Dermoscopy from A to Z in VS .NET

Creating QR Code in VS .NET Dermoscopy from A to Z

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Dermoscopy from A to Z
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Table 1-5
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CRITERIA FOR VARIOUS LESIONS
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CRITERIA FOR A MELANOCYTIC LESION Pigment network (trunk and extremities) Aggregated globules Homogeneous blue color of a blue nevus Parallel patterns on acral sites By default CRITERIA FOR A SEBORRHEIC KERATOSIS Milia-like cysts Pseudofollicular openings Fissures and ridges Fat fingers Fingerprint pattern Hairpin-shaped vessels Moth-eaten borders Sharp demarcation CRITERIA FOR A BASAL CELL CARCINOMA Absence of pigment network Arborizing blood vessels Pigmentation Ulceration Spoke-wheel structures CRITERIA FOR A DERMATOFIBROMA Central white patch Peripheral pigment network CRITERIA FOR A VASCULAR LESION Vascular spaces (lacunae )
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When they penetrate areas of diffuse pigmentation, reticular-like structures are formed that are referred to as the pseudonetwork Monomorphous appendageal openings can often be seen on the skin of the face without any pigmentation They should not be confused with the milia-like cysts seen in seborrheic keratosis It is not always possible to make the differentiation Consequences could be misdiagnosing lentigo maligna for a seborrheic keratosis This criterion can also be seen with nonmelanocytic lesions (ie, solar lentigo, seborrheic keratosis) It is not 100% diagnostic of a melanocytic lesion Roundish structures distinguished only by their relative sizes Dots (01mm) are smaller than globules (greater than 01mm) Black, brown, gray, or red When black, they can represent melanin or atypical melanocytes in the epidermis Regular brown dots and globules represent nests of melanocytes at the dermo-epidermal junction Irregular brown dots and globules represent nests of atypical melanocytes at the dermo-epidermal junction Fine grayish dots ( peppering ) represent free melanin and/or melanophages in the papillary dermis, which can be seen in regression areas along with other criteria or alone in benign pathology such as late stage lichen planus-like keratosis or posttraumatic Reddish globules can be seen in melanoma (neovascularization) It is written and taught that globules identify a melanocytic lesion with no mention of the smaller dots The reality is that both dots and globules define a melanocytic lesion (Figure 1-2)
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DOTS AND GLOBULES
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Figure 1-1 Amelanotic Melanoma This is a melanocytic lesion by
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default because there is an absence of criteria for a melanocytic lesion, seborrheic keratosis, basal cell carcinoma, dermatofibroma, or hemangioma The blue-white color (arrow) is a clue that this might be a melanocytic lesion There are pinpoint/dotted (yellow boxes) and irregular linear (black boxes) vessels plus a general milky-red background color Note: This interdigital melanoma was mistakenly treated as a tinea for two years (Reproduced, with permission, from Journal of Drugs in Dermatology New Methods and Technologies May 2008-Vol 7-Issue 5 Fig 1b)
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Figure 1-2 Acquired Nevus This is a melanoctic lesion because it has
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pigment network (black boxes) and globules (circles) There is a small hemangioma adjacent to the nevus (arrow)
DERMOSCOPY: AN ILLUSTRATED SELF-ASSESSMENT GUIDE
Figure 1-3 Blue Nevus The classic homogenous blue color of a blue nevus
Figure 1-4 Acral Nevus This is a melanocytic lesion on acral skin with the
benign parallel furrow pattern Pigmentation is in the thin furrows (arrows) with globules (boxes) in the thicker ridges (stars)
HOMOGENEOUS BLUE PIGMENTATION
Structureless blue color usually in the absence of local criteria such as pigment network, dots, or globules (Figure 1-3) Many variations of homogeneous blue color with or without the white color of scarring usually represent a blue nevus The history is important because there is a differential diagnosis which could include A lesion as banal as a radiation tattoo One more ominous such as nodular or cutaneous metastatic melanoma
Thick fibrillar variant with thick oblique lines Thin filamentous variant with fine thin lines Pressure can change the lattice-like pattern into a fibrillar pattern Irregular thick and pigmented line segments could be seen in an acral melanoma
GLOBULAR PATTERN (BENIGN)
Brown globules without a parallel component A lesion with only pigment network Brown homogeneous color Absence of local criteria (ie, pigment network, globules)
RETICULAR PATTERN (BENIGN)
PARALLEL PATTERNS/ACRAL PATTERNS/VOLAR SURFACES ON GLABROUS NON HAIR BEARING SKIN
HOMOGENEOUS PATTERN (BENIGN)
Furrows (also referred to as fissures) and ridges on the skin of the palms and soles Dermatoglyphics are the skin markings that can form whorls, loops, and arches Can create parallel patterns
PARALLEL FURROW PATTERN (BENIGN PATTERN)
Single thin or thick brown parallel lines in the furrows of the skin (crista superficialis limitans) Variations include two brown lines on both sides of the hypopigmented furrows with or without dots and globules Single line of dots and globules along the furrows (single-dotted variant) Double line of dots and globules parallel to the hypopigmented furrows (double-dotted variant) (Figure 1-4)
LATTICE-LIKE PATTERN (BENIGN PATTERN)
Brown parallel lines in the furrows Brown lines running perpendicular to the furrows forming a ladder-like picture (Figure 1-5) Uniform brown lines that run in an oblique (///////) direction
FIBRILLAR PATTERN (BENIGN PATTERN)
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