Criteria to be assessed by dermoscopic examination

The dermoscopic diagnosis of pigmented skin lesions is based on various analytic approaches or algorithms that have been set forth in the last few years, namely, pattern analysis, ABCD rule and seven-point checklist to quote but a few. The common denominator of all these diagnostic methods are particular dermoscopic features or, better, dermoscopic criteria that represent the backbone for the morphologic diagnosis of pigmented skin lesions.

In the second step of this course several examples of all relevant dermoscopic criteria and their underlying histopathologic structures will be demonstrated in order to teach students of the subject the letters of the dermoscopic alphabet. These letters, at least in our estimation, represent a ‘conditio sine qua non’ for learning and understanding dermoscopy. Also, knowledge of dermoscopic criteria yields a basic source for further studies in this field and may help communicate the method of dermoscopy to the clinical dermatologist. In order to achieve this goal we will focus on already well established criteria while refining some not clearly elaborated ones. Further, some new dermocopic criteria such as exophytic papillary structures and central white patches are introduced.

By assessing dermoscopic images, basically two common groups, namely, global and local features, can be recognized. They will be displayed systematically in the following pages. 

  • First, we will focus on nine morphologically rather distinctive global features that allow a quick, albeit only preliminary categorization of a given pigmented skin lesion prior to more detailed assessment.

  • Second, we will turn to the various local features representing the letters of the dermoscopic alphabet.


  1. Akasu R, Sugiyama H, Araki M, Ohtake N, Furue M, Tamaki K. Dermatoscopic and videomicroscopic features of melanocytic plantar nevi. Am J Dermatopathol 1996;18:10-18.

  2. Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Sammarco E, Delfino M. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7 point checklist based on pattern analysis. Arch Dermatol 1998;134:1563-1570.

  3. Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Delfino M. Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness. J Am Acad Dermatol 1999;40:61-68.

  4. Bahmer FA, Fritsch P, Kreusch J, et al. Terminology in surface microscopy. J Am Acad Dermatol 1990;23:1159-1162.

  5. Kreusch J, Koch F. Auflichtmikroskopische Charakterisierung von Gefaessmustern in Hauttumoren. Hautarzt 1996;47:264-272.

  6. Menzies SW, Crotty KA, McCarty WH. The morphologic criteria of the pseudopod in surface microscopy. Arch Dermatol 1995;131:463-440.

  7. Oguchi S, Saida T, Koganehira Y, Ohkubo S, Ishihara Y, Kawachi S. Characteristic epiluminescent microscopic features of early malignant melanoma on glabrous skin. A videomicroscopic analysis. Arch Dermatol 1998,134:563-568.

  8. Saida T, Oguchi S, Ishihara Y. In vivo observation of magnified features of pigmented lesions on volar skin using video macroscope: Usefulness of epiluminescence techniques in clinical diagnosis. Arch Dermatol 1995;131:298-304.

  9. Soyer HP, Smolle J, Hoedl S, et al. Surface microscopy: a new approach to the diagnosis of cutaneous pigmented tumors. Am J Dermatopathol 1989;11:1-11.

  10. Yadav S, Vossaert KA, Kopf AW, et al. Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy). Am J Dermatopathol 1993;15:297-305.