One third of the nonusers
One third of the nonusers (n = 31) thought that dermatoscope was too expensive. This rate was higher than that reported in the United States (6.6%). In another Australian survey, over half of the trainees did not own a dermatoscope most likely because of its cost; however, many training institutions supplied clinicians with dermatoscopes. If medical centers, regional hospitals, or even private clinics could offer public dermatoscopes, the use of dermoscopy might increase. Regarding the time required for dermoscopic examination, nearly one fourth of the nonusers (n = 23) considered that dermoscopy is time consuming, but most of the users spent < 5 minutes to analyze a single skin lesion. A previous study found that the time required for a complete skin examination in skin cancer screening by dermoscopy is 142 seconds, which is significantly longer than the 70 seconds required for naked eye examination. Although quantifying the quality of an examination with and without dermoscopy is difficult, complete examination with dermoscopy requires < 5 minutes, which is a reasonable amount of time to potentially make a more accurate clinical diagnosis than naked eye examination.
Because of the coverage of National Health Insurance system, the charge for a skin biopsy is relatively cheap in Taiwan. Arranging a skin biopsy is convenient and available even in private clinics. Under these circumstances, dermatologists may prefer to order a skin biopsy than perform a dermoscopy examination for patients. However, skin biopsy is an invasive procedure, which may be associated with some postoperative complications. Patients have to wait for a proton pump inhibitors to obtain their pathology reports. Dermoscopy is a noninvasive technique, which can assist dermatologists in making primary diagnosis and treatment plans in a few minutes. Among experienced users, dermoscopy is also useful in reducing the number of biopsies performed and enabling them to determine where to perform a biopsy for a large lesion. Thus, dermoscopy may play an important role in clinical decision making and is worth popularizing in Taiwan.
The results of this study should be carefully interpreted because of certain limitations. First, the response rate (21.3%) was lower than that of several previous surveys, probably because the caption of the questionnaire indicated that it pertained to dermoscopy use. Dermatologists not interested in, or unfamiliar with, dermoscopy may have discarded the questionnaire. Conversely, dermatologists using dermoscopy may feel more involved and therefore may have responded more than nonusers. The questionnaire also contained detailed questions about the application of dermoscopy, particularly for specific types of skin conditions, and the confidence in using this technique. Thus, reading and completing the questionnaire may have required a prolonged time, which could have lowered the response rate. Second, the response rate was higher from residents than from attending physicians, and the rate of dermoscopy use was also higher among residents. Younger dermatologists are generally more interested in learning new techniques and expressing their opinions. Third, the participants from Eastern and Southern Taiwan were fewer than those from Northern Taiwan, probably because most training courses and lectures are held in Northern Taiwan. Dermatologists from other medical districts might be less likely to realize the usefulness of dermoscopy. The aforementioned factors may introduce a sampling bias of users versus nonusers completing the survey, which might have overestimated dermoscopy use. Despite these limitations, this survey provided general information about the prevalence of dermoscopy use, and showed attitudes toward dermoscopy among Taiwanese dermatologists.
Acknowledgments The results of this study have been reported, in part, in the 40th Annual Meeting of the Taiwanese Dermatological Association. We thank all Taiwanese dermatologists who responded to this survey and the secretary of TDA. In addition, we are grateful to the staff of the Dermatology Department at Far Eastern Memorial Hospital for their assistance with mailing questionnaires to the dermatologists.