Dermoscopic evaluation of skin lesions
- Ashfaq A Marghoob, MD
Ashfaq A Marghoob, MD
- Attending Physician
- Memorial Sloan-Kettering Cancer Center
- Natalia Jaimes, MD
Natalia Jaimes, MD
- Assistant Professor
- Miller School of Medicine, University of Miami
Dermoscopy is a noninvasive, in vivo technique primarily used for the examination of pigmented skin lesions; however, it can also assist clinicians in assessing amelanotic lesions. Dermatoscopy, epiluminescence microscopy, incident light microscopy, and skin-surface microscopy are synonyms. Dermoscopy is performed with a handheld instrument called a dermatoscope. The procedure allows for the visualization of subsurface skin structures in the epidermis, dermoepidermal junction, and superficial dermis; these structures are not visible to the naked eye [1-3].
Dermoscopic diagnosis involves the recognition of specific structures, or their absence, to rule out or confirm a given diagnosis. From a cognitive perspective, this task may be accomplished using a bottom-up or a top-down strategy. In the bottom-up approach, the observer performs a visual search for salient details (individual features) to arrive at a diagnosis, whereas in the top-down strategy the observer recognizes the general context, generates a hypothesis of the likely clinical diagnosis, and performs a targeted dermoscopic search for specific features to confirm the presumed clinical diagnosis .
This topic will review several algorithms and scoring systems that use mainly a top-down strategy to help clinicians distinguish melanocytic lesions from nonmelanocytic lesions (First Step) and differentiate benign melanocytic lesions from suspicious or malignant lesions (Second Step). The general principles of dermoscopy, dermoscopic structure terminology, dermoscopic evaluation of skin lesions, and the dermoscopic evaluation of facial, mucosal, and acral volar skin lesions are discussed separately. Dermoscopy of nail pigmentation and dermoscopic algorithms for skin cancer triage are also discussed separately.
●(See "Overview of dermoscopy".)
●(See "Dermoscopy of facial lesions".)
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- THE TWO-STEP ALGORITHM FOR SKIN LESION EVALUATION
- FIRST STEP: MELANOCYTIC VERSUS NONMELANOCYTIC
- Criteria for melanocytic lesions
- - Dermatofibroma
- Criteria for basal cell carcinoma
- Criteria for squamous cell carcinoma
- Criteria for seborrheic keratoses
- Criteria for hemangioma/angioma and angiokeratoma
- Vascular structures in skin lesions
- Featureless lesions (feature poor, nonspecific, nonclassifiable, or structureless)
- SECOND STEP: NEVUS VERSUS SUSPICIOUS LESION OR MELANOMA
- ABCD rule of dermoscopy
- Menzies method
- The seven-point check list
- CASH algorithm
- Pattern analysis
- - Nevi: Global and local features
- - Melanoma: Global and local features
- DERMOSCOPY FROM A MANAGEMENT PERSPECTIVE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS