The color wheel approach

From dermoscopedia

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 Editor: Ashfaq A. Marghoob

 Author(s): Nadeem Marghoob     ·  Corinna Psomadakis     ·  Orit Markowitz
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Author(s) Nadeem Marghoob · Corinna Psomadakis · Orit Markowitz
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Status update March 5, 2019
Status by Ralph P. Braun


What is the Color Wheel?

The Color Wheel approach is a tool for biopsy decision-making that serves to complement and streamline traditional pattern recognition methods of dermoscopyThe 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.. Utilizing the clinical and dermoscopic colorsThis glossary term has not yet been described. of a lesion, as well as the lesion’s clinical history and morphologyThis glossary term has not yet been described., helps clinicians to arrive at a narrow differential diagnosisis 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 prior to engaging in dermoscopic pattern analysisThis glossary term has not yet been described.. This may be particularly useful in the case of early malignant lesions, especially amelanotic melanomatype of skin cancer in which the cells do not make melanin, when dermoscopic patternsThis glossary term has not yet been described. may not yet be present.

After taking into consideration patient risk factors and the gross features of the lesion, the 4 steps of the Color Wheel can be used to build a list of possible diagnoses. The 4th step is only taken if malignant lesions remain on the differential list. By that pointThis glossary term has not yet been described., the list of possible diagnoses should be quite small, making the dermoscopic examination and pattern analysis much more focused and less daunting, especially for dermoscopy beginners. After going through the steps of the Color Wheel approach, the clinician should be able to confidently make the decision whether to biopsy.

Using the Color Wheel

Step 1: Is the lesion flat or raised?

This step is a component of the clinical examinationThis glossary term has not yet been described.. It is sometimes appeciated visually, or may require palpating the lesion.

Step 2: What color is the lesion on clinical asssessment?

The Color Wheel gives a high-yield differential diagnosis based on each color seen clinically. The clinical color categories include pink-clear, pale brown, brown-black, and othersThis glossary term has not yet been described.This glossary term has not yet been described. (yellow, purple, red). Having already determined whether the lesion is flat or raised, one can go through the list of diagnoses considered for a particular clinical color and eliminate the inapplicable choices.

Step 3: What color is the lesion dermoscopically?

Using the respective Color Wheel, we cross-reference the list of possible diagnoses that remain after Step 2 with the list corresponding to the relevant dermoscopic colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue.. The dermoscopic colors considered are red, multicolored, brown, and yellow.

Step 4: Is further elucidation needed to decide whether or not to biopsy?

In the case that the narrowed-down list of differential diagnoses includes malignancy, the lesion should be further analyzed for benign or malignant patterns specific to the diagnoses we are ruling out. Often this can be determined with limited dermoscopic patterns.


In the case of elevated neoplasms of uncertain nature, a biopsy is always indicated as the differential includes advanced, aggressive tumorThis glossary term has not yet been described. types. However in uncertain flat lesions without malignant features dermoscopic monitoring can also be an option. This is best achieved with serial dermoscopic imagingThis glossary term has not yet been described..

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