Diagnostic Dermoscopy

Jonathan Bowling, MBChB FRCP Consultant Dermatologist, Oxford, UK. John Paoli, Ph.D. Professor, Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; and Consultant Dermatologist, Sahlgrenska University Hospital, Gothenburg, Sweden. Alex Chamberlain, MB BS (Hons) FACD Adjunct Senior Lecturer, Central Clinical School, Monash University; and Specialist Dermatologist, Victorian Melanoma Service, Alfred Health, Prahran, Victoria, Australia.

• Preface xiChapter 1 Introduction 1Introduction 2Dermoscopy and diagnosis 3Dermoscopy principle I – illumination 4Dermoscopy principle II – magnification 5Dermoscopy colours I – eumelanin 6Dermoscopy colours II – non‐eumelanin 7Imaging modes I – colours 8Imaging modes II – structures 9Dermoscopy of normal skin 10Dermoscopy of photodamaged skin 11Vascular morphologies 12Characteristic vascular patterns 13Polarised dermoscopy – shiny white structures 14Chapter 2 Melanocytic naevi 15Early naevi – globular 16Acquired naevi – reticular 17Acquired naevi – homogeneous 18Acquired naevi – evolving 19Acquired naevi in light skin 20Acquired naevi in medium-toned skin 21Atypical melanocytic lesions 22Atypical melanocytic lesions cases 23Dermal naevus – pigmented 24Dermal naevus – hyperpigmented 25Dermal naevus in dark skin 26Combined naevus 27Blue naevus 28Blue naevus – sclerotic/hypochromic 29Recurrent naevus 30Halo naevus 31Congenital naevus 32Agminated naevus and naevus spilus 33Reed naevus I 34Reed naevus II 35Pigmented Spitz naevus 36Hypomelanotic Spitz naevus I 37Hypomelanotic Spitz naevus II 38Chapter 3 MelanomaChapter 3.1 Melanoma – clinical variants 39Small diameter 40Small diameter cases 41Geometric border 42Geometric border cases 43Geographic border 44Geographic border cases 45Disordered polarity 46Disordered polarity cases 47Naevus-associated 48Naevus-associated cases 49Congenital melanocytic naevus-associated 50Chapter 3.2 Melanoma – pigment variants 51Multicoloured 52Multicoloured cases 53Multicomponent 54Multicomponent cases 55Hypermelanotic/hyperpigmented 56Hypermelanotic/hyperpigmented cases 57Amelanotic macules 58Amelanotic macules – cases 59Amelanotic papules 60Amelanotic papules – cases 61Hypomelanotic macules 62Hypomelanotic macules – cases 63Hypomelanotic tan plaques 64Hypomelanotic tan plaques cases 65Chapter 3.3 Melanoma – dermoscopic features 66Features of early melanoma 67Atypical network – focal 68Atypical network – focal cases 69Atypical network – multifocal 70Atypical network – multifocal cases 71Atypical beaded network 72Atypical beaded network cases 73Black dots and globules 74Black dots and globules cases 75Eccentric brown blotch 76Eccentric brown blotch – cases 77Eccentric black blotch 78Eccentric black blotch – cases 79Eccentric grey blotch 80Eccentric grey blotch – cases 81Angulated lines 82Angulated lines cases 83Negative network 84Negative network cases 85Extensive regression 86Extensive regression cases 87Focal regression 88Focal regression cases 89Blue-whitish veil 90Blue-whitish veil cases 91Dermal pigmentation 92Dermal pigmentation cases 93Polymorphous vessels 94Polymorphous vessels cases 95Skin surface markings 96Skin surface markings cases 97Chapter 4 Non- melanocytic lesions 110Macrocomedone 111Solar lentigo – fingerprint pattern 112Solar lentigo – homogeneous pattern 113Solar lentigo – reticular pattern 114Solar lentigo – hyperpigmented ‘ink spot’ 115Solar lentigo – evolving seborrhoeic keratosis 116Seborrhoeic keratosis – cerebriform pattern 117Seborrhoeic keratosis – homogeneous pattern 118Seborrhoeic keratosis – keratotic pattern 119Seborrhoeic keratosis – hyperpigmented 120Seborrhoeic keratosis – hypopigmented 121Seborrhoeic keratosis – irritated 122Seborrhoeic keratosis – traumatised 123Seborrhoeic keratosis – clonal 124Clear cell acanthoma 125Benign lichenoid keratosis – inflammatory phase 126Benign lichenoid keratosis – post-inflammatory phase 127Dermatofibroma 128Dermatofibroma – hypopigmented 129Dermatofibroma – hyperpigmented 130Dermatofibroma – atypical 131Dermatofibrosarcoma protuberans 132Neurofibromas 133Porokeratosis 134Porokeratosis cases 135Epidermal naevus 136Epidermal naevus cases 137Cutaneous T-cell lymphoma 138Pseudolymphoma 139Eccrine poroma 140Chapter 3.4 Melanoma – high-risk scenarios 98Late features of melanoma 99Feature-poor melanoma 100Feature-poor melanoma cases 101Nodular melanoma 102Nodular melanoma cases 103Amelanotic nodular melanoma 104Amelanotic nodular melanoma cases 105Metastatic melanoma 106Metastatic melanoma cases 107Rare melanoma subtypes 108Synchronous melanoma 109Chapter 5 Basal cell carcinoma 141Superficial basal cell carcinoma – pink 142Superficial basal cell carcinoma – pink cases 143Superficial basal cell carcinoma – pigmented 144Superficial basal cell carcinoma – pigmented cases 145Nodular basal cell carcinoma – pink and small 146Nodular basal cell carcinoma – pink and small cases 147Nodular basal cell carcinoma – pigmented and small 148Nodular basal cell carcinoma – pigmented and small cases 149Nodular basal cell carcinoma – pink and large 150Nodular basal cell carcinoma – pink and large cases 151Morphoeic/infiltrative basal cell carcinoma 152Morphoeic/infiltrative basal cell carcinoma cases 153basal cell carcinoma 154Hyperpigmented basal cell carcinoma 155Seborrhoeic keratosis-like basal cell carcinoma 156Fibroepithelioma of Pinkus 157Chapter 6 Keratinocyte dysplasia 158Actinic keratosis grade I 159Actinic keratosis grade II 160Actinic keratosis grade III 161Actinic keratosis – follicular hyperkeratosis 162Bowen’s disease – classical 163Bowen’s disease – hypertrophic 164Bowen’s disease – pigmented 165Bowen’s disease – digital 166Squamous cell carcinoma – white circles 167Squamous cell carcinoma – keratoacanthoma 168Squamous cell carcinoma – moderately differentiated 169Squamous cell carcinoma – ulcerated 170Squamous cell carcinoma – poorly differentiated 171Chapter 7 Special sites Periungual warts 194Onychomycosis 195Chloronychia – green nails 196Nail pigmentation – exogenous 197Capillaroscopy 198Chapter 7.3 Facial lesions 199Venous lake 200Mucosal melanosis 201Milium/keratin cyst 202Hidrocystoma 203Epidermoid cysts 204Pilomatricoma 205Sebaceous hyperplasia 206Sebaceous adenoma 207Sebaceous naevus 208Malignant adnexal carcinomas 209Juvenile xanthogranuloma 210Granulomatous folliculitis 211Fibrous papule 212Trichilemmoma 213Chapter 7.1 Acral melanocytic lesions 172 Dermal naevus 214Acquired acral naevi 173Dermal naevus cases 215Acral parallel furrow pattern 174Solar lentigo – fingerprinting 216Acral lattice pattern 175Solar lentigo – homogeneous pigmentation 217Acral fibrillar pattern 176Solar lentigo – moth-eaten border 218Congenital acral naevus 177Ink spot lentigo 219Acral lentiginous melanoma 178Benign lichenoid keratosis 220Acral lentiginous melanoma cases 179Benign lichenoid keratosis – post-inflammation phase 221ALM – brown-grey pigmentation 180Lentigo maligna 222ALM – brown-grey pigmentation cases 181Lentigo maligna – annular granular pigmentation 223Advanced acral lentiginous melanoma 182Lentigo maligna – circles 224Lentigo maligna – perifollicular pigmentation 225Lentigo maligna – young adults 226Chapter 7.2 Onychoscopy 183 Lentigo maligna melanoma – I 227Nail matrix naevi 184Lentigo maligna melanoma – II 228Nail apparatus melanoma in situ 185Early invasive nail apparatus melanoma 186Advanced nail apparatus melanoma – pigmented 187 Chapter 7.4 Scalp lesions 229Advanced nail apparatus melanoma – non-pigmented 188 Scalp naevus – dermal 230Nail apparatus squamous cell carcinoma 189Scalp naevus – junctional 231Erythronychia 190Scalp naevus – blue 232Onychopapilloma 191 Scalp naevus – reticular homogeneous 233Subungual haematoma 192 Scalp seborrhoeic keratosis 234Subungual haematoma cases 193 Scalp seborrhoeic keratosis cases 235Scalp melanoma – thin 236Scalp melanoma – thin cases 237Scalp melanoma – thick 238Scalp metastases 239Scalp basal cell carcinoma 240Scalp basal cell carcinoma cases 241Scalp B-cell lymphoma 242Scalp cylindromas/spiradenomas 243Scalp sarcoidosis 244Chapter 7.5 Trichoscopy 245Alopecia areata 246Androgenetic alopecia 247Frontal fibrosing alopecia 248Lichen planopilaris 249Discoid lupus erythematosus 250Tufted folliculitis 251Steroid-induced telangiectasia 252Pseudopelade 253Circle hairs 254Trichostasis spinulosa 255Picker’s nodule 256Traction/frictional alopecia 257Pseudonits 258Chapter 8 Vascular lesions 259Telangiectasia 260Spider telangiectasia 261Subcorneal haematoma – parallel pattern 262Subcorneal haematoma – parallel pattern cases 263Subcorneal haematoma – homogeneous pattern 264Subcorneal haematoma – homogeneous pattern cases 265Haemangiomas – red 266Haemangiomas – purple 267Angiokeratomas 268Lymphangiomas 269Pyogenic granulomas 270Pyogenic granulomas – acral cases 271Vascular tumours 272Purpura – traumatic 273Chapter 9 Inflammoscopy 274Mastocytosis 275Acne 276Rosacea 277Eczema 278Psoriasis 279Lichen planus 280Lichen planus pigmentosus 281Capillaritis 282Vasculitis 283Granulomatous conditions 284Granuloma annulare 285Tinea corporis 286Pityriasis rosea 287Cutaneous lupus erythematosus 288Chapter 10 Genodermatoses 289Gorlin syndrome 290Cowden syndrome 291Birt-Hogg-Dubé syndrome 292Familial cylindromatosis syndrome 293Muir-Torre syndrome 294Reed syndrome 295Familial melanoma 296Carney complex 297Chapter 11 Entomodermoscopy 298Delusional parasitosis 299Scabies – Sarcoptes scabiei 300Scabies cases 301Head lice – Pediculosis capitis 302Bed bugs – Cimex lectularius 303Tick bites – Ixodidae 304Leishmaniasis 305Molluscum contagiosum 306Viral warts – Verrucae vulgaris 307Sea urchin – Echinoidea 308Jellyfish – Cnidaria 309Tungiasis – Tunga penetrans 310Myiasis – Dermatobia hominis 311Chapter 12 Miscellaneous 312Keloids and hypertrophic scars 313Foreign body 314Foreign body cases 315Exogenous pigmentation 316Exogenous pigmentation cases 317Laser 318Cryotherapy 319Radiotherapy 320Index 321