4 курс / Дерматовенерология / Дерматоскопия (3)

320

Cases

Table 10.6

Pattern

Color

Clues

Dermatoscopic

Histopathologic

diagnosis

diagnosis

Top

More than one

More than one

None

Clark nevus or

Clark nevus

pattern (structureless

color, central

"superficial"

in the center, reticular

hyperpigmentation

congenital nevus

and dots in the

periphery). The

patterns are arranged

symmetrically (no

chaos).

Middle

More than one

More than one

None. The dots in the

Clark nevus

Clark nevus

pattern (reticular

color, eccentric

periphery are brown

and dots), arranged

hyperpigmentation

and not black.

asymmetrically

(chaotic)

Bottom

One pattern (reticular)

One color (brown)

None

Clark nevus

Clark nevus

322

Cases

Table 10.7

Pattern

Color

Clues

Dermatoscopic

Histopathologic

diagnosis

diagnosis

Top

More than one pattern

More than one color,

Thin reticular lines

Dermatofibroma

Not excised

(structureless in the

white in the center

in the periphery and

center, reticular in

a white structureless

the periphery). The

center are a clue to

patterns are arranged

dermatofibroma.

symmetrically (no

chaos).

Middle

More than one

More than one

Clue to melanoma:

Melanoma or

Combined congenital

pattern (clods and

color, eccentric

Eccentric structureless

melanoma in

nevus

structureless), arranged

hyperpigmentation

area

association with

asymmetrically

a nevus

(chaotic)

Bottom

One pattern (circles)

Brown (not gray or

Clue to seborrheic

Seborrheic keratosis or

Seborrheic keratosis

black)

keratosis: Some circles

solar lentigo

are "distorted", i.e.

they appear oval or

even polygonal (see

also figure 7.4 for

higher magnification)

324

Cases

Table 10.8

Pattern

Color

Clues

Dermatoscopic

Histopathologic

diagnosis

diagnosis

Top

More than one pattern

Brown

Discrete circles and

Seborrheic keratosis

Seborrheic keratosis

(clods and curved

curved lines are clues

lines). The few circles

to seborrheic keratosis

were not counted as a

pattern. If the circles

are regarded as an

additional pattern the

diagnosis would be the

same.

Middle

One pattern (reticular)

One color (brown)

None

Clark nevus

Not excised but no

change during follow-

up therefore Clark

nevus

Bottom

One pattern

More than one

Polymorphous vascular

Melanoma (a basal

Melanoma (invasion

(structureless)

color, melanin (blue

pattern, gray and blue

cell carcinoma does

thickness > 1 mm)

and gray), the

structures

not occur on acral

colors are arranged

skin)

asymmetrically (chaos)

326

Cases

Table 10.9

Pattern

Color

Clues

Dermatoscopic

Histopathologic

diagnosis

diagnosis

Top

One pattern (reticular)

One color (brown)

None

Clark nevus or

Not excised but no

"superficial"

change during follow-

congenital nevus

up

Middle

One pattern (reticular)

Variegate

Terminal hairs are a

"Superficial" or

"Superficial and deep"

clue to a congenital

"superficial and deep"

congenital nevus

nevus. No clue to

congenital nevus

melanoma.

Bottom

More than one

Structureless = brown

White clods are a clue

Seborrheic keratosis

Seborrheic keratosis

pattern (clods and

Clods = white

to seborrheic keratosis

structureless)

328

Cases

Table 10.10

Pattern

Color

Clues

Dermatoscopic

Histopathologic

diagnosis

diagnosis

Top

More than one

Brown and black

Clues to melanoma:

Melanoma

Melanoma

pattern (clods and

Pseudopods in the

structureless). The

periphery, black clods

patterns are arranged

in the periphery

asymmetrically

(chaos).

Middle

One pattern (clods)

Brown and gray

Discrete orange and

Seborrheic keratosis

Seborrheic keratosis,

yellow clods and sharp

with unconventional

clonal type

circumscription point to

criteria (gray clods

a seborrheic keratosis

are rarely found in a

seborrheic keratosis)

Bottom

One pattern (large

Skin colored and light

Curved vessels in the

Unna nevus (in

Unna nevus (in

polygonal clods)

brown

center of skin colored

combination with a

combination with a

clods. Hyperkeratotic

viral wart)

viral wart)

zone at 3 o’clock.