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The yellowish clinical appearance and globules are the main features used to differentiate sebaceous gland hyperplasia from basal cell carcinoma Lesion with the dermoscopic criteria for two different pathologies One can find a triple collision lesion with three different pathologies Collision tumors are commonly seen Diagnostic criteria can be side by side or one can be seen within the other Examples include Seborrheic keratosis, basal cell carcinoma Seborrheic keratosis, in situ or invasive squamous cell carcinoma Seborrheic keratosis, amelanotic or pigmented melanoma Seborrheic keratosis, eccrine porocarcinoma Basal cell carcinoma, seborrheic keratosis, clear cell acanthoma Any combination is possible (Figure 1-34)
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Scabies Burrows appear as discrete yellowish scaly linear areas Mites can be seen as a small triangle/gray delta structure that corresponds to the front section of the body with its mouth/biting apparatus and legs Higher magnification and oil/fluid increases the visibility of the mite, stool, and eggs
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Multiple scaly lesions favor the diagnosis of actinic keratosis over lentigo maligna Both can have pigmented and nonpigmented variants Pink or reddish scaly macules, papules, patches, plaques Pinpoint and/or glomerular vessels Clusters or diffuse distribution of vessels throughout the lesion With or without foci of pigmentation A rapidly growing reddish scaly nodule of short duration on sun exposed areas Centrally located yellowish keratinous material Peripheral whitish background Hairpin vessels with or/without a white halo at the periphery Delled yellow papules seen clinically Multiple grouped white or yellow globules Small caliber basal cell carcinoma-like vessels The vessels have been termed crown or wreath-like vessels Supposedly never to reach the center of the lesion This is a misnomer because in reality the vessels rarely meet this criterion and can be found anywhere in the lesion
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Bowen Disease (In Situ Squamous Cell Carcinoma)
Keratoacanthoma
Sebaceous Gland Hyperplasia
Figure 1-34 Collison Tumor Squamous Cell Carcinoma and Seborrheic Keratosis A rapidly growing nodule (arrows) representing a squamous cell carcinoma and the mountain and valley pattern of a seborrheic keratosis (box) characterizes this lesion The cobblestone pattern of a nevus is in the dermoscopic differential diagnosis
DERMOSCOPY: AN ILLUSTRATED SELF-ASSESSMENT GUIDE
Pediculosis Capitis Direct visualization of the parasite and nits It is possible to see if the nits are full (vital nits) or empty, which helps determine the success or failure of treatment Pediculosis Pubis It is possible to easily see the parasite attached to adjacent pubic hairs or hairs at other sites Lichen Planus Peppering Brown blotches White reticular areas (Wickham striae) Negative pigment network/white pigment network/reticular depigmentation is in the dermoscopic differential diagnosis of Wickham striae Warts Red and/or black dots (thrombosed capillaries) With or without a white halo Psoriasis Red scaly plaque or plaques Diffuse distribution of pinpoint and/or glomerular vessels identical to Bowen disease Distribution of lesions will help differentiate Psoriasis from Bowen disease Both can have single or multiple lesions Nail Folds Normal capillary loops are hairpin-shaped and run parallel to the axis of the nail The main value of nail fold dermoscopy is the early diagnosis of scleroderma before there are positive clinical and serologic findings (Figure 1-35)
Scleroderma Pattern The triad of Rarefied capillaries (less than 6 loops per mm) Thin loops Megacapillaries Pearly shining sclerosis cotton balls Dermatomyositis Mega, twisted, branched loops, microhemorrhage Lupus Erythematosus Considerable variation of loops, branching, twisted, megacapillaries, microhemorrhage Trichoscopy The use of dermoscopy to evaluate scalp skin and hair follicles Structures that can be visualized include Hair shafts Hair-follicle openings Perifollicular epidermis Cutaneous microvasculature Higher magnifications (20-70 fold) with digital systems and fluid (70% ethanol) are preferred Hand-held instrumentation with lower magnification and other fluids such as emersion oil or gels can also be used Genetic Hair-Shaft Abnormalities
Monilethrix
Multiple constrictions of the hair shaft alternating with elliptical nodosities that look like a pearl necklace A high tendency to fracture, which gives hair a stubblelike appearance Hair shafts bend regularly in multiple places and curving in different directions regularly bended ribbon sign
Figure 1-35 Nail Fold Capillaries in Cutaneous Lupus Uniform hairpin-shaped capillary loops are replaced with large (mega) irregularly-shaped capillary loops that still have a hairpin shape The surrounding skin is atrophic with diffuse telangietatic vessels
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