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LIVE BLOG: Dermoscopy: Is It For Me?

In this live blog from the Fall SDPA Confernce in Atlanta, GA, Jennifer Holman, MD, discusses “Dermoscopy: Is It For Me?” She starts with a definition of dermoscopy and highlights some of her favorite things about the practice of using dermoscopes. Be sure to visit to to find some great deals for SDPA members on dermoscopy equipment and other products.


  • Define dermoscopy
  • Explain the applications of dermoscopy
  • Recognize dermoscopy basics
  • Identify dermatoscopic characteristics of melanoma
  • Identify dermatoscopic characteristics of common non-pigmented lesions
  • Investment vs Return

Is Dermoscopy for Me?

Dermoscopy is the examination of skin lesions with a dermatoscope. It is primarily used as a aid to differentiate benign and malignant lesions.

History of Dermoscopy:

  • 1663: Idea introduced by Kolhaus 
  • 1878: Improved by addition of oil immersion by Ernest Abbe
  • 1893: Transferred to skin surface by Unna
  • 1920: Johann Saphier added a built-in light source
  • 1950: Goldman coined the term “dermascopy” and looked at pigmented lesions
  • 1971: Rona MacKie used for diagnosis

Applications for Dermatoscopes:

  • Aid in melanoma diagnosis
  • Monitor pigmented lesions
  • Diagnosis of scabies or pubic lice
  • Wart diagnosis
  • Fungal diagnosis
  • Differentiate and diagnose tinea vs alopecia areata 
  • Trichoscopy
  • Differentiation of various papulosquamous disorders
  • Surgical margin determination 
  • Increase diagnostic accuracy for melanoma
  • Increased sensitivity by 20%
  • Increased specificity by 10%
  • Use of dermoscopy increases clinical diagnostic accuracy between 5 and 30% over clinical visual inspection, based on the type of skin lesion and the experience of the physician

“The evolution of dermoscopy has resulted in the development of a new generation of excellent and more confident clinicians. This ultimately advances our most important goal, namely the provision of the best possible care for our patients!”   – Ashfaq A Marghoob, MD J Am Acad Dermatol 2013;69:814-5

Dermoscopy Basics:

  • Melanocytic lesions are composed of 3 basic structures
  • Pigment Network
  • Dots and Globules
  • Streaks
  • Amorphous Areas
  • Blue Areas

Pigment Network:

  • A delicate regular grid of brownish lines over a light brown background
  • Correlates to rete ridges (pigment) and dermal papillae
  • A pigment network is the hallmark of a melanocytic lesion
  • Reticular Pattern
  • Lattice like structure
  • Localized or Diffuse

Melanocytic: Benign or Not? Things to consider:

  • Color
  • The Tyndall Effect
  • Symmetry
  • Shape
  • Pattern

Mulitple Methods for Dermascopy (is it melanocytic or not):

  • 3 point Rule – see below
  • Menzies Method 
  • 7 point Rule – see below 
  • Pattern Analysis 
  • ABCD 
  • Kittler Method – great, however the base is pattern recognition – look into it if you enjoy dermoscopy

3 point method: 
Scoring: 1 point for each. If you get 2 points then you should biopsy.

  • Asymmetry of color
  • Asymmetry of pattern
  • Blue or white structures

7 point method:
Scoring: majors get 2 points, minors get 1 point – if you get greater than 3 you should biopsy.

Major Criteria 

  • Irregular Pigment Network 
  • Blue White Veil 
  • Irregularvascularity

Minor Criteria 

  • Irregular dots and globules 
  • Irregularstreaks 
  • Irregularblotches 
  • RegressionStructures

Non melanoma lesions:

  • Seborrheic keratosis
  • BCC/pigmented bcc
  • Dermatofibramas

Determinations of non melanoma lesions:

  • No true network/globules
  • Milia like cysts
  • Clods
  • Fat fingers/cerebriform surface
  • Fissures/crypts

Basal cell carcinoma (things to look for):

  • Absence of pigment network
  • Linear and arborizing telangiectasia
  • Leaf like areas (typically more difficult to appreciate)
  • Blue-grey areas

Vascular lesions:

  • Widespread lacunae
  • Hemorrhage (need a history)


Image: Wikimedia Commons

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