Exceptions to rules & mimickers

From dermoscopedia

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Description The two-step dermoscopy algorithm aims to differentiate between melanocytic and non-melanocytic lesions and to determine if a melanocytic lesion is benign or malignant. While algorithms serve as guidelines that apply to the majority of cases, one should remember that every rule has exceptions. The recognition of the exceptions is essential for the maintenance of high diagnostic precision.
Author(s) Ayelet Rishpon · Ashfaq A. Marghoob
Responsible author Ash Marghoob → send e-mail
Status unknown
Status update March 5, 2018
Status by Ralph P. Braun


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Feature Differential Diagnosis Mimickers
Negative Network Melanoma Ridges of Seborrheic keratoses
Spitz/Reeds Globular Structures of dermatofibromas
Severe Dysplastic nevi
CMN
Streaks Melanoma Leaf-like areas of BCC
Spitz/Reeds nevus Ridges (fat-fingers) of seborrheic keratoses
Pigmented periphery of Bowen's disease
Pigmented periphery of cutaneous mets
Network Nevi Fingerprinting of solar lentigines
Melanoma Cerebriform pattern of seborrheic keratoses
Solar lentigo
Ink spot lentigo
Dermatofibroma
Accessory nipple
Mastocytosis
Globules Nevus Lacuna
Melanoma Ovoid nests
Clonal Seborrheic keratosis Blue-gray ovoid nests
Cutaneous metastasis Pigmented cysts
Comedo-like openings
Peppering/granularity Melanoma Blue-gray dots of BCC
Lichen planus-like keratosis Linear brown dots of pigmented Bowen’s disease
Pigmented actinic keratosis
Nevi (focal and limited)
Vessels Various melanocytic and non-melanocytic lesions Small ulcerations as in superficial BCC
Linear brown/red dots of pigmented Bowen’s disease
Red globules of BCC
Background vessels in normal skin and sun-damaged skin
Blotch Melanoma Subcorneal hemorrhage
Clark's nevi Thrombosed angioma
Blue nevus Black lamella
Reed's nevi Exogeneous pigmentation
Heavily pigmented seborrheic keratoses
Heavily pigmented BCC
Venous angiomas
Shiny-white streaks Melanoma Negative network
Spitz nevus White lines of scalp nevi
BCC Wickham striae
Dermatofibroma Rail lines (pyogenic granuloma)
Scar
Circles-white Actinic keratoses Milia-like cysts
SCC Lobules of sebaceous hyperplasia
White clods of BCC
Lacunes of lymphangiomas
White globules of balloon cell nevi
Folliculitis
Molluscum
Circles-brown Dermatofibroma Curved lines of solar lentigines and seborrheic keraotoses
Bowen's disease Comedo-like openings
Facial melanoma
Facial nevi
Facial solar lentigines
Angulated lines Melanoma of sun-damaged skin Spoke-wheel areas
Pigmented actinic keratosis Fingerprinting
Lichen planus-like keratosis Prominent network of congenital nevi and Clark's nevi
Prominent lines of ink spot lentigo
Lattice like pattern of acral nevi

The examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections.

In mathematics and computer science, an algorithm (Listeni/ˈælɡərɪðəm/ AL-gə-ri-dhəm) is a self-contained sequence of actions to be performed. Algorithms can perform calculation, data processing and automated reasoning tasks.

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is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions

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lines radial (always at periphery) streaks Reed nevus melanoma recurrent nevus

Brown to gray/blue discrete linear or bulbous structures coalescing at a common off center base creating structures that resemble a leaf-like pattern.

Abbreviation for Basal Cell Carcinoma

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lines brown curved parallel thin

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Dermatofibromas are hard solitary slow-growing papules (rounded bumps) that may appear in a variety of colours, usually brownish to tan; they are often elevated or pedunculated. A dermatofibroma is associated with the dimple sign; by applying lateral pressure, there is a central depression of the dermatofibroma.

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clods blue large clustered

Gray dots

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also known as squamous cell carcinoma in situ[1] is a neoplastic skin disease. It can be considered as an early stage or intraepidermal form of squamous cell carcinoma. It was named after John T. Bowen

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Actinic keratosis (also called solar keratosis and senile keratosis; abbreviated as AK) is a pre-cancerous patch of thick, scaly, or crusty skin.

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Dark structureless areas

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Angiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls (endothelium) or derived from cells of the tissues surrounding these vessels.[1][2] Angiomas are a frequent occurrence as patients age, but they might be an indicator of systemic problems such as liver disease. They are not commonly associated with malignancy.

is a type of melanocytic nevus that clinically and dermoscopically will appear blue

lines radial (always at periphery) streaks Reed nevus melanoma recurrent nevus

Serpiginous interconnecting broadened hypopigmented lines that surround elongated and curvilinear globules.

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Squamous cell carcinoma

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Syn: polygons, zig-zag pattern Gray-brown lines that are connected at an angle or coalescing to form polygons

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is a type of melanocytic nevus (or mole) found in infants at birth. This type of birthmark occurs in an estimated 1% of infants worldwide; it is located in the area of the head and neck 15% of the time.

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