Maui Derm 2016 Highlights: Dermoscopy Workshop

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)