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Dermoscopic algorithms for skin cancer triage

Natalia Jaimes, MD
Ashfaq A Marghoob, MD
Section Editor
Hensin Tsao, MD, PhD
Deputy Editor
Rosamaria Corona, MD, DSc


Dermoscopy is a noninvasive, in vivo technique used for the evaluation of skin lesions. It allows the visualization of subsurface skin structures in the epidermis, dermoepidermal junction, and upper dermis, which are otherwise not visible to the naked eye [1-3].

Numerous clinical trials and meta-analyses of studies performed in experimental and clinical settings have demonstrated that dermoscopy increases the sensitivity for the diagnosis of melanoma compared with naked-eye examination [4-8]. However, in general dermatology and primary care practices the main purpose of dermoscopy in the evaluation of pigmented and nonpigmented skin lesions is to help the clinician decide whether or not to perform a skin biopsy, refer to an expert, reassure the patient, or monitor the lesion over time clinically and dermoscopically [4].

Triage refers to the sorting out and classification of patients and lesions to determine priority of need and proper place of treatment [9]. In the setting of skin cancer triage, dermoscopy is an important tool that helps identify lesions for which malignancy needs to be ruled out. In the triage setting, a correct management decision (eg, to biopsy or not) is paramount, whereas making a specific diagnosis is of minor importance. For the purpose of deciding which lesion(s) should be biopsied, several simplified algorithms have been proposed for use in a skin cancer triage setting [10-13].

This topic will review several dermoscopic algorithms for pigmented and nonpigmented lesions (table 1). The principles of dermoscopy and dermoscopic evaluation of skin, mucosal, and nail lesions are discussed separately.

(See "Overview of dermoscopy".)


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Literature review current through: Sep 2016. | This topic last updated: Nov 16, 2015.
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  1. Marghoob AA, Swindle LD, Moricz CZ, et al. Instruments and new technologies for the in vivo diagnosis of melanoma. J Am Acad Dermatol 2003; 49:777.
  2. Menzies SW, Ingvar C, McCarthy WH. A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma. Melanoma Res 1996; 6:55.
  3. Argenziano G, Soyer HP. Dermoscopy of pigmented skin lesions--a valuable tool for early diagnosis of melanoma. Lancet Oncol 2001; 2:443.
  4. Argenziano G, Puig S, Zalaudek I, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 2006; 24:1877.
  5. Bafounta ML, Beauchet A, Aegerter P, Saiag P. Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol 2001; 137:1343.
  6. Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol 2008; 159:669.
  7. Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol 2002; 3:159.
  8. Westerhoff K, McCarthy WH, Menzies SW. Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy. Br J Dermatol 2000; 143:1016.
  9. Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. http://www.ncbi.nlm.nih.gov/mesh/68014218 (Accessed on April 03, 2015).
  10. Soyer HP, Argenziano G, Zalaudek I, et al. Three-point checklist of dermoscopy. A new screening method for early detection of melanoma. Dermatology 2004; 208:27.
  11. Luttrell MJ, Hofmann-Wellenhof R, Fink-Puches R, Soyer HP. The AC Rule for melanoma: a simpler tool for the wider community. J Am Acad Dermatol 2011; 65:1233.
  12. Argenziano G, Longo C, Cameron A, et al. Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma. Br J Dermatol 2011; 165:1251.
  13. Rosendahl C, Cameron A, McColl I, Wilkinson D. Dermatoscopy in routine practice - 'chaos and clues'. Aust Fam Physician 2012; 41:482.
  14. Benvenuto-Andrade C, Dusza SW, Agero AL, et al. Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions. Arch Dermatol 2007; 143:329.
  15. Wang SQ, Dusza SW, Scope A, et al. Differences in dermoscopic images from nonpolarized dermoscope and polarized dermoscope influence the diagnostic accuracy and confidence level: a pilot study. Dermatol Surg 2008; 34:1389.
  16. Agero AL, Taliercio S, Dusza SW, et al. Conventional and polarized dermoscopy features of dermatofibroma. Arch Dermatol 2006; 142:1431.
  17. Zalaudek I, Argenziano G, Soyer HP, et al. Three-point checklist of dermoscopy: an open internet study. Br J Dermatol 2006; 154:431.
  18. Luttrell MJ, McClenahan P, Hofmann-Wellenhof R, et al. Laypersons' sensitivity for melanoma identification is higher with dermoscopy images than clinical photographs. Br J Dermatol 2012; 167:1037.
  19. Rosendahl C, Tschandl P, Cameron A, Kittler H. Diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions. J Am Acad Dermatol 2011; 64:1068.
  20. Rosendahl C, Cameron A, Tschandl P, et al. Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy. Dermatol Pract Concept 2014; 4:59.
  21. Scope A, Benvenuto-Andrade C, Agero AL, Marghoob AA. Nonmelanocytic lesions defying the two-step dermoscopy algorithm. Dermatol Surg 2006; 32:1398.
  22. Stolz W, Riemann A, Cognetta AB, et al. ABCD rule of dermatoscopy: a new practical method for early recognition of malignant melanoma. Eur J Dermatol 1994; 4:521.
  23. Emiroglu N, Pelin Cengiz F, Hofmann-Wellenhof R. Dermoscopic and clinical features of trunk melanomas. Postepy Dermatol Alergol 2014; 31:362.
  24. Seidenari S, Pellacani G, Martella A. Acquired melanocytic lesions and the decision to excise: role of color variegation and distribution as assessed by dermoscopy. Dermatol Surg 2005; 31:184.
  25. Unified Dermoscopy Algorithm study, in progress. Preliminary results.
  26. Braun RP, Gaide O, Oliviero M, et al. The significance of multiple blue-grey dots (granularity) for the dermoscopic diagnosis of melanoma. Br J Dermatol 2007; 157:907.
  27. Jaimes N, Marghoob AA, Rabinovitz H, et al. Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin. J Am Acad Dermatol 2015; 72:1027.
  28. Balagula Y, Braun RP, Rabinovitz HS, et al. The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. J Am Acad Dermatol 2012; 67:194.e1.
  29. Liebman TN, Rabinovitz HS, Balagula Y, et al. White shiny structures in melanoma and BCC. Arch Dermatol 2012; 148:146.
  30. Pizzichetta MA, Talamini R, Marghoob AA, et al. Negative pigment network: an additional dermoscopic feature for the diagnosis of melanoma. J Am Acad Dermatol 2013; 68:552.