Ashfaq Marghoob, MD

A two-step dermoscopy algorithm can be employed for the assessment of skin lesions:

• Step 1 is determination of whether a lesion is melanocytic or non-melanocytic and involves assessment of:
  • Network
  • Aggregated or peripheral rim of nodules
  • Streaks
  • Homogeneous blue pigment
  • Parallel pattern on volar skin
  • Pseudo-network system on the face
• If the lesion has any of these features then, Step 2 is assessment with one of four algorithms:
  • Pattern analysis
  • The 7-point Checklist
  • The ABCD rule
  • The Menzies method
• Diagnoses:
  • Nevus (reassure the patient)
  • Suspicious (biopsy, soft tissue myoepithelioma [STMM))
  • Melanoma (biopsy)
• If the lesion is non-melanocytic, potential Step 2 diagnoses are:
  • Benign (dermatofibroma, seborrheic keratosis, clear cell acanthoma, hemangioma)
  • Malignant (basal cell carcinoma, squamous cell carcinoma)
  • If the lesion has no melanocytic or non-melanocytic features and no recognizable vascular pattern, reconsider melanoma:
  • Biopsy
  • Digital monitoring for STMM (but never for raised lesions)