Applied Evidence

Dermoscopy in family medicine: A primer

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Sebaceous hyperplasia is the overgrowth of sebaceous glands. It can mimic BCC on the face. Sebaceous hyperplasia presents with multiple vessels in a crown-like arrangement that do not cross the center of the lesion. The sebaceous glands resemble popcorn (FIGURE 8).

Sebaceous hyperplasia

Clear-cell acanthoma is a benign erythematous epidermal tumor usually found on the leg with a string-of-pearls pattern. This pattern is vascular so the pearls are red in color (FIGURE 9).

Clear-cell acanthoma with string-of-pearls vessels

Malignant nonmelanocytic lesions

BCC is the most common type of skin cancer. Features often include:

  • spoke-wheel-like structures or concentric structures (FIGURE 10A)
  • leaf-like areas (FIGURE 10B)
  • arborizing vessels (FIGURE 10b and 10C)large blue-gray ovoid nest (FIGURE 10A)
  • multiple blue-gray non-aggregated globules
  • ulceration or multiple small erosions
  • shiny white structures and strands (FIGURE 10C).
Basal cell carcinomas

Additional dermoscopic clues include short, fine, superficial telangiectasias and multiple in-focus dots in a buck-shot scatter distribution.

Squamous cell carcinomas (SCCs) of the skin are keratinizing malignant tumors. Each SCC generally has some of the following features (FIGURE 11):

  • dotted and/or glomerular vessels, commonly distributed focally at the periphery. They can also be diffuse or aligned linearly within the lesion.
  • scale (yellow or white)
  • rosettes (seen with polarized light)
  • white circles or keratin pearls
  • brown circles
  • ulcerations
  • brown dots or globules arranged in a linear configuration.
Squamous cell carcinoma in situ with dotted vessels

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