|
|||||||||||||
|
First step: Diagnostic Algorithm for Differentiating Melanocytic from Non-Melanocytic Lesions [Modified according to Kreusch, Stolz, and Menzies]
|
||||||||||||
Criteria for melanocytic lesion
|
- Pigment network - pseudonetwork (See exception 1) - Aggregated globules (not multiple blue-gray globules) - Branched streaks - Homogeneus blue pigmentation (See exception 2) - Parallel pattern (on palms/soles and mucosal areas)
|
||||||||||||
Criteria for seborrheic keratosis
|
- Multiple milia-like cysts - Comedo-like openings (irregular crypts) - Light-brown fingerprint-like structures - Fissures/ridges (brain-like appearance)
|
||||||||||||
Criteria for basal cell carcinoma
|
- Absent pigment network AND one of: - Arborizing vessels - Leaf-like areas - Large blue-gray ovoid nests - Multiple blue-gray globules - Spoke wheel areas - Ulceration (See exception 3)
|
||||||||||||
Criteria for vascular lesion
|
- Red-blue lacunas - Red-bluish to red-black homogeneus areas
|
||||||||||||
None of the listed criteria
|
|||||||||||||
Exception 1: |
Pigment network or pseudo-network is also present in solar lentigo and seborrheic keratosis. A delicate, annular pigment network is commonly seen also in dermatofibroma (clue for diagnosis of dermatofibroma: central white patch). |
||||||||||||
Exception 2: |
Homogeneous blue pigmentation (dermoscopic hallmark of blue nevus) is also seen (uncommonly) in some hemangiomas and basal cell carcinomas and (commonly) in intradermal melanoma metastases. |
||||||||||||
Exception 3: |
Ulceration is also seen less commonly in invasive melanoma.
|
||||||||||||
|