When a clinical-dermoscopic correlation is warranted

Journal of Dermatological Case Reports, 2013

The incidence of cutaneous melanoma is increasing worldwide and early diagnosis is essential since the prognosis is poor in advanced stages of disease. Dermoscopy emerged as an additional and important diagnostic procedure for the early diagnosis of cutaneous melanoma.

International Journal of Dermatology, 2013

Steinbach PJ, et al. Transglutaminase-1 gene mutations in autosomal recessive congenital ichthyosis: summary of mutations (including 23 novel) and modeling of TGase-1. Hum Mutat 2009; 30: 537-547.

Background: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions.

Journal of the European Academy of Dermatology and Venereology, 2018

Dermoscopy has been documented to increase the diagnostic accuracy of clinicians evaluating skin tumors, improving their ability to detect skin cancer and better recognize benign moles. However, dermoscopically "false positive" and "false negative" tumors do exist. False positive diagnosis usually leads to unnecessary excisions. False negative diagnosis is much more dangerous, since it might result in overlooking a cancer, with severe undesirable consequences for the patient and the physician. Therefore, management strategies should mainly focus on addressing the risk of dermoscopically false negative tumors. The most frequent benign tumors that might acquire dermatoscopic characteristics suggestive of malignancy are seborrheic keratosis (SK), including solar lentigo, melanoacathoma, irritated, clonal and regressive SK, angioma (mainly thrombosed angioma and angiokeratoma), dermatofibroma, benign adnexal tumors and nevi (Clark, Spitz, recurrent, combined, sclerosing). The most useful clues to recognize these tumors are the following: solar lentigo-broad network; melanoacanthoma-sharp border; irritated SKregularly distributed white perivascular halos; clonal SK-classic SK criteria; regressive SK-remnants of SK; targetoid hemosiderotic angioma-dark center and reddish periphery; thrombosed angioma-sharp demarcation; angiokeratoma-dark lacunae; atypical dermatofibromas-palpation; follicular tumors-white color; sebaceous tumors-yellow color; Clark nevi-clinical context; Spitz/Reed nevi-age; combined nevi-blue central area; recurrent nevi-pigmentation within the scar; sclerosing nevi-age and location on the upper back; blue nevi-history Malignant tumors that might mimic benign ones and escape detection are melanoma (in-situ, nevoid, spitzoid, verroucous, regressive, amelanotic), squamous cell carcinoma (mainly well-differentiated variants) and rarely basal cell carcinoma (non-pigmented variants). The most useful clues to recognize the peculiar melanoma subtypes are: melanoma in situ-irregular hyperpigmented areas; nevoid melanoma-history of growth; spitzoid melanoma-age; verrucous melanoma: blue-black sign; regressive melanoma-peppering or scar-like depigmentation; amelanotic melanoma-pink color, linear irregular vessels, dotted vessels. In this paper we summarized the most frequent dermoscopic variations of common skin tumors that are often misinterpreted, aiming to assist clinicians to reduce the number of false diagnoses.

Dermatology Practical & Conceptual, 2019

The technique of dermoscopy has come a long way since its inception for characterization of suspicious nevi for early detection of dysplastic changes in predisposed individuals. Not only has its scope expanded to aid in quick diagnosis of a majority of nonmelanocytic disorders of the skin, hair, and nails, but it is being rightfully exploited for a plethora of nondiagnostic uses. Its use in the diagnosis of various pigmentary, papulosquamous, and infectious disorders and disorders of the scalp and hair, nails, and mucosa bears testimony to the ongoing expansion of its protean indications across skin types. Dermoscopy has transformed the conventional approach to dermatological diagnosis from clinicopathological correlation to clinico-dermoscopic-pathological correlation. It aids in convincing an otherwise reluctant patient to agree to biopsy and guides the selection of optimum site for the same. Dermoscopic clues suggestive of stability or activity of the lesion and/or disease in var...

Melanomas and nevi displaying regression features can be difficult to differentiate.

Cancer, 2002

BACKGROUND. Dermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results.

British Journal of Dermatology, 2004

Background Dermoscopic vascular criteria remain poorly evaluated and analysed. The increasing number of descriptions of amelanotic melanoma showing isolated vascular dermoscopic findings adds interest to this topic. Objective To evaluate and classify the dermoscopic vascular structures seen in nontumoral dermatoses (NTD). Patients and methods The affected skin of 414 consecutive patients suffering from a variety of 31 different biopsy-proven NTD was evaluated with the dermoscope and photographed with the Dermaphot camera. Results The dermoscopic vascular structures seen in NTD consisted of round dotted and globular vessels, linear vessels and glomerular vessels. In addition, structureless coloured patches were also found. In some NTD the distribution of the vascular structures took on special arrangements. The most common vascular findings were the linear and the rounded vessels, which were distributed either homogeneously throughout the lesion or were present together with other vascular or pigmented features in a mixed pattern. Conclusion The present study proposes a new classification of dermoscopic vascular features based on the screening of a large spectrum of nontumoral dermatoses. This list may be useful to define further dermoscopic semiology and to understand the vascular features most relevant to the diagnosis not only of different NTD but also of pigmented and amelanotic melanoma.

Journal of Pakistan Association of Dermatology, 2018

Objective To describe predominant dermoscopic patterns in common pigmented skin lesions in skin of colour. Methods It was an observational study carried out at department of dermatology unit-II, Mayo Hospital Lahore. A total of 44 patients (12 males, 32 females) with common pigmented skin lesions were enrolled and interviewed. Their clinical pictures were taken with iPhone 6 & clinical differentials or diagnosis was formulated by three examiners via mutual agreement. Dermoscopic pictures were taken at the same time with Firefly DE350® using both optical and digital magnification. Predominant patterns were described keeping in mind the internationally accepted terminology and criteria. Results Common pigmented skin lesions included seborrheic keratosis (SK), solar lentigo, freckles, blue nevi, melanocytic nevi, dysplastic nevi etc. Melanocytic nevi had pigmented network, aggregated or peripheral globules and various types of pigment. Predominant pattern of SKs was milia like cysts an...

Australasian Journal of Dermatology, 2017

Background/Objective: To describe the dermoscopic features of melanoma in situ using the Chaos and Clues method. Method: Histologically proven primary melanoma in situ (MIS) diagnosed through a specialist teledermoscopy clinic were reviewed by three dermatologists. By consensus they agreed on the global dermoscopic pattern, colours, presence of chaos (asymmetry of colour and structure and more than one pattern), and each of the nine clues described for malignancy. Results: One hundred MIS in 92 patients of European ethnicity (45 males) were assessed. Mean age was 67.3 years (range 20-95). The mean dimensions of the lesions were 11.1 9 12.0 mm (range 2.5-31.3 9 2.3-32.3 mm). Using pattern analysis, 82% of the lesions had three or more patterns (multicomponent) and the rest had 2 patterns. Colours included light brown (100%), dark brown (98%) and grey (75%). All MIS demonstrated chaos. The most prevalent clues were thick lines (88%), eccentric structureless areas (88%), and grey or blue structures (75%). Conclusion: Dermoscopy can be very helpful in the early diagnosis of melanoma and MIS. The Chaos and Clues method is simple to use. Its unambiguous descriptors can be successfully used to describe MIS. The presence of chaos and clues to malignancy (including thick lines, eccentric structureless areas, and blue/grey structures) should raise a red flag and lead to referral or excision.

Dermatology, 2006

Dermoscopy improves the diagnostic accuracy in the clinical evaluation of pigmented skin lesions, but it is also useful for the assessment of vascular structures that are not visible to the naked eye. As a consequence, dermoscopy has been employed more and more for the differential diagnosis of nonpigmented skin disorders, including tumors but also infl ammatory and infectious diseases. This article provides a review of the dermoscopic features seen in various nonpigmented tumoral and nontumoral skin lesions as well as the dermoscopic criteria used for monitoring skin reactions to various treatments.

British Journal of Dermatology, 2005

Clinics in Dermatology, 2002