Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non‐neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society

Abstract

Summary Background Over the last few years, several articles on dermoscopy of non‐neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies. Objectives We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non‐neoplastic dermatoses through an expert consensus. Methods The modified Delphi method was followed, with two phases: (i) identification of a list of possible items based on a systematic literature review and (ii) selection of parameters by a panel of experts through a three‐step iterative procedure (blinded e‐mail interaction in rounds 1 and 3 and a face‐to‐face meeting in round 2). Initial panellists were recruited via e‐mail from all over the world based on their expertise on dermoscopy of non‐neoplastic dermatoses. Results Twenty‐four international experts took part in all rounds of the consensus and 13 further international participants were also involved in round 2. Five standardized basic parameters were identified: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) ‘other structures’ (including colour and morphology); and (v) ‘specific clues’. For each of them, possible variables were selected, with a total of 31 different subitems reaching agreement at the end of the consensus (all of the 29 proposed initially plus two more added in the course of the consensus procedure). Conclusions This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians and researchers in this field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. What's already known about this topic? Over the last few years, several papers have been published attempting to describe the dermoscopic features of non‐neoplastic dermatoses, yet there is poor consistency in the terminology among different studies. What does this study add? The present expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This consensus should enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology.

Dermoscopy in adult colloid milium

“…sarcoidosis and lupus vulgaris), lichen aureus and amyloidosis, 2,3 due to the presence of a dense cellular infiltration or material deposits in the dermis ("mass effect") as well as hemosiderin dermal depositions. 3 However, according to our case and the previously reported instance, ACM lack other dermoscopic findings visible in the aforementioned conditions; in particular: (i) both sarcoidosis and lupus vulgaris commonly show well-focused linear-branching vessels as the dermal granulomatous infiltrate pushes the vessels towards the epidermis, thus making them more sharp; 4 (ii) lichen aureus generally features purple dots/globules due to erythrocyte extravasation; 3 and (iii) nodular amyloidosis may also reveal shiny white structures and elongated/serpentine vessels. 5 Notably in our instance of ACM, we also observed linear-curved blurred telangiectasias and a few milia-like cysts, yet such findings are too unspecific to be considered useful.…”

Dermoscopy in general dermatology: a ‘Delphinitive’ step forward

“…In the study of Errichetti et al, 24 dermoscopy experts took part in a three-round Delphi process. 6 Surprisingly, the dropout rate of contacted experts was quite high (14 of 38) but the number of remaining experts was still above the recommended threshold of 20. At the end of the Delphi process an agreement was reached for five basic parameters: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) 'other structures' (including colour and morphology); and (v) 'specific clues'.…”

“…In the study of Errichetti et al ., 24 dermoscopy experts took part in a three‐round Delphi process . Surprisingly, the drop‐out rate of contacted experts was quite high (14 of 38) but the number of remaining experts was still above the recommended threshold of 20.…”

“…In this issue of the BJD , Errichetti et al . report the standardization of dermoscopic terminology and parameters in general (non‐neoplastic) dermatology, using a modified Delphi consensus method.…”

“…In this issue of the BJD, Errichetti et al 6 report the standardization of dermoscopic terminology and parameters in general (non-neoplastic) dermatology, using a modified Delphi consensus method. The Delphi method is based on the assumption that group judgements are more valid than individual judgements.…”