Vascular structures

From dermoscopedia

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 Editor: Ralph P. Braun

 Author(s): Ralph P. Braun
The given value "Blood vessels are critical to the survival and growth of cells and tissues. The rate of growth and ultimate tumor size, whether benign or malignant, is governed at least in part by the tumor’s ability to derive ample blood flow to support the metabolic demands of its cells. Therefore, tumors may manifest signs of an increase in blood vessels and flow. This is readily observed in many basal cell carcinomas (BCCs) in which the clinical morphology often reveals telangiectasias. Although other tumors may not clinically manifest vasculature, vessels are indeed present but may be of small caliber or situated deeper within the skin. Dermoscopy, by providing magnification and visual access to subepidermal structures, has per- mitted clinicians to observe many of these vessels[1]. " contains strip markers and therefore it cannot be parsed sufficiently.
Author(s) Ralph P. Braun
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Status released
Status update June 28, 2019
Status by Ralph P. Braun

It has the following subchapters:

Anatomy of normal skin vasculature Ralph P. Braun
Vessels in the tumor micro environment Ralph P. Braun
Arborizing blood vessels Ralph P. Braun
Hairpin vessels Ralph P. Braun
Milky red globules / areas Ralph P. Braun
Glomerular vessels Ralph P. Braun
Comma vessels Ralph P. Braun
Dotted vessels Ralph P. Braun
Linear irregular vessels Ralph P. Braun
Polymorphous vessels Ralph P. Braun
Corkscrew / tortous vessels Ralph P. Braun
Crown vessels Ralph P. Braun
Strawberry pattern Ralph P. Braun
String of pearls pattern Ralph P. Braun


Currently two different terminologies are used: the descriptive terminologyTerminology using descriptive terms and the metaphoric terminologyThis glossary term has not yet been described.. dermoscopediaDermoscopedia is the name of this website and is providing state of knowledge information concerning dermoscopy - a non invasive diagnostic method. uses both approaches because most individuals are more familiar with the metaphoric terms than with the descriptive terms. A table with the descriptive vessel terminology can be found here,
The skin receives vascular sup- ply through superficialThis glossary term has not yet been described. and deep vascular plexuses in the dermis (Fig. 12.1). These plexuses constitute anatomic landmarks in skin histologyThis glossary term has not yet been described.—the superficial vascular plexus marks the junction between the papillary and reticular dermis, whereas the deep vascular plexus separates the reticular dermis from subcutaneous fat (Lever). The superficial plexus is made up of anastomosing small-caliber arterioles that branch into capillaries, which extend into dermal papillae to sup- ply the overlying epidermis, as well as envelop adnexal structures. The deep plexus is made up of medium-caliber vessels, which emanate from larger vessels that traverse the adipose septae of the subcutis. Addition- ally, the deep plexus connects with the superficial vascular plexus through vertically oriented vessels.

Another more recently described vascular feature is the pattern of follicular red dotsDots are small, round structures of less than 0.1 mm in diameter that have a red color when corresponding to blood vessels; however, when due to melanin, their color ranges from black, brown, to blue-gray depending on the depth and concentration of the melanin in the skin (Tyndall effect)., which have been described in active discoid lupus erythematosusis a chronic skin condition of sores with inflammation and scarring favouring the face, ears, and scalp and at times on other body areas. These lesions develop as a red, inflamed patch with a scaling and crusty appearance. The centre areas may appear lighter in colour with a rim darker than the normal skin.. The follicular red dots are seen surrounding the hair follicle openingsThis glossary term has not yet been described. and consist of regularly distributed, concentric reddish dots in a region of alopecia. This may represent dilation of blood vessels with extravasation of red blood cells surrounding the widened infundibula.
The recognition of vascular structuresThis glossary term has not yet been described. under 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. has become increasingly important for a range of diagnoses. The identification of specific vascular characteristics is an important element of the two-step dermoscopic algorithmIn 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.. When the lesion is categorized as a nonmelanocyticThis glossary term has not yet been described. lesion, vascular features can helpRefers to giving assistance or support to others for mutual benefit to diagnose the lesion more specifically, and hence guide managementThis glossary term has not yet been described. (Level 5 of the revised two-step dermoscopic algorithm). If the lesion is clearly recognized as a melanocyticThis glossary term has not yet been described. tumor, then the identification of vessel type and distribution may facilitate the differentiation between benign and malignant diagnoses (Level 6 of the revised two-step dermoscopic algorithm). For more ambiguous cases in which the lesion cannot be easily classified as melanocytic or nonmelanocytic, the clinician may need to rely on vascular structures as the only recognizable features that can assist in the 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.

In conclusion, it has become apparent that a finite number of morphologically distinct blood vessels can be visualized under dermoscopy. The vessel morphologyThis glossary term has not yet been described. and distribution along with other accompanying features can assist the clinician in correctly identifying many benign and malignant lesions. In general, vessels in melanocytic lesions include dotted vesselstiny pinpoint vessels, comma vesselslinear curved short vessels dermal nevi, linear irregularlinear vessels with multiple bends vessels/serpentine vesselslinear irregular vessels with multiple bends. Seen with flat BCC and melanoma, milky red globulesThis glossary term has not yet been described., vascular blush, and polymorphous vesselsmultiple types of vessels are present may indicate malignancy in appropriate context for example in flat melanocytic lesions. VesselsThis glossary term has not yet been described. suggestive of nonmelanocytic lesions include arborizing vesselsanalytic term is branched vessels; Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels; BCC, hairpin vessels, glomerular vesselsThis glossary term has not yet been described., crown vesselsRadial serpentine or arborizing vessels at the periphery of the lesion that radiate towards the center but do not cross the midline of the lesion. sebaceous hyperplasia, and dotted vessels in a string of pearlsCoiled or dotted vessels arranged in lines clear cell acanthoma pattern.

ReferencesThis is material contained in a footnote or bibliography holding further information.:
  1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.