Exceptions to rules & mimickers

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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

Feature Differential Diagnosis Mimickers
Negative Network Melanoma Ridges of Seborrheic keratoses
Spitz/Reeds Globular Structures of dermatofibromas
Severe Dysplastic nevi
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
Accessory nipple
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)
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
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
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