How to diagnose nonpigmented skin tumors: A review of vascular structures seen with dermoscopy Part I. Melanocytic skin tumors (original) (raw)
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How to diagnose nonpigmented skin tumors: A review of vascular structures seen with dermoscopy
Journal of the American Academy of Dermatology, 2010
Dermoscopy is a noninvasive tool that can be helpful in the diagnosis of nonpigmented skin tumors. This is because dermoscopy permits the visualization of key vascular structures that are usually not visible to the naked eye. Much work has concentrated on the identification of specific morphologic types of vessels that allow a classification into melanocytic versus nonmelanocytic and benign versus malignant nonpigmented skin tumors. Among a broad spectrum of different types of vascular patterns, six main morphologies can be identified. These are comma-like, dotted, linear-irregular, hairpin, glomerular, and arborizing vessels. With some exceptions, comma, dotted, and linear irregular vessels are associated with melanocytic tumors, while the latter three vascular types are generally indicative of keratinocytic tumors. Aside from vascular morphology, the architectural arrangement of vessels within the tumor and the presence of additional dermoscopic clues are equally important for the diagnosis. This article provides a general overview of the dermoscopic evaluation of nonpigmented skin tumors and is divided into two parts. Part I discusses the dermoscopic vascular patterns of benign and malignant melanocytic skin tumors. Part II discusses the dermoscopic vascular patterns of benign and malignant nonmelanocytic nonpigmented skin tumors. In each part, additional special management guidelines for melanocytic and nonmelanocytic nonpigmented skin tumors, respectively, will be discussed. ( J Am Acad Dermatol 2010;63:361-74.) Learning objectives: After completing this learning activity, participants should be able to categorize different vascular structures and the architectural arrangement of vessels within tumors and additional dermoscopic clues of nonpigmented skin tumors, recognize the diagnostic significance of vessels associated with nevi and melanoma, and appropriately manage nonpigmented melanocytic skin tumors.
Nonmelanoma skin cancer refers to a broad class of tumors, including actinic keratosis, basal cell carcinoma, and squamous cell carcinoma, and as a group these are the most frequent cancers occurring in light skinned humans. In contrast to the rarity of amelanotic melanoma, nonmelanoma skin cancer commonly lacks pigmentation. Although these tumors rarely cause death related to metastases, they commonly destroy underlying tissues and should be removed at the earliest possible stage. Dermoscopy improves the clinical diagnosis of nonpigmented skin tumors by allowing the visualization of specific vascular structures that are usually not visible to the naked eye. Dermoscopic vascular patterns of several nonmelanocytic nonpigmented skin tumors, such as sebaceous hyperplasia, seborrheic keratosis, clear cell acanthoma, Bowen disease, or nodular cystic basal cell carcinoma are highly specific, allowing a ready diagnosis in most cases. Others, such as actinic keratosis, pyogenic granuloma, or uncommon adnexal tumors, may be difficult to differentiate even with the aid of dermoscopy. For this reason, general guidelines have been established to assist in making the most appropriate management decision. In the second part of this review of dermoscopic vascular structures of nonpigmented skin tumors, the dermoscopic patterns associated with benign and malignant nonmelanocytic skin tumors and recommendations for the management of these tumors will be discussed. ( J Am Acad Dermatol 2010;63:377-86.) Learning objectives: After completing this learning activity, participants should be able to recognize the vascular morphology, architectural arrangement of vessels, and additional dermoscopic clues of nonmelanocytic nonpigmented skin tumors, recognize the diagnostic significance of vessels associated with benign and malignant nonmelanocytic tumors, and apply rules for the management of these tumors.
Vascular Structures in Skin Tumors
Archives of Dermatology, 2004
To describe the different vascular structures seen by dermoscopy and to evaluate their association with various melanocytic and nonmelanocytic skin tumors in a large series of cases. Design: Digital dermoscopic images of the lesions were evaluated for the presence of various morphologic types of vessels. Setting: Specialized university clinic. Patients: From a larger database, 531 excised lesions (from 517 patients) dermoscopically showing any type of vascular structures were included. Main Outcome Measures: The frequency and positive predictive value of the different vascular structures seen in various tumors were calculated, and the differences were evaluated by the 2 or Fisher exact test. Results: Arborizing vessels were seen in 82.1% of basal cell carcinomas, with a 94.1% positive predictive value (PϽ.001). Dotted vessels were generally predictive for a melanocytic lesion (90.0%, PϽ.001), and were especially seen in Spitz nevi (77.8% of lesions). In melanoma, linear-irregular, dotted, and polymorphous/ atypical vessels were the most frequent vascular structures, whereas milky-red globules/areas were the most predictive ones (77.8%, P=.003). The presence of erythema was most predictive for Clark nevus, whereas comma, glomerular, crown, and hairpin vessels were significantly associated with dermal/congenital nevi, Bowen disease, sebaceous hyperplasia, and seborrheic keratosis, respectively (PϽ.001 for all). Conclusions: Different morphologic types of vessels are associated with different melanocytic or nonmelanocytic skin tumors. Therefore, the recognition of distinctive vascular structures may be helpful for diagnostic purposes, especially when the classic pigmented dermoscopic structures are lacking.
British Journal of Dermatology, 2004
Background Dermoscopic vascular criteria remain poorly evaluated and analysed. The increasing number of descriptions of amelanotic melanoma showing isolated vascular dermoscopic findings adds interest to this topic. Objective To evaluate and classify the dermoscopic vascular structures seen in nontumoral dermatoses (NTD). Patients and methods The affected skin of 414 consecutive patients suffering from a variety of 31 different biopsy-proven NTD was evaluated with the dermoscope and photographed with the Dermaphot camera. Results The dermoscopic vascular structures seen in NTD consisted of round dotted and globular vessels, linear vessels and glomerular vessels. In addition, structureless coloured patches were also found. In some NTD the distribution of the vascular structures took on special arrangements. The most common vascular findings were the linear and the rounded vessels, which were distributed either homogeneously throughout the lesion or were present together with other vascular or pigmented features in a mixed pattern. Conclusion The present study proposes a new classification of dermoscopic vascular features based on the screening of a large spectrum of nontumoral dermatoses. This list may be useful to define further dermoscopic semiology and to understand the vascular features most relevant to the diagnosis not only of different NTD but also of pigmented and amelanotic melanoma.
Exploring the Dermoscopic Spectrum and Examination of Non-Melanocytic Benign Skin Tumors in Humans
Texila International Journal of Public Health, 2024
Dermoscopy unveils distinctive features aiding non-melanocytic benign skin tumor identification. This study aimed to delineate and characterize these unique dermoscopic patterns, essential for precise diagnosis and tailored treatment. The study was conducted between December 2022 and June 2023, this descriptive study in a tertiary hospital assessed 96 patients with various benign skin tumors. Dermoscopic evaluations were blinded, ensuring rigorous data collection. Dermatofibroma displays a central white globule encircled by a peripheral pigmented network, while neurofibroma exhibits finger-print-like pigmentary lines. Mucosal neurofibroma stands out with its vascular reticulate network against a homogenous white background, contrasting with trichoepithelioma's structureless shiny white structures. Angiofibroma presents as unevenly distributed brown pigmentation, distinct from pyogenic granuloma's white collarette. Steatocystoma displays peripheral reticulate brown pigmentation, while keratoacanthoma showcases a central keratin mass. Cylindroma is characterized by a salmon pink-yellow color background with arborizing blood vessels at the periphery, whereas syringoma manifests multiple pigmented clusters. This study emphasizes dermoscopy's significance as a non-invasive tool enhancing diagnostic accuracy and guiding effective treatment modalities in dermatological practice.
Background Naevoid melanoma (NeM), a rare variant of melanoma, can be difficult to detect as its clinical and histopathological morphology can simulate a naevus. Objectives To describe the clinical and dermoscopic features associated with NeM. Methods Lesions with a histopathological diagnosis of NeM were collected via an e-mail request sent to all members of the International Dermoscopy Society. All lesions were histopathologically reviewed and only lesions fulfilling a set of pre-defined histopathological criteria were included in the study and analysed for their clinical and dermoscopic features. Results Twenty-seven of 58 cases (47%) fulfilled the predefined histopathological criteria for NeM and were included in the study. Clinically, 16 of the 27 NeMs presented as a nodular lesion (59%), eight (30%) as plaque type and three (11%) as papular. Analysis of the global dermoscopic pattern identified three types of NeM. The first were naevus-like tumours (n = 13, 48%), typified by a papillomatous surface resembling a dermal naevus. In these lesions local dermoscopic features included irregular dots/globules (46%), multiple milia-like cysts (38%) and atypi-cal vascular structures (46%). The second type were amelanotic tumours (n = 8, 30%), typified by an atypical vascular pattern (75%). The third type consisted of tumours displaying a multicomponent pattern (n = 4, 15%), characterized by classical local melanoma-specific criteria. Two lesions (7%) were classified as mixed-pattern tumours as they did not manifest any of the aforementioned patterns. Conclusions While NeMs may be clinically difficult to differentiate from naevi, any papillomatous lesion displaying dermoscopically atypical vessels and/or irregular dots/globules should prompt consideration for the possible diagnosis of NeM.
Dermatology practical & conceptual, 2017
The diagnosis of a single small pink papule poses a real challenge to the clinician, as the differential diagnosis of such lesions includes benign entities such as a neurofibroma or hemangioma, as well as aggressive and potentially fatal skin malignancies such as amelanotic melanoma or Merkel cell carcinoma (MCC). The absence of a benign vascular pattern and the presence of atypical vascular features under dermoscopy direct the clinician to proceed to histologic evaluation in order to rule out a malignant process in such lesions. The diagnosis of MCC is particularly problematic, given that this tumor usually lacks specific clinical diagnostic features. Low clinical suspicion for MCC may result in delayed diagnosis and poor outcomes. The dermoscopic features of MCC are also non-specific, most commonly including milky-red areas and linear irregular vessels. We report a patient who presented with two discrete pink papules on different digits that appeared three years apart. Dermoscopy ...