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- Presentation
Common Dermatoscopic Features of Melanoma
Description
This lecture reviews common dermatoscopic features of melanoma and emphasizes that dermatoscopy improves both early detection and specificity by reducing unnecessary biopsies, but findings must always be interpreted in clinical context. The speaker outlines a classic two-step approach: first determine whether a lesion is melanocytic, then decide if it is benign, malignant, or indeterminate. Key melanoma-associated patterns discussed include atypical pigment network, prominent skin markings, irregular dots and globules, irregular blotches, shiny white structures, blue-white veil, regression structures such as peppering and scar-like depigmentation, asymmetric streaks and pseudopods, angulated lines, negative network, and atypical vascular patterns. Throughout the talk, examples show that some lesions appear clinically suspicious despite subtle dermatoscopic findings, while others look benign clinically but reveal concerning dermatoscopic features that prompt biopsy. The presenter stresses that no single feature is definitive on its own, that benign and malignant lesions can share overlapping patterns, and that clinicians should consider lesion evolution, body site, sun damage, age, and overall appearance when deciding management. The lecture concludes by reminding clinicians to examine many lesions, avoid overreliance on pathology alone in very thin or clinically benign-appearing lesions, and use dermatoscopy as an adjunct to careful clinical judgment.
View moreConclusions
- Dermatoscopy improves melanoma detection by increasing sensitivity and reducing unnecessary biopsies, but it must always be interpreted in clinical context.
- No single dermatoscopic feature is definitive on its own; the overall lesion pattern and the clinical appearance together drive management.
- An atypical pigment network is one of the most important signs of melanoma, especially when it is asymmetric, chaotic, or combined with other suspicious structures.
- Atypical dots, globules, blotches, streaks, and negative network are important warning signs when they are focal, irregular, and asymmetrically distributed.
- Shiny white structures and blue-white/gray veils are concerning for melanoma, especially when lesions are raised or invasive.
- Regression structures such as peppering and scar-like depigmentation add suspicion for melanoma, particularly in flat or macular areas.
- Angulated lines, rhomboids, and other geometric patterns are associated with chronically sun-damaged skin and can be highly suspicious for lentigo maligna or lentigo maligna melanoma.
- A negative network has relatively good observer agreement and is strongly associated with melanoma when present focally, especially in melanomas arising in nevi.
- Atypical vascular patterns can support the diagnosis of melanoma, but they are not specific on their own.
- Because thin and early melanomas can be subtle and pathology agreement can be low for small flat lesions, clinicians should maintain a low threshold for biopsy and skepticism when the clinical picture and pathology seem discordant.
- Marghoob, Nadeem & Liopyris, Konstantinos & Jaimes, Natalia. (2019). Dermoscopy: A Review of the Structures That Facilitate Melanoma Detection. The Journal of the American Osteopathic Association. 119. 380-390. 10.7556/jaoa.2019.067.#10.7556/jaoa.2019.067
- Kittler et al, JAAD 2016.
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- Prominent Skin Markings: A New Reason to Suspect Melanoma.#10.1016/j.adengl.2021.02.004