The Usefulness of Combined Digital Dermatoscopy and Ultrasound with Colour Doppler in the Diagnosis of Skin Lesions

Background: Ultrasound and colour Doppler are adjuvant techniques widely used in clinical settings in obstetrics, cardiology, and others. Its use in dermatology is more incipient although it presents potential for clinical use namely in dermo-oncology. Objective: This study explores the usefulness of the combination of cutaneous ultrasound with Doppler after digital dermatoscopy in distinguishing between most common benign and malignant skin lesions, focusing on the importance of different vascular patterns. To streamline the diagnostic process, we propose a combined imaging workflow that integrates dermoscopic findings with vascular and structural data obtained via Doppler ultrasound. Methods: In total, 42 benign and malignant skin tumours were analysed in a population of 42 patients using a Fotofinder digital dermatoscopy device and a GE ultrasound machine with a high-frequency probe (20 MHz). Doppler was applied to assess lesion vascularization and identify distinct blood flow patterns. Results: Cutaneous ultrasound revealed that malignant lesions often exhibited intense and disorganized vascularization, while benign lesions displayed more ordered and peripheral blood flow patterns. In all of our cases, ultrasound with Doppler imaging clarified the uncertainties raised by dermatoscopy. Conclusions: The use of Doppler cutaneous ultrasound after digital dermatoscopy proved to be a valuable tool to aid the diagnosis in dermatology, as it improved the differential diagnosis between benign and malignant lesions, contributing to the establishment of the final diagnosis in the studied cases.