Re: Dermoscopy – Time for plastic surgeons to embrace a new diagnostic tool?

We applaud Townley et al. for their well-conducted and interesting study in dermatoscopy and its use by plastic surgeons in the diagnosis of cutaneous lesions. However, we suspect the study is not particular to plastic surgeons since a clinician of any discipline trained on the course would show similar improved diagnostic acumen with the aid of adjunctive dermatoscopy. The study is used to facilitate the attempt to promote the use of dermatoscopy in plastic surgeons’ practice. Whilst we would ordinarily not be averse to the field of plastic surgery incorporating these new diagnostic and therapeutic manoeuvres into their armamentarium, the practice of dermatoscopy has a steep learning curve and is not one that clinicians can ‘dip into’ from time to time to sort out the ‘wheat from the chaff’. Dermatologists consult on significantly more cutaneous lesions than do plastic surgeons due to the latter’s varied practice and primary care referral patterns and therefore, based on the premise that practice and increased numbers lead to better results, the former group of clinicians would be and are better at using dermatoscopy. If patient safety and an efficacious health care model were paramount we would not suggest this was the step forward. Joint ‘see and treat’ clinic sessions between the dermatologists and plastic surgeons are to be promoted, engendering not only better patient care but also a closer link between the two specialties. This works very well in our trust and is a model that should be considered by other trusts. It allows each specialty to retain focus and achieve excellence in their respective areas. The cutting edge of skin cancer management or any disease management warranting multidisciplinary care is not to unnecessarily replicate and compete for a similar job or task but to work together harmoniously to create and deliver an efficient and fiscally effective service for our patients.