Pattern analysis

From dermoscopedia

(6 votes)

 Editor: Harald Kittler

Description This chapter describes the pattern analysis in dermoscopy
Author(s) Florentia Dimitriou · Harald Kittler
Responsible author Harald Kittler→ send e-mail
Status unknown
Status update October 4, 2019
Status by Ralph P. Braun

This chapter describes the pattern analysis in dermoscopy

It has the following subchapters:

Structures used in pattern analysisHarald Kittler
Colors used in pattern analysisHarald Kittler
Chaos and cluesHarald Kittler


  • “Simplified” algorithms such as the ABCD rule, the 7-point checklist, the CASH algorithm, or Menzies' method were developed as uncomplicated and easily assimilated guidelines for daily use. These algorithms are easy to learn but, with the exception of Menzies' method, not easy to apply.
  • Menzies' method is the only scoring system that follows an initial screening based on an overall assessment of pattern and color to determine whether a detailed investigation is worthwhile.
  • The sequence of assessment, first pattern, then color, and finally clues, concurs exactly with the approach of pattern analysis. Menzies' method is a highly simplified version of the algorithms of pattern analysis, but limited to melanocytic lesions.
  • Simple and easily learned rules of thumb based on pattern analysis can be formulated, that fulfill the demand for a rapid and uncomplicated algorithm, but without this restriction to melanocytic lesions (chaos and clues)
  • The basics of pattern analysis are easy to learn, but its application is sometimes complex and needs experience.

Full pattern analysis

  • Pigmented skin lesions can be described very clearly and reliably with the aid of the patterns, colors and clues.
  • Pattern analysis is a structured description in the form of an algorithm with fixed and reproducible rules.

The algorithm always follows this formula:

Pattern + Color + Clues = Diagnosis

  • Based on patterns, colors and clues, the number of potential diagnoses is minimized.
  • In cases in which it is not possible to dispel all doubts in respect of the diagnosis, the degree of doubt and the type of possible diagnoses will be decisive factors to determine whether a histopathological investigation should be performed.


  1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.
  2. Altamura, D., Menzies, S.W., Argenziano, G., et al., 2010, Dermatoscopy of basal cell carcinoma: morphologic variability of global and local features and accuracy of diagnosis. J Am Acad Dermatol, 62, 67–75.
  3. Argenziano, G., Soyer, H., Chimenti, S., et al., 2003, Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol, 48, 679–93.
  4. Binder, M., Kittler, H., Steiner, A., et al., 1999, Reevaluation of the ABCD rule for epiluminescence microscopy. J Am Acad Dermatol, 40(2 Pt 1), 171–6.
  5. Binder, M., Schwarz, M., Winkler, A., et al., 1995, Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol, 131, 286–91.
  6. Braun, R.P., Gaide, O., Oliviero, M., et al., 2007, The significance of multiple blue-grey dots (granularity) for the dermoscopic diagnosis of melanoma. Br J Dermatol, 157, 907–13.
  7. Cameron, A., Rosendahl, C., Tschandl, P., Riedl, E. & Kittler, H., 2010, Dermatos- copy of pigmented Bowen’s disease. J Am Acad Dermatol, 62, 597–604.
  8. Chamberlain, A.J., Fritschi, L. & Kelly, J.W., 2003, Nodular melanoma: patients’ per- ceptions of presenting features and implications for earlier detection. J Am Acad Dermatol, 48, 694–701.
  9. Kittler, H., 2007, Dermatoscopy: introduction of a new algorithmic method based on pattern analysis for diagnosis of pigmented skin lesions. Dermatopathol Pract Conc, 13, 1.
  10. Kittler, H., Riedl, E., Rosendahl, C. & Cameron, A., 2010, Dermatoscopy of unpig- mented lesions of the skin: a new classification of vessel morphology based on pattern analysis. Dermatopathol Pract Conc, 14, 3.
  11. Menzies, S.W., Crotty, K.A. & McCarthy, W.H., 1995, The morphologic criteria of the pseudopod in surface microscopy. Arch Dermatol, 131, 436–40.
  12. Pehamberger, H., Steiner, A. & Wolff, K., 1987, In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions. J Am Acad Dermatol, 17, 571–83.