eMedicine Specialties > Dermatology > Technology & Dermatology

Dermoscopy: Multimedia

Author: Ignazio Stanganelli, MD, Director of Cutaneous Oncology, Niguarda Ca' Granda Hospital; Director, Skin Cancer Unit, Center for Cancer Prevention, Italy
Coauthor(s): Maria Antonietta Pizzichetta, MD, Consulting Staff, Division of Preventive Oncology, Centro Di Riferimento Oncologico of Aviano, Italy
Contributor Information and Disclosures

Updated: May 27, 2008

References

Multimedia

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Media file 1: Hand-held dermatoscope and stereomicroscope.

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Hand-held dermatoscope and stereomicroscope.

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Media file 2: Videodermatoscope. Courtesy of DS Medica, Milan, Italy.

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Videodermatoscope. Courtesy of DS Medica, Milan, Italy.

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Media file 3: Digital epiluminescence microscopy equipment, Skin Cancer Unit, Centro Prevenzione Oncologica, Ravenna, Italy.

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Digital epiluminescence microscopy equipment, Skin Cancer Unit, Centro Prevenzione Oncologica, Ravenna, Italy.

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Media file 4: Digital camera with implemented EPI30 zoom lens. Courtesy of Alpha Strumenti, Milan, Italy.

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Digital camera with implemented EPI30 zoom lens. Courtesy of Alpha Strumenti, Milan, Italy.

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Media file 5: Brown pigment network in a melanocytic nevus.

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Brown pigment network in a melanocytic nevus.

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Media file 6: Brown pigment network in a melanocytic nevus.

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Brown pigment network in a melanocytic nevus.

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Media file 7: Light-brown pigment network in a melanocytic nevus.

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Light-brown pigment network in a melanocytic nevus.

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Media file 8: Brown pigment network in a melanocytic nevus.

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Brown pigment network in a melanocytic nevus.

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Media file 9: Brown pigment network in a melanocytic nevus.

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Brown pigment network in a melanocytic nevus.

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Media file 10: Dark-brown pigment network in a melanocytic nevus.

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Dark-brown pigment network in a melanocytic nevus.

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Media file 11: Dark-brown pigment network in a melanocytic nevus.

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Dark-brown pigment network in a melanocytic nevus.

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Media file 12: Dark-brown pigment network in a melanocytic nevus.

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Dark-brown pigment network in a melanocytic nevus.

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Media file 13: Dark-brown pigment network in a melanocytic nevus.

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Dark-brown pigment network in a melanocytic nevus.

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Media file 14: In situ melanoma with asymmetric color distribution, irregular pigment network, and a whitish veil (*).

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In situ melanoma with asymmetric color distribution, irregular pigment network, and a whitish veil (*).

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Media file 15: In situ melanoma with asymmetric color distribution, irregular pigment network, and pigment dots with varied size (*).

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In situ melanoma with asymmetric color distribution, irregular pigment network, and pigment dots with varied size (*).

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Media file 16: Dysplastic nevus with irregular pigment network and a whitish veil (*).

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Dysplastic nevus with irregular pigment network and a whitish veil (*).

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Media file 17: Pseudopigment network of a nevus located on the face.

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Pseudopigment network of a nevus located on the face.

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Media file 18: Solar lentigo.

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Solar lentigo.

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Media file 19: Malignant melanoma in situ on face or lentigo maligna.

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Malignant melanoma in situ on face or lentigo maligna.

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Media file 20: Melanoma in situ with radial streamings at periphery and a whitish veil (*).

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Melanoma in situ with radial streamings at periphery and a whitish veil (*).

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Media file 21: Microinvasive melanoma with pseudopods at the periphery and a whitish veil (*).

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Microinvasive melanoma with pseudopods at the periphery and a whitish veil (*).

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Media file 22: Melanocytic nevus with globular pattern.

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Melanocytic nevus with globular pattern.

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Media file 23: Melanocytic nevus with globular pattern.

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Melanocytic nevus with globular pattern.

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Media file 24: Melanocytic nevus with regular distribution of globules at periphery.

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Melanocytic nevus with regular distribution of globules at periphery.

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Media file 25: Melanocytic nevus with regular distribution of globules at periphery.

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Melanocytic nevus with regular distribution of globules at periphery.

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Media file 26: Peripheral irregular globules with varied colors in an invasive melanoma.

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Peripheral irregular globules with varied colors in an invasive melanoma.

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Media file 27: Pigmented dots (*) in a melanocytic nevus.

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Pigmented dots (*) in a melanocytic nevus.

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Media file 28: Invasive melanoma with white and gray areas (**), different expressions of pigmented dots (*), and globules (O).

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Invasive melanoma with white and gray areas (**), different expressions of pigmented dots (*), and globules (O).

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Media file 29: Whitish blue veil in a pigmented Spitz nevus.

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Whitish blue veil in a pigmented Spitz nevus.

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Media file 30: Whitish blue veil and gray-blue areas in invasive melanoma.

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Whitish blue veil and gray-blue areas in invasive melanoma.

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Media file 31: Homogeneous steel blue areas in a blue nevus.

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Homogeneous steel blue areas in a blue nevus.

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Media file 32: Hypopigmented areas in a melanocytic nevus.

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Hypopigmented areas in a melanocytic nevus.

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Media file 33: White areas in invasive melanoma.

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White areas in invasive melanoma.

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Media file 34: Milialike cysts (*) and comedolike openings (O) in seborrheic keratosis.

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Milialike cysts (*) and comedolike openings (O) in seborrheic keratosis.

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Media file 35: Comedolike openings (*) in seborrheic keratosis.

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Comedolike openings (*) in seborrheic keratosis.

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Media file 36: Red vascular lagoons.

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Red vascular lagoons.

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Media file 37: Subungual hemorrhage.

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Subungual hemorrhage.

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Media file 38: Maple leaf–like pigmentation (*), treelike vascular pattern, and gray-blue ovoid nests in a basal cell carcinoma.

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Maple leaf–like pigmentation (*), treelike vascular pattern, and gray-blue ovoid nests in a basal cell carcinoma.

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Media file 39: On the left, treelike vessels in a basal cell carcinoma, and, on the right, corona vessels that are thin and curved and are surrounding a sebaceous gland hyperplasia.

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On the left, treelike vessels in a basal cell carcinoma, and, on the right, corona vessels that are thin and curved and are surrounding a sebaceous gland hyperplasia.

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Media file 40: On the left, comma-shaped vessels parallel to the skin surface in a dermal nevi. On the right, point vessels in an actinic keratosis.

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On the left, comma-shaped vessels parallel to the skin surface in a dermal nevi. On the right, point vessels in an actinic keratosis.

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Media file 41: Linear irregular vessels and pinpoint dots in a malignant melanoma.

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Linear irregular vessels and pinpoint dots in a malignant melanoma.

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Media file 42: Global and local patterns such as additional features in the pattern analysis classification system.

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Global and local patterns such as additional features in the pattern analysis classification system.

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Media file 43: A typical globular pattern in a Clark nevus and the multifaceted colors and structures visible in a microinvasive malignant melanoma according to the pattern analysis classification. CNMD is Consensus Net Meeting on Dermoscopy.

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A typical globular pattern in a Clark nevus and the multifaceted colors and structures visible in a microinvasive malignant melanoma according to the pattern analysis classification. CNMD is Consensus Net Meeting on Dermoscopy.

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Media file 44: Typical starburst pattern characterized by the presence of pseudopods (streaks) visible at the periphery of the lesion radially distributed in a Reed nevus.

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Typical starburst pattern characterized by the presence of pseudopods (streaks) visible at the periphery of the lesion radially distributed in a Reed nevus.

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Media file 45: The main patterns in acral lesions: parallel furrow pattern, latticelike pattern, fibrillar pattern, and parallel ridge pattern.

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The main patterns in acral lesions: parallel furrow pattern, latticelike pattern, fibrillar pattern, and parallel ridge pattern.

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Media file 46: ABCD rule of dermoscopy. Asymmetry and border with relative weight and score.

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ABCD rule of dermoscopy. Asymmetry and border with relative weight and score.

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Media file 47: ABCD rule of dermoscopy. Color and different structures with relative weight and score.

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ABCD rule of dermoscopy. Color and different structures with relative weight and score.

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Media file 48: The scoring system developed using the ABDC rule of dermoscopy.

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The scoring system developed using the ABDC rule of dermoscopy.

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Media file 49: Grading of melanocytic lesions using total dermoscopy score of the ABCD rule of dermoscopy.

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Grading of melanocytic lesions using total dermoscopy score of the ABCD rule of dermoscopy.

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Media file 50: Application of ABCD rule of dermoscopy in melanocytic lesions.

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Application of ABCD rule of dermoscopy in melanocytic lesions.

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Media file 51: Menzies method. Classification system used to make a diagnosis of suspected melanoma.

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Menzies method. Classification system used to make a diagnosis of suspected melanoma.

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Media file 52: Application of Menzies method to evaluate the different spectra of melanocytic lesions.

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Application of Menzies method to evaluate the different spectra of melanocytic lesions.

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Media file 53: Seven-point checklist uses 7 melanoma-specific criteria: 3 major criteria (score 2 points each) and 4 minor criteria (score 1 point each).

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Seven-point checklist uses 7 melanoma-specific criteria: 3 major criteria (score 2 points each) and 4 minor criteria (score 1 point each).

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Media file 54: A typical benign melanocytic lesion and a malignant melanoma classified using the 7-point checklist parameters and the relative score.

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A typical benign melanocytic lesion and a malignant melanoma classified using the 7-point checklist parameters and the relative score.

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Media file 55: Stratification of risk levels correlated to the different spectra of melanocytic lesions and relative management.

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Stratification of risk levels correlated to the different spectra of melanocytic lesions and relative management.

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Media file 56: A low-risk melanocytic lesion with a typical pigment network (Clark nevus) and a very high-risk melanocytic lesion (melanoma) classified using the level of risk stratification method.

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A low-risk melanocytic lesion with a typical pigment network (Clark nevus) and a very high-risk melanocytic lesion (melanoma) classified using the level of risk stratification method.

More on Dermoscopy

References

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References

Pehamberger H, Binder M, Steiner A, Wolff K. In vivo epiluminescence microscopy: improvement of early diagnosis of melanoma. J Invest Dermatol. Mar 1993;100(3):356S-362S. [Medline].
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. Dec 1998;134(12):1563-70. [Medline].
Kenet RO, Fitzpatrick TB. Reducing mortality and morbidity of cutaneous melanoma: a six year plan. B). Identifying high and low risk pigmented lesions using epiluminescence microscopy. J Dermatol. Nov 1994;21(11):881-4. [Medline].
Pizzichetta MA, Stanganelli I, Bono R, Soyer HP, Magi S, Canzonieri V, et al. Dermoscopic features of difficult melanoma. Dermatol Surg. Jan 2007;33(1):91-9. [Medline].
Puig S, Argenziano G, Zalaudek I, Ferrara G, Palou J, Massi D, et al. Melanomas that failed dermoscopic detection: a combined clinicodermoscopic approach for not missing melanoma. Dermatol Surg. Oct 2007;33(10):1262-73. [Medline].
Pizzichetta MA, Talamini R, Stanganelli I, Puddu P, Bono R, Argenziano G, et al. Amelanotic/hypomelanotic melanoma: clinical and dermoscopic features. Br J Dermatol. Jun 2004;150(6):1117-24. [Medline].
Akasu R, Sugiyama H, Araki M, Ohtake N, Furue M, Tamaki K. Dermatoscopic and videomicroscopic features of melanocytic plantar nevi. Am J Dermatopathol. Feb 1996;18(1):10-8. [Medline].
Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. May 2003;48(5):679-93. [Medline].
Ascierto PA, Palmieri G, Botti G, Satriano RA, Stanganelli I, Bono R, et al. Early diagnosis of malignant melanoma: Proposal of a working formulation for the management of cutaneous pigmented lesions from the Melanoma Cooperative Group. Int J Oncol. Jun 2003;22(6):1209-15. [Medline].
Bahmer FA, Fritsch P, Kreusch J, Pehamberger H, Rohrer C, Schindera I, et al. Terminology in surface microscopy. Consensus meeting of the Committee on Analytical Morphology of the Arbeitsgemeinschaft Dermatologische Forschung, Hamburg, Federal Republic of Germany, Nov. 17, 1989. J Am Acad Dermatol. Dec 1990;23(6 Pt 1):1159-62. [Medline].
Binder M, Schwarz M, Winkler A, Steiner A, Kaider A, Wolff K, et al. Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol. Mar 1995;131(3):286-91. [Medline].
Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat JH. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. Jan 2005;52(1):109-21. [Medline].
Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat JH. Pattern analysis: a two-step procedure for the dermoscopic diagnosis of melanoma. Clin Dermatol. May-Jun 2002;20(3):236-9. [Medline].
Carli P, De Giorgi V, Giannotti B. Dermoscopy and early diagnosis of melanoma: the light and the dark. Arch Dermatol. Dec 2001;137(12):1641-4. [Medline].
Carli P, De Giorgi V, Giannotti B. Dermoscopy as a second step in the diagnosis of doubtful pigmented skin lesions: how great is the risk of missing a melanoma?. J Eur Acad Dermatol Venereol. Jan 2001;15(1):24-6. [Medline].
Del Mar C, Green A, Cooney T, Cutbush K, Lawrie S, Adkins G. Melanocytic lesions excised from the skin: what percentage are malignant?. Aust J Public Health. Jun 1994;18(2):221-3. [Medline].
Kenet RO, Kang S, Kenet BJ, Fitzpatrick TB, Sober AJ, Barnhill RL. Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy. Grading protocol and atlas. Arch Dermatol. Feb 1993;129(2):157-74. [Medline].
Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol. Mar 2002;3(3):159-65. [Medline].
Kreusch JF. Diagnosis of amelanotic melanoma by dermoscopy: the importance of vascular structures. In: Marghoob AA, Braun RP, Kopf AW, et al, eds. Atlas of Dermoscopy. Taylor & Francis; 2005:246-51.
Massone C, Di Stefani A, Soyer HP. Dermoscopy for skin cancer detection. Curr Opin Oncol. Mar 2005;17(2):147-53. [Medline].
Menzies SW, Ingvar C, Crotty KA, McCarthy WH. Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features. Arch Dermatol. Oct 1996;132(10):1178-82. [Medline].
Menzies SW, Ingvar C, McCarthy WH. A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma. Melanoma Res. Feb 1996;6(1):55-62. [Medline].
Miller M, Ackerman AB. How accurate are dermatologists in the diagnosis of melanoma? Degree of accuracy and implications. Arch Dermatol. Apr 1992;128(4):559-60. [Medline].
Peris K, Ferrari A, Argenziano G, Soyer HP, Chimenti S. Dermoscopic classification of Spitz/Reed nevi. Clin Dermatol. May-Jun 2002;20(3):259-62. [Medline].
Atlas of Dermatoscopy [educational CD-ROM]. MMA Worldwide Group, Inc; 1998. Rabinovitz H.
Soyer HP, Smolle J, Hodl S, et al. Surface microscopy. A new approach to the diagnosis of cutaneous pigmented tumors. Am J Dermatopathol. Feb 1989;11(1):1-10. [Medline].
Stanganelli I, Bucchi L. Epiluminescence microscopy versus clinical evaluation of pigmented skin lesions: effects of Operator's training on reproducibility and accuracy. Dermatology and Venereology Society of the Canton of Ticino. Dermatology. 1998;196(2):199-203. [Medline].
Stanganelli I, Burroni M, Rafanelli S, Bucchi L. Intraobserver agreement in interpretation of digital epiluminescence microscopy. J Am Acad Dermatol. Oct 1995;33(4):584-9. [Medline].
Stolz W, Braun-Falco O, Bilek P, et al. Color Atlas of Dermatoscopy. London, England: Blackwell Science; 2002.
Yadav S, Vossaert KA, Kopf AW, Silverman M, Grin-Jorgensen C. Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy). Am J Dermatopathol. Aug 1993;15(4):297-305. [Medline].

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Keywords

epiluminescence microscopy, digital epiluminescence microscopy, videodermatoscope, video dermatoscope, video-dermatoscope, cutaneous malignant melanoma, pigmented skin lesions, malignant melanoma, skin cancer, skin cancer diagnosis, CMM, PSL, ELM, dermatologic color evaluation, skin lesion color evaluation

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Contributor Information and Disclosures

Author

Ignazio Stanganelli, MD, Director of Cutaneous Oncology, Niguarda Ca' Granda Hospital; Director, Skin Cancer Unit, Center for Cancer Prevention, Italy
Disclosure: Nothing to disclose.

Coauthor(s)

Maria Antonietta Pizzichetta, MD, Consulting Staff, Division of Preventive Oncology, Centro Di Riferimento Oncologico of Aviano, Italy
Disclosure: Nothing to disclose.

Medical Editor

Harold S Rabinovitz, MD, Clinical Professor, Department of Dermatology, University of Miami School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Amanda Oakley, MBChB, FRACP, Clinical Director, Clinical Associate Professor, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand
Amanda Oakley, MBChB, FRACP is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Search for CME/CE on This Topic »

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eMedicine Specialties > Dermatology > Technology & Dermatology

Dermoscopy: Multimedia

Multimedia

Hand-held dermatoscope and stereomicroscope.

Videodermatoscope. Courtesy of DS Medica, Milan, Italy.

Digital epiluminescence microscopy equipment, Skin Cancer Unit, Centro Prevenzione Oncologica, Ravenna, Italy.

Digital camera with implemented EPI30 zoom lens. Courtesy of Alpha Strumenti, Milan, Italy.

Brown pigment network in a melanocytic nevus.

Brown pigment network in a melanocytic nevus.

Light-brown pigment network in a melanocytic nevus.

Brown pigment network in a melanocytic nevus.

Brown pigment network in a melanocytic nevus.

Dark-brown pigment network in a melanocytic nevus.

Dark-brown pigment network in a melanocytic nevus.

Dark-brown pigment network in a melanocytic nevus.

Dark-brown pigment network in a melanocytic nevus.

In situ melanoma with asymmetric color distribution, irregular pigment network, and a whitish veil (*).

In situ melanoma with asymmetric color distribution, irregular pigment network, and pigment dots with varied size (*).

Dysplastic nevus with irregular pigment network and a whitish veil (*).

Pseudopigment network of a nevus located on the face.

Solar lentigo.

Malignant melanoma in situ on face or lentigo maligna.

Melanoma in situ with radial streamings at periphery and a whitish veil (*).

Microinvasive melanoma with pseudopods at the periphery and a whitish veil (*).

Melanocytic nevus with globular pattern.

Melanocytic nevus with globular pattern.

Melanocytic nevus with regular distribution of globules at periphery.

Melanocytic nevus with regular distribution of globules at periphery.

Peripheral irregular globules with varied colors in an invasive melanoma.

Pigmented dots (*) in a melanocytic nevus.

Invasive melanoma with white and gray areas (**), different expressions of pigmented dots (*), and globules (O).

Whitish blue veil in a pigmented Spitz nevus.

Whitish blue veil and gray-blue areas in invasive melanoma.

Homogeneous steel blue areas in a blue nevus.

Hypopigmented areas in a melanocytic nevus.

White areas in invasive melanoma.

Milialike cysts (*) and comedolike openings (O) in seborrheic keratosis.

Comedolike openings (*) in seborrheic keratosis.

Red vascular lagoons.

Subungual hemorrhage.

Maple leaf–like pigmentation (*), treelike vascular pattern, and gray-blue ovoid nests in a basal cell carcinoma.

On the left, treelike vessels in a basal cell carcinoma, and, on the right, corona vessels that are thin and curved and are surrounding a sebaceous gland hyperplasia.

On the left, comma-shaped vessels parallel to the skin surface in a dermal nevi. On the right, point vessels in an actinic keratosis.

Linear irregular vessels and pinpoint dots in a malignant melanoma.

Global and local patterns such as additional features in the pattern analysis classification system.

A typical globular pattern in a Clark nevus and the multifaceted colors and structures visible in a microinvasive malignant melanoma according to the pattern analysis classification. CNMD is Consensus Net Meeting on Dermoscopy.

Typical starburst pattern characterized by the presence of pseudopods (streaks) visible at the periphery of the lesion radially distributed in a Reed nevus.

The main patterns in acral lesions: parallel furrow pattern, latticelike pattern, fibrillar pattern, and parallel ridge pattern.

ABCD rule of dermoscopy. Asymmetry and border with relative weight and score.

ABCD rule of dermoscopy. Color and different structures with relative weight and score.

The scoring system developed using the ABDC rule of dermoscopy.

Grading of melanocytic lesions using total dermoscopy score of the ABCD rule of dermoscopy.

Application of ABCD rule of dermoscopy in melanocytic lesions.

Menzies method. Classification system used to make a diagnosis of suspected melanoma.

Application of Menzies method to evaluate the different spectra of melanocytic lesions.

Seven-point checklist uses 7 melanoma-specific criteria: 3 major criteria (score 2 points each) and 4 minor criteria (score 1 point each).

A typical benign melanocytic lesion and a malignant melanoma classified using the 7-point checklist parameters and the relative score.

Stratification of risk levels correlated to the different spectra of melanocytic lesions and relative management.

A low-risk melanocytic lesion with a typical pigment network (Clark nevus) and a very high-risk melanocytic lesion (melanoma) classified using the level of risk stratification method.

More on Dermoscopy

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor