Dermatoscopy A–Z

The Many Roles of Dermoscopy in Melanoma Detection

“…Cutaneous melanoma may be classified into the following subtypes: superficial spreading, nodular, lentigo maligna, acral lentiginous, amelanotic, and desmoplastic (rare subtype formed by scant spindle cells with minimal cellular atypia) [ 4 ]. The dermatoscopic diagnosis of melanoma is based on the recognition of its chaotic appearance and morphological asymmetry and/or one or more of the following characteristics: atypical network, irregular blotch, irregular dots/globules, irregular streaks/pseudopods, regression structures, white shiny streaks, blue-white veil, atypical vascular pattern, irregular hyperpigmented areas, prominent skin markings, and polygons/angulated lines [ 10 ]. Other dermoscopic criteria that may be found in melanomas are the rainbow pattern (a sign of invasive melanoma) [ 11 ], rosettes (unknown mechanism) [ 12 ], and crusts/erosions (a sign of advanced lesions) [ 8 ].…”

“…Only one tumor was a nodular melanoma. Conventional melanoma dermoscopic findings are typically not found in nodular melanomas as these criteria are specific for this type of tumor: blue and black color (blue-black rule), atypical vascular pattern (linear irregular vessels/more than two types of vessels), milky-red color [ 10 ]. The studied tumor had a symmetrical shape and the following dermoscopic criteria: blue-white veil, white shiny streaks, and crusts/erosions.…”

“…Dermoscopy helps increase the diagnostic accuracy of melanoma and may be of help in estimating the tumoral thickness [ 13 ]. Each dermoscopic color has a histopathological correspondent that can help estimate the depth of the pigments and the tumoral thickness: black—melanin found in the stratum corneum, dark/light brown—melanin found in the epidermis or the dermal/epidermal junction, grey—melanin found in the dermis (mostly superficial dermis), blue—melanin found in the deep dermis, yellow/orange—serum/keratin in the epidermis, white—fibrosis, collagen located in the dermis, red—blood found in the vessels in the superficial dermis, purple—low oxygen levels in the blood vessels (the color of blood varies from red to purple/blue, depending on the degree of oxygenation)—located in the deep dermis [ 1 , 10 ]. One of the most important prognostic factors for melanoma is the Breslow index (IB) [ 3 ].…”

“…To estimate the Breslow index, we assessed the melanomas that had five colors (black, brown, grey, blue, and white) and the highest score (8 points) at the Seven-Point Checklist algorithm. The black/brown colors encountered in this tumor are associated with melanin located in the epidermis, whereas the blue color is associated with melanin found in the deep dermis [ 1 , 10 ]. As for the dermoscopic structures, this tumor had: atypical pigmented network/eccentric hyperpigmentation—mostly correlated with elongated rete ridges with melanin found at the dermal-epidermal junction (DEJ) [ 15 ]; blue-white veil—typical to an elevated part of the lesion and its histologic correspondent are extremely pigmented atypical melanocytes/melanophages located in the dermis; pseudopods—associated with heavily pigmented nests of melanocytes mostly located in the DEJ or superficial dermis; irregular dots/globules—melanin located in the epidermis [ 15 ]; regression structures—associated with fibrosis located in the dermis [ 15 ].…”

Roles of Epiluminescence Dermoscopy beyond the Diagnoses of Cutaneous Malignancies and Other Skin Diseases

“…If the dermoscope goes wrong in a dermatoscope-guided operation, the clinician might merely switch his eyesight from the monitor to the patient and proceed with the operation smoothly. Dermoscopy is commencing to be applied to a wide range of surgical procedures for skin diseases [28][29][30].…”