Integrating history and examination

The most effective skin assessments combine what you hear with what you see. Here is a practical framework for bringing these two streams of information together.

Before you look

Gather the essentials before you pick up the dermatoscope. You want to know the lesion story (duration, change, symptoms), the patient's risk profile (previous skin cancer, family history, UV exposure, immunosuppression), and why they are here today.

This takes two to three minutes. It shapes every interpretation that follows.

While you look

As you examine the lesion, hold the history in mind. You are not just looking at patterns — you are asking whether what you see is consistent with what you have been told.

A lesion that the patient says appeared two months ago should look like a two-month-old lesion. If it looks like it has been there for years (well-organised, mature-appearing pattern), question the history. If it looks aggressive despite a reported long duration, question the history from the other direction — perhaps it changed recently within a longstanding lesion.

After you look

Bring the two streams together. The dermoscopic findings and the clinical history should point in the same direction. When they do, you can proceed with confidence. When they do not, the discrepancy itself is information — and it usually argues for caution.

Concordance: history and dermoscopy agree → proceed accordingly.

Discordance: history is concerning but dermoscopy is reassuring → history takes priority. Consider referral.

Discordance: dermoscopy is concerning but history is bland → dermoscopy takes priority. Refer based on features.

Both concerning: → refer promptly.

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