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 septae | 72.7% | — |
| Blue-black coloring in lacunae (when thrombosed) in absence of other structures | 72.7% | — |
| Seborrheic keratosis (level 1) | ||
| Milia-like cysts (cloudy or starry) and comedo-like openings | 93.9% | — |
| “Fissures and ridges”/“gyri and sulci”/cerebriform pattern | 93.9% | — |
| Moth-eaten (sharply demarcated) borders | 87.9% | — |
| Fat fingers | 78.8% | — |
| Fingerprint-like structures (parallel lines) | 78.8% | — |
| Hairpin (looped) vessels | 78.8% | — |
| Dermatofibroma (level 1) | ||
| Central scar-like white patch/depigmentation | 100.0% | — |
| Fine/delicate surrounding/peripheral network-like structures | 100.0% | — |
| Central shiny white lines/streaks under polarized dermoscopy | 84.8% | — |
| Ring-like globules | 66.7% | ↓ 60.0% |
| Solar lentigo (level 1) | ||
| Moth-eaten (sharply demarcated) borders | 90.9% | — |
| Fingerprint-like structures (parallel lines) | 90.9% | — |
| Homogenous light brown pigmentation | 87.9% | — |
| Uniform brown perifollicular pigmentation | 75.8% | — |
| Network-like structures | 63.6% | ↓ 63.3% |
| Basal cell carcinoma (level 1) | ||
| Arborizing vessels | 97.0% | — |
| Ulceration/erosion | 93.9% | — |
| Leaf-like structures/areas | 90.9% | — |
| Blue-gray ovoid nests | 87.9% | — |
| Spoke-wheel-like structures/areas/concentric structures | 87.9% | — |
| Multiple blue-gray dots and globules (buckshot scatter) | 84.8% | — |
| Shiny white blotches and strands/structures under polarized dermoscopy | 69.7% | ↑ 76.7% |
| Short fine telangiectasias (superficial BCC) | 69.7% | ↑ 70.0% |
| Squamous cell carcinoma (level 1) | ||
| Yellow keratin mass/scale-crust | 100.0% | — |
| Ulceration/blood spots/hemorrhage | 93.9% | — |
| White circles (“keratin pearls”) | 90.9% | — |
| Glomerular (coiled) vessels | 90.9% | — |
| Hairpin vessels | 78.8% | — |
| Rosettes | 75.8% | — |
| Actinic keratosis (level 1) | ||
| Surface scale | 97.0% | — |
| Rosettes | 81.8% | — |
| 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 opening | 100.0% | — |
| Crown vessels, out of focus | 90.9% | — |
| Pigmented actinic keratosis (level 2) | ||
| Surface scale | 90.9% | — |
| Rosettes | 75.8% | — |
| Annular-granular pattern (gray dots around follicular openings) | 66.7% | ↓ 53.3% |
| Red pseudonetwork† | 57.6% | — |
| Patent/evident follicles† | 57.6% | — |
| Squamous cell carcinoma in situ (level 2) | ||
| Irregularly arranged glomerular (coiled)/dotted vessels | 93.9% | — |
| Surface scale | 87.9% | — |
| Keratoacanthoma (level 2) | ||
| Central keratin mass | 93.9% | — |
| Hairpin (looped) or serpentine (linear-irregular) vessels, usually at the periphery, with white-yellow halo | 87.9% | — |
| Angiokeratoma (level 2) | ||
| Red/purple/black (“dark”) lacunae | 93.9% | — |
| Hemorrhagic crust | 75.8% | — |
| Lichen planus-like keratosis (level 2) | ||
| Features of a lentigo or seborrheic keratosis in an area | 72.7% | — |
| Peppering (evenly spaced gray dots) | 69.7% | ↓ 63.3% |
| Sharp cut-off borders (scalloped/moth-eaten) | 69.7% | ↓ 63.3% |
| Coarse gray granularity | 63.6% | ↓ 53.3% |
| Ink spot lentigo (level 2) | ||
| Prominent dark homogenous (uniform) reticular network | 93.9% | — |
| Chicken-wire fence | 63.6% | ↓ 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).