Dermoscopy Flashcards
Dermal naevus derm features
Often cobblestone
Comma or curvi linear vessels
What do globules represent
Junctional nests of melanocytes
What does cobblestone reflect
Large dermal nests of melanocytes
The most common type of combined naevi
Blue naevus and overlying junctional naevus
How does a halo naevus develop
Immune system attacks the melanocytes within a naevus and surrounding skin causing depigmentation - first stay is the formation of a halo of depigmentation around a naevus followed by depigmentation of the central naevus
Spitz naevus derm features
Predominant vascular pattern composed of dotted vessels
Combination of vessels and variable pigmentation may also be present - mimicking amelanotic/hypomelanotic melanoma
What type of naevi do you get as a teenager, 30s and >50
Globular teenager
Reticular adults
Homogenous >50
Seven features of melanoma
Eccentric atypical network Blue white veil Regression structures Irregular streaks Atypical vessels Eccentric homogenous pigmentation Asymmetrical pigmented globules
MIS derm features
Maybe localized to specific focus within the lesion
Eccentric atypical network
Regression structures
Eccentric homogenous pigmentation
Asymmetrical pigmented globules
Thin invasive melanoma findings
Eccentric atypical network Blue white veil Regression structures Irregular streaks Eccentric homogenous pigmentation Asymmetric pigmented globules
Compared to MIS more colours and asymmetry
What do you see in more intermediate thickness melanomas
Atypical blood vessels and blue white veil
What does the variability in colour reflect in multicoloured melanoma
Different depths affected by Tumour cells
Pink: neovascularisation and atypical vessels
Brown: epidermal
Blue: dermal
Few colours are seen in very thick tumours as boundaries become less distinct
Hypopigmented melanoma derm features
Pigmented remnants
Dotted vessels
Linear irregular vessels
Foci of eccentric pigmentation and atypical vessels
Nodular melanoma derm features
Regular things seen in SSMM may be lacking
Pseudolacunaes (also see in pigmented nodular BCCs) Blue white veil Irregular vessels Ulceration Homogenous pigmentation
Featureless melanoma derm
Look closely for multicoloured macular with areas of ill defined pigmentation and change in background vascular pattern
Where do you see negative networks
Early melanoma and Spitz naevi
White reticular pattern is due to elongation of rete ridges
What is regression
Immune mediated response by the host to melanoma
Gradual replacement of melanocytic diagnostic detail by grey and white structures representing fibrosis in the papillae dermis and pigmentation in melanophages
Seb k derm features
Cerebriform Comedo like openings Hairpin vessels Fingerprint structure Milia like cysts Moth eaten border
Features that solar lentigines and seb ks share
Pseudofollicular openings
Homogenous pigmentation
Fingerprint structure
Moth eaten border
Lichenoid keratosis derm
Inflammatory destruction of an epidermal lesion
Inflammation then oigmentation
On dermoscopy: grey granular pigment evenly distributed throughout the lesion
Ink spot lentigo dermoscopy
Hyperpigmentation of basal keratinocytes
Uniformly hyperpigmented network on dermoscopy
Solar lentigo derm
Result from basal keratinocytes hyperpigmentation and may be a precursor to seb k
Pseudofollicular openings
Homogenous pigmentation
Fingerprint structure
Moth eaten border
Clear cell acanthoma derm
Seb k with distinct vascular pattern: multiple dotted, hair pin or even glomerular vessels course a linear pattern throughout the lesion _ ‘string of pearls’
Porokeratosis dermoscopy
Central erythema
Double line at margin
Haemangioma dermoscopy
Dilated subepidermal blood vessels form large vascular spaces which may thrombose
Homogenous lacunaes
Angiokeratoma dermoscopy
Dark lacunae seen more commonly than red lacunae
The darker the higher the degree of thrombosis within the vascular spaces
Whitish veil: due to hyper keratosis and acanthosis
So multicoloured lacunae and blue white veil
Sebaceous hyperplasia dermoscopy
Comedo like openings
Yellow sebaceous gland aggregates
Crown vessels
Dermatofibroma dermoscopy
Benign proliferation of dermal connective tissue
Pseudo network (from acanthotic epidermis with elongation and basilar pigmentation of the rete ridges) Central scar - central papilas component effaced the overlying epidermis replacing the pseudo network
AL dermoscopy
Keratin plugs
Erythema
Scale
Can have increased prominence of follicular units - seeds of strawberry
Bowens dermoscopy
Glomerular vessels - focal nests of tortuous vessels resembling the vessels in the renal glomerulus
Keratosis
Scale
Erythema
SCC/KA dermoscopic
Central yellow keratinous plugs
Arborising vessels centrally
Hairpin vessel in milky halo peripherally
Well differentiated will have more keratinising structures, less diff have more vascular features
BCC features dermoscopy
Multiple blue grey dots and globules Spoke wheel pigmentation Leaf like areas Blue grey ovoid nests Arborizing vessels and erythema Erosions and ulceration
SBCC dermoscopy
Pear lines to edge Anastomusing telangiectasias Macro and micro arborising vessels Peripheral pink homogenous mantle when pressure obscures the blood vessels of the clinical pearly border Short fine telangiectasia also seen
NBCC dermoscopy
Leaf like and spoke wheel pigmentation Blue grey ovoid nests Blue grey pigmentation Arborising vessels Erythema Focal erosions Ulceration
Morphoeic BCC derm
Arborising telangiectasia
