The Furrow Ink Test

Abstract

Background: Dermoscopy is a helpful tool that can assist experienced users improve the diagnostic accuracy for pigmented lesions in acral sites. As a simplification, one can assume that if pigment is found predominantly in the furrows, the lesion can be considered benign, and if the pigmentation is present predominantly on the ridges, the lesion should be considered malignant. The differentiation between furrows and ridges is the main clue for the diagnosis, but this can sometimes be difficult to discern. For this reason, we describe a simple in vivo technique that makes this task much easier for the clinician.Observations: Liquid ink (ie, from a fountain pen) should be applied directly onto the lesion. The ink should be left on the skin for a few seconds to allow the ink to penetrate into the furrows. The excess ink should then be wiped off. The ink will at first diffusely color the entire skin surface. The subsequent cotton swab wiping will only remove the ink on the skin overlying the ridges. The furrows will retain the stain and become clearly visible on dermoscopic examination as thin inked lines. This in turn will make it easy to evaluate whether the melanin pigmentation follows the ink lines (benign pattern) or if the pigmentation is located in between these ink lines (malignant pattern). Conclusion:The furrow ink test is a quick and easy method to facilitate the correct identification of furrows and ridges on volar skin and facilitates dermoscopic diagnosis of pigmented lesions in acral sites.

Tips and tricks in the dermoscopy of pigmented lesions

“…Sometimes, it is not easy to distinguish the location of the pigment, whether it concerns either furrows or ridges, and this makes the diagnosis of a pigmented lesion much more difficult. In doubtful cases, Braun et al [21] recommend a simple ink furrow test. This in turn will make it easy to evaluate whether the melanin pigmentation follows the ink lines (the benign pattern) (Figure 5) or if the pigmentation is located between these ink lines (the malignant pattern).…”

Tips and tricks in the dermoscopy of pigmented lesions

“…Sometimes, it is not easy to distinguish the location of the pigment, whether it concerns either furrows or ridges, and this makes the diagnosis of a pigmented lesion much more difficult. In doubtful cases, Braun et al [21] recommend a simple ink furrow test. This in turn will make it easy to evaluate whether the melanin pigmentation follows the ink lines (the benign pattern) (Figure 5) or if the pigmentation is located between these ink lines (the malignant pattern).…”

Vertical ex vivo dermoscopy in diagnosing and differentiating skin lesions

“…In cases of more intense pigmentation, it is more difficult to determine whether the pigment is in a groove or a ridge, so in some cases, it is used to cover the lesions with pen ink, which remains in the grooves after wiping with alcohol, which makes it easier to distinguish ridges from grooves. 19 …”

Implementation of a dermatoscopy curriculum during residency at Augsburg University Hospital in Germany

“…[29][30][31] Nevertheless, Hussain et al warned of online-or teledermatoscopyonly courses because dynamic dermatoscopy examinations such as tape stripping can only be assessed in-person and would otherwise lead to less qualified dermatologists. [32][33][34] For this reason, we combined the online curriculum with supervision by a dermatoscopy specialist. Boespflug et al confirmed this concept based on improvement of the participants in pre-and posttest scores.…”

Tips and tricks in the dermoscopy of pigmented lesions

“…Sometimes, it is not easy to distinguish the location of the pigment, whether it concerns either furrows or ridges, and this makes the diagnosis of a pigmented lesion much more difficult. In doubtful cases, Braun et al [21] recommend a simple ink furrow test. This in turn will make it easy to evaluate whether the melanin pigmentation follows the ink lines (the benign pattern) (Figure 5) or if the pigmentation is located between these ink lines (the malignant pattern).…”

Vertical ex vivo dermoscopy in diagnosing and differentiating skin lesions

“…In cases of more intense pigmentation, it is more difficult to determine whether the pigment is in a groove or a ridge, so in some cases, it is used to cover the lesions with pen ink, which remains in the grooves after wiping with alcohol, which makes it easier to distinguish ridges from grooves. 19 …”

Implementation of a dermatoscopy curriculum during residency at Augsburg University Hospital in Germany

“…[29][30][31] Nevertheless, Hussain et al warned of online-or teledermatoscopyonly courses because dynamic dermatoscopy examinations such as tape stripping can only be assessed in-person and would otherwise lead to less qualified dermatologists. [32][33][34] For this reason, we combined the online curriculum with supervision by a dermatoscopy specialist. Boespflug et al confirmed this concept based on improvement of the participants in pre-and posttest scores.…”

Tips and tricks in the dermoscopy of pigmented lesions

“…Sometimes, it is not easy to distinguish the location of the pigment, whether it concerns either furrows or ridges, and this makes the diagnosis of a pigmented lesion much more difficult. In doubtful cases, Braun et al [21] recommend a simple ink furrow test. This in turn will make it easy to evaluate whether the melanin pigmentation follows the ink lines (the benign pattern) (Figure 5) or if the pigmentation is located between these ink lines (the malignant pattern).…”

Vertical ex vivo dermoscopy in diagnosing and differentiating skin lesions

“…In cases of more intense pigmentation, it is more difficult to determine whether the pigment is in a groove or a ridge, so in some cases, it is used to cover the lesions with pen ink, which remains in the grooves after wiping with alcohol, which makes it easier to distinguish ridges from grooves. 19 …”

Implementation of a dermatoscopy curriculum during residency at Augsburg University Hospital in Germany

“…[29][30][31] Nevertheless, Hussain et al warned of online-or teledermatoscopyonly courses because dynamic dermatoscopy examinations such as tape stripping can only be assessed in-person and would otherwise lead to less qualified dermatologists. [32][33][34] For this reason, we combined the online curriculum with supervision by a dermatoscopy specialist. Boespflug et al confirmed this concept based on improvement of the participants in pre-and posttest scores.…”