Dermoscopy: Clinical Pearls

Ashfaq Marghoob, MD

Are you performing dermsocopy in your clinical practice? Dr Marghoob provides us with his clinical pearls…

1. Dermoscopy helps in differentiating benign lesions from skin cancer.
2. The presence of network (reticular network, negative network, polygonal lines), streaks (radial streaming, pseudopods), aggregated globules/peripheral globules, homogeneous blue pigmentation is most often seen in melanocytic lesions.
3. Melanocytic lesions that deviate from the 10 benign patterns and has at least one of the 10 melanoma-specific structures needs to be biopsied to rule out melanoma.
4. The presence of spoke wheel structures and/or leaf like areas is 100% specific for BCC.
5. Comedo like openings and milia cyst are often seen in SK but can also be seen in other lesions including melanoma.
6. Polarized light makes blood vessels and crystalline structures more conspicious, and makes milia cyst less conspicuous.
7.  A polymorphous vascular pattern in an amelanotic lesion should raise concern for melanoma.
8. Dermoscopy improves the clinician’s diagnostic accuracy.
9. All structureless or featureless or not-otherwise-diagnosable lesions should be viewed with suspicion.
10. Raised lesions should never be monitored for change.