Table 3.

Dermoscopic Characteristics of Nonmelanocytic Lesions

Diagnosis (Level 1 or 2)
Feature included as a learning objective (>70% positive responses)
Round 1: % Positive Responses* (n = 33)Round 2: % Positive Responses* (n = 30)
Hemangioma (level 1)
Red, blue-red, red-purple, or maroon lacunae/lagoons with white septae72.7%
Blue-black coloring in lacunae (when thrombosed) in absence of other structures72.7%
Seborrheic keratosis (level 1)
Milia-like cysts (cloudy or starry) and comedo-like openings93.9%
“Fissures and ridges”/“gyri and sulci”/cerebriform pattern93.9%
Moth-eaten (sharply demarcated) borders87.9%
Fat fingers78.8%
Fingerprint-like structures (parallel lines)78.8%
Hairpin (looped) vessels78.8%
Dermatofibroma (level 1)
Central scar-like white patch/depigmentation100.0%
Fine/delicate surrounding/peripheral network-like structures100.0%
Central shiny white lines/streaks under polarized dermoscopy84.8%
 Ring-like globules66.7%↓ 60.0%
Solar lentigo (level 1)
Moth-eaten (sharply demarcated) borders90.9%
Fingerprint-like structures (parallel lines)90.9%
Homogenous light brown pigmentation87.9%
Uniform brown perifollicular pigmentation75.8%
 Network-like structures63.6%↓ 63.3%
Basal cell carcinoma (level 1)
Arborizing vessels97.0%
Ulceration/erosion93.9%
Leaf-like structures/areas90.9%
Blue-gray ovoid nests87.9%
Spoke-wheel-like structures/areas/concentric structures87.9%
Multiple blue-gray dots and globules (buckshot scatter)84.8%
Shiny white blotches and strands/structures under polarized dermoscopy69.7%↑ 76.7%
Short fine telangiectasias (superficial BCC)69.7%↑ 70.0%
Squamous cell carcinoma (level 1)
Yellow keratin mass/scale-crust100.0%
Ulceration/blood spots/hemorrhage93.9%
White circles (“keratin pearls”)90.9%
Glomerular (coiled) vessels90.9%
Hairpin vessels78.8%
Rosettes75.8%
Actinic keratosis (level 1)
Surface scale97.0%
Rosettes81.8%
Strawberry pattern (pink-red pseudonetwork ± fine wavy vessels [straight or coiled] surrounding  hair follicles ± white circles with central yellow clod [targetoid hair follicles])78.8%
Sebaceous hyperplasia (level 2)
Pale yellow lobules (popcorn-like structures) around a central follicular opening100.0%
Crown vessels, out of focus90.9%
Pigmented actinic keratosis (level 2)
Surface scale90.9%
Rosettes75.8%
 Annular-granular pattern (gray dots around follicular openings)66.7%↓ 53.3%
 Red pseudonetwork57.6%
 Patent/evident follicles57.6%
Squamous cell carcinoma in situ (level 2)
Irregularly arranged glomerular (coiled)/dotted vessels93.9%
Surface scale87.9%
Keratoacanthoma (level 2)
Central keratin mass93.9%
Hairpin (looped) or serpentine (linear-irregular) vessels, usually at the periphery, with white-yellow  halo87.9%
Angiokeratoma (level 2)
Red/purple/black (“dark”) lacunae93.9%
Hemorrhagic crust75.8%
Lichen planus-like keratosis (level 2)
Features of a lentigo or seborrheic keratosis in an area72.7%
 Peppering (evenly spaced gray dots)69.7%↓ 63.3%
 Sharp cut-off borders (scalloped/moth-eaten)69.7%↓ 63.3%
 Coarse gray granularity63.6%↓ 53.3%
Ink spot lentigo (level 2)
Prominent dark homogenous (uniform) reticular network93.9%
 Chicken-wire fence63.6%↓ 50.0%
  • * % of panelists who indicated on a 5-point Likert scale that they “strongly agree” (5) or “agree” (4) with the feature being included in dermoscopy training for primary care providers.

  • Suggested by a panelist during round 1 of the features survey series.

  • Abbreviations: BCC, basal cell carcinoma; SCCIS, squamous cell carcinoma in situ (Bowen’s disease).