Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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A dermatoscope does something a magnifying glass cannot: by eliminating surface reflection it makes the skin translucent to a depth of roughly a millimetre, revealing the pigment network, vessel patterns and structural features that determine whether a lesion is behaving normally. Digital dermoscopy adds the second half — recording those images so the same lesion can be compared against itself months or years later. Appearance is judged by the first; behaviour is judged by the second, and behaviour is usually the more informative of the two.
Why the Skin Becomes Transparent
Most of what stops you seeing into skin is light bouncing off the surface. The stratum corneum scatters incident light before it penetrates, so the naked eye receives a reflection rather than a view.
Dermoscopy defeats that in one of two ways. Immersion contact dermoscopy places a fluid between the lens and the skin, matching the refractive index of the surface so light passes through instead of scattering. Polarised dermoscopy uses cross-polarised filters to cancel the reflected component electronically, without needing contact or fluid. Both make the sub-surface visible; they emphasise slightly different features, which is why an experienced examiner uses both. The distinction is set out in polarised versus non-polarised dermoscopy.
What appears once the reflection is removed is the diagnostic material: a structured world of networks, dots, globules and vessels that is entirely invisible from the outside.
What the Examiner Is Looking At
Dermoscopic assessment is not an impression. It is the identification of specific structures, each corresponding to a known arrangement of cells and pigment beneath the surface.
| Structure | What it represents | Why it matters |
|---|---|---|
| Pigment network | Melanin along the rete ridges, seen as a grid | Regular and evenly spaced in benign lesions; broadened, irregular or abruptly cut off in concerning ones |
| Dots and globules | Clusters of pigmented cells | Uniform size and distribution suggests benign; irregular scattering does not |
| Streaks and pseudopods | Radial pigment extensions at the edge | Asymmetric distribution suggests horizontal growth |
| Blue-white veil | Pigment deep in the dermis with overlying compact keratin | One of the more specific concerning features |
| Vascular patterns | Blood vessel architecture | Arborising vessels point towards basal cell carcinoma; irregular vessels raise concern in a pigmented lesion |
| Regression structures | Areas where the lesion has partly involuted | Scar-like white areas within a pigmented lesion warrant attention |
| Milia-like cysts, comedo openings | Keratin-filled spaces | Characteristic of seborrhoeic keratosis — a common melanoma mimic |
That last row does a great deal of work in practice. Seborrhoeic keratoses are frequently mistaken for melanoma by patients and occasionally by clinicians without dermoscopy, and their dermoscopic signature is distinctive — the subject of telling seborrhoeic keratosis from melanoma.
Placed side by side, the difference is obvious. The point of dermoscopy is that on the surface, with the naked eye, it frequently is not.
Which Lesions Get Imaged
Not every lesion on a body is photographed dermoscopically — on a patient with two hundred moles that would be neither practical nor useful. Selection follows a clinical logic:
- Anything atypical on examination — irregular in outline, colour or structure.
- The patient’s own concern. A lesion someone has been watching is imaged regardless of how it appears, because their observation carries information the single visit does not.
- Outliers. Lesions that differ from the patient’s prevailing pattern — the ugly duckling principle applied at the imaging stage.
- Sites that are difficult to self-monitor — back, posterior scalp margin, soles.
- Anything previously flagged, so the comparison series continues uninterrupted.
Everything else is captured by the standardised whole-body photographs, which are what detect a new lesion appearing between visits. The two image sets divide the work: overview photography finds what is new, dermoscopy examines what is there.
Sequential Imaging: The Part That Changes Decisions
A single dermoscopic image supports a judgement about appearance. Two images of the same lesion separated by an interval support a judgement about behaviour, and that is a materially stronger position.
The clinical value runs in both directions:
- It prevents unnecessary excisions
- A lesion with mildly atypical features but no change across a documented interval can reasonably be monitored rather than removed. Without a baseline the safe course is excision, which on a visible site means a scar that may not have been necessary.
- It catches lesions that look unremarkable
- The reverse case matters more. A lesion that appears entirely ordinary at baseline and shows definite structural change at follow-up is removed on the strength of the change alone — not because it looks wrong, but because it is not the same lesion it was.
This is the specific reason a consistent interval matters and why images must be captured in reproducible conditions. Comparison is only meaningful if the two photographs differ because the lesion differs, and not because the lighting, angle or magnification did.
What Dermoscopy Cannot Settle
Dermoscopy improves diagnostic accuracy substantially in trained hands. It does not make a diagnosis definitive, and three limits are worth stating.
- It is depth-limited. Structures below roughly a millimetre are not visualised, so it describes the surface architecture of a lesion rather than its full extent.
- It does not replace histology. Where a lesion is genuinely suspicious, tissue is examined by a pathologist. Dermoscopic features raise or lower suspicion; they do not confirm.
- It is operator-dependent. The instrument shows structures; recognising what they mean is a trained skill, and the same image supports different conclusions in different hands.
Palpation remains part of the examination for the same reason: firmness and fixation are not visible in any image, and a firm lesion is assessed differently from a soft one with identical dermoscopic features.
Where This Sits in a Mole Map
Digital dermoscopy is one component of the surveillance process rather than the whole of it. In a mole mapping appointment it follows the clinical consultation and the standardised full-body photography, and precedes the AI comparison and consultant review — the full sequence is in your mole mapping appointment.
The instrument itself comes in two forms. A handheld dermatoscope is used at the point of examination; a digital system captures and stores the image for comparison. Both have their place and they answer different questions, compared in handheld versus digital dermoscopy. How the imaging is automated across the whole body is covered in automated total-body mapping.
Cost
| Item | Price |
|---|---|
| Mole mapping — complete package | £300 |
| Initial consultation | £100 |
| Mole removal | £350 |
| Histological analysis | £180 |
Dermoscopic imaging is included within the mole mapping package rather than charged separately. Appointments: mole mapping at 101 Harley Street or contact the clinic.
Frequently Asked Questions
- What is digital dermoscopy?
- Magnified imaging of a lesion using polarised light or an immersion fluid to eliminate surface reflection, captured and stored so the same lesion can be compared against itself at a later visit. It reveals pigment and vessel structures beneath the surface that are not visible to the naked eye.
- How is it different from taking a photograph?
- A photograph records the surface. Dermoscopy sees through it. Eliminating reflection makes the upper layers effectively translucent, exposing the pigment network, dots, globules and vascular patterns that the diagnosis actually depends on.
- Does it hurt?
- No. The lens rests lightly against the skin, sometimes with a drop of fluid to improve the optics, or hovers just above it when polarised. Nothing pierces or heats the skin.
- Is every mole imaged this way?
- No, and it would not be useful if it were. Dermoscopic imaging is directed at atypical lesions, lesions the patient is concerned about, outliers that differ from the rest, hard-to-monitor sites and anything previously flagged. New lesions are picked up by the standardised whole-body photographs instead.
- Does dermoscopy improve accuracy?
- Substantially, in trained hands — it is the standard of care for pigmented lesion assessment for that reason. It is operator-dependent: the instrument reveals structures, and interpreting them is a learned skill.
- Can it replace a biopsy?
- No. Dermoscopic features raise or lower suspicion; they do not confirm a diagnosis. Where a lesion is genuinely suspicious it is removed and examined histologically, and for a pigmented lesion that means removing it whole so depth can be assessed.
- What is sequential dermoscopic imaging?
- Imaging the same lesion at intervals and comparing directly. It works in both directions: an atypical-looking but stable lesion can be monitored rather than excised, and an ordinary-looking lesion that has definitely changed is removed on the strength of the change alone.
- Why does the interval have to be consistent?
- Because comparison is only meaningful if the difference between two images reflects the lesion rather than the conditions. Consistent timing, positioning, magnification and lighting are what make a change attributable to the skin.
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