SRS142 - Drawing the line: revisiting Dermoscopy’s role in surgical excision of non-melanoma skin cancer—an updated systematic review and meta-analysis

Abstract Aims To update and expand on previous evidence regarding the use of dermoscopy as an adjunct to surgical excision of non-melanoma skin cancer (NMSC), with a focus on margin control and recurrence outcomes. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search of PubMed, EMBASE, and Cochrane databases was performed up to October 2024. Studies evaluating dermoscopy-guided versus conventional excision of histologically confirmed NMSC were included. Risk of bias was assessed using the ROBINS-I tool. Meta-analysis was performed using a DerSimonian-Laird random-effects model, with incomplete excision as the primary outcome. Results Ten studies (n = 1151 patients; 1186 lesions) were included in the qualitative synthesis, and four in the meta-analysis. Most studies investigated basal cell carcinomas; squamous cell carcinoma was less frequently assessed. Dermoscopy consistently improved tumour delineation and margin clearance. The meta-analysis showed a significant reduction in incomplete excision with dermoscopy (pooled OR = 0.30, 95% c.i.: 0.27–0.34; I² = 0%). Dermoscopy also enabled narrower excision margins without increased recurrence. However, studies were limited by observational design, small sample sizes, and heterogeneity in outcome reporting. Conclusions Dermoscopy enhances margin assessment in NMSC excision, reducing incomplete excision risk by ∼70% and enabling narrower, tissue-preserving margins without compromising safety. While findings support its routine use, particularly in BCC, evidence remains limited by observational designs and moderate bias. High-quality randomised trials are needed to confirm its effectiveness, standardise its use, and support broader clinical adoption.