographed. These signs do not identify a diagnosis by themselves. They matter because the clinician may need to re-examine the lesion and decide whether tissue sampling is appropriate.

Does the dermoscopic appearance fit an actinic keratosis? Were any features unclear or concerning? Would removing surface scale, treating the patch or taking a biopsy provide better information? If an image was saved, how and when will it be compared?