Table 1.

Relative limitations of conventional approach to cutaneous diagnosis employing standard* tests and investigations versus the potential of dermoscopy

Investigation-dependent	Investigator-dependent
Typically invasive (skin biopsy) to semi-invasive (e.g., slit skin smears)	Level of training, especially regarding the perfect site for taking the specimen
Relative non-compliance of patients to undergo an invasive procedure. Typically difficult in children	Counseling skills of the dermatosurgeon, and skill to produce a scar-less biopsy. Interpretation skill of the Dermatopathologist and Clinical microbiologist
Unlike dermoscopy that can provide in-vivo diagnostic clues, the conventional investigations like skin biopsy provide results available from the investigation done in-vitro	The sectioning and slide preparation depend on the skill(s) of the pathologist and technical staff. False negatives may occur if the section examined is relatively peripheral from the main pathology in the specimen
Unlike dermoscopy, where the region of suspicion may be repeatedly, and non-invasively evaluated a few number of times as per patient comfort; in case of a non-committal false-negative dermatopathology report, the wrong site and/ or wrong sectioning are responsible. Repeating another biopsy is often fraught with strong patient non-compliance	Same as Above
Possibility of local anesthesia-associated rare, but known adverse effects; especially hypersensitivity	Need for an emergency resuscitation kit in the event of a rare anaphylactic reaction to the local anesthetic agent
Overall, more time-consuming (results of histopathology and cultures take a week or more)	Skills and efficiency of the pathology/microbiology unit and the reporting specialist
Storage of images is tedious, requires specialized equipment, and not feasible for large number of cases	Skills and efficiency of the pathology/microbiology unit and the reporting specialist; willingness to use special equipment for photomicrography to provide images for records
Cumbersome with need for specialized infrastructure	Interdepartmental coordination (dermatology, pathology, microbiology) essential for clinicopathological correlation (CPC) or clinicomicrobiological correlation (CMC) for final diagnosis
Overall, costlier to the patient	The cost depends on the kind of health-care set-up

*Skin biopsy and dermatopathology, skin smears for microbiological investigations including wet smears, KOH-based smears, regular and special stains, microbial cultures etc