The Tremendous Importance and Impact of Guidelines and Standardized Protocols in Dermatologic Ultrasound

The emergence of dermatologic ultrasound as a new imaging subspecialty has created the need for evidence-based guidelines and standardized examination protocols. However, to date, it is common for institutions and codification systems to consider all soft tissue ultrasound examinations as essentially the same type of examination, including dermatologic exams. Unlike conventional soft tissue ultrasound examinations, dermatologic ultrasound usually requires a much longer time, and the mandatory use of color and/or power Doppler and pulsed Doppler. It includes an integrated clinical approach that combines direct inspection, palpation, and obtaining the patient's medical history before scanning. The implementation of standardized protocols-including the systematic use of grayscale, color/power Doppler, and spectral Doppler modes with high- and/or ultra-high-frequency transducers-enhances diagnostic accuracy and reproducibility across inflammatory, oncologic, nail, and aesthetic conditions, among many other applications. For example, in inflammatory diseases such as hidradenitis suppurativa and morphea, scanning bilateral and adjacent corporal regions allows for the early detection of subclinical lesions, which influences therapeutic decisions. In skin cancer, studying the primary tumor and performing locoregional staging improves surgical planning. For nail disorders, bilateral and comparative evaluation supports the diagnosis of dystrophies and small tumors, as well as the assessment of disease extent in nail psoriasis or lichen planus. In aesthetics, facial and submandibular mapping are crucial for identifying subclinical filler migration and glandular inflammation. Standardized and validated protocols not only improve the quality and diagnostic consistency but also allow accurate cost estimation and time allocation for real-world implementation.