Dermoscopy and dermatopathology correlates of cutaneous neoplasms

Published:October 12, 2018DOI:https://doi.org/10.1016/j.jaad.2018.07.073
      Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc) to inform clinical management decisions. Dermoscopic findings or images provided to pathologists offer important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form provide little value to pathologists. Most dermoscopic structures have direct histopathologic correlates, and therefore dermoscopy can act as an excellent communication bridge between the clinician and the pathologist. In the first article in this continuing medical education series, we review dermoscopic features and their histopathologic correlates.

      Key words

      Abbreviations used:

      AK (actinic keratosis), BCC (basal cell carcinoma), DEJ (dermoepidermal junction), IDS (International Dermoscopy Society), LM (lentigo maligna), LPLK (lichen planus–like keratosis), SCC (squamous cell carcinoma), SK (seborrheic keratosis)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bernhardt M.S.
        The history of dermatopathology.
        JAMA Dermatol. 2013; 149: 1140
        • Argenziano G.
        • Puig S.
        • Zalaudek I.
        • et al.
        Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer.
        J Clin Oncol. 2006; 24: 1877-1882
        • Rosendahl C.
        • Cameron A.
        • McColl I.
        • et al.
        Dermatoscopy in routine practice – ‘chaos and clues’.
        Aust Fam Physician. 2012; 41: 482-487
        • Kittler H.
        • Marghoob A.A.
        • Argenziano G.
        • et al.
        Standardization of terminology in dermoscopy/dermatoscopy: results of the third consensus conference of the International Society of Dermoscopy.
        J Am Acad Dermatol. 2016; 74: 1093-1106
        • Kittler H.
        • Braun R.
        Terminology.
        (Available at:) (Accessed Febrary 25, 2018)
        • Marghoob A.A.
        • Braun R.P.
        • Malvehy J.
        Atlas of Dermoscopy.
        2nd ed. Informa Healthcare, New York2012
        • Woltsche N.
        • Schmid-Zalaudek K.
        • Deinlein T.
        • et al.
        Abundance of the benign melanocytic universe: dermoscopic-histopathological correlation in nevi.
        J Dermatol. 2017; 44: 499-506
        • Zalaudek I.
        • Docimo G.
        • Argenziano G.
        Using dermoscopic criteria and patient-related factors for the management of pigmented melanocytic nevi.
        Arch Dermatol. 2009; 145: 816-826
        • Malvehy J.
        Handbook of Dermoscopy.
        Informa Healthcare, London2006
        • Braun R.
        • Kerl K.
        Histopathologic correlation of dermoscopic structures.
        (Available at:)
        • Jaimes N.
        • Braun R.P.
        • Stolz W.
        • et al.
        White globules correlate with balloon cell nevi nests.
        J Am Acad Dermatol. 2011; 65: e119-e120
        • Banuls J.
        • Arribas P.
        • Berbegal L.
        • et al.
        Yellow and orange in cutaneous lesions: clinical and dermoscopic data.
        J Eur Acad Dermatol Venereol. 2015; 29: 2317-2325
        • Neitz J.
        • Jacobs G.H.
        Polymorphism in normal human color vision and its mechanism.
        Vis Res. 1990; 30: 621-636
        • Bajaj S.
        • Marchetti M.A.
        • Navarrete-Dechent C.
        • et al.
        The role of color and morphologic characteristics in dermoscopic diagnosis.
        JAMA Dermatol. 2016; 152: 676-682
        • Chen L.L.
        • Dusza S.W.
        • Jaimes N.
        • et al.
        Performance of the first step of the 2-step dermoscopy algorithm.
        JAMA Dermatol. 2015; 151: 715-721
        • Argenziano G.
        • Soyer H.P.
        • Chimenti S.
        • et al.
        Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet.
        J Am Acad Dermatol. 2003; 48: 679-693
        • Zaballos P.
        • Puig S.
        • Llambrich A.
        • et al.
        Dermoscopy of dermatofibromas: a prospective morphological study of 412 cases.
        Arch Dermatol. 2008; 144: 75-83
        • Argenziano G.
        Dermoscopy of melanocytic hyperplasias: subpatterns of lentigines (ink spot).
        Arch Dermatol. 2004; 140: 776
        • Blum A.
        • Roehm S.
        Accessory nipple looks like dermatofibroma in dermoscopy.
        Arch Dermatol. 2003; 139: 948-949
        • Scope A.
        • Benvenuto-Andrade C.
        • Agero A.L.
        • et al.
        Nonmelanocytic lesions defying the two-step dermoscopy algorithm.
        Dermatol Surg. 2006; 32: 1398-1406
        • De Giorgi V.
        • Massi D.
        • Stante M.
        • et al.
        False “melanocytic” parameters shown by pigmented seborrheic keratoses: a finding which is not uncommon in dermoscopy.
        Dermatol Surg. 2002; 28: 776-779
        • Longo C.
        • Zalaudek I.
        • Moscarella E.
        • et al.
        Clonal seborrheic keratosis: dermoscopic and confocal microscopy characterization.
        J Eur Acad Dermatol Venereol. 2014; 28: 1397-1400
        • Navarrete-Dechent C.
        • Bajaj S.
        • Marchetti M.A.
        • et al.
        Association of shiny white blotches and strands with nonpigmented basal cell carcinoma: evaluation of an additional dermoscopic diagnostic criterion.
        JAMA Dermatol. 2016; 152: 546-552
        • Rishpon A.
        • Marghoob A.
        Exceptions to the algorithm.
        (Available at:)
        • Massi D.
        • De Giorgi V.
        • Soyer H.P.
        Histopathologic correlates of dermoscopic criteria.
        Dermatol Clin. 2001; 19: 259-268
        • Russo T.
        • Piccolo V.
        • Ferrara G.
        • et al.
        Dermoscopy pathology correlation in melanoma.
        J Dermatol. 2017; 44: 507-514
        • Pizzichetta M.A.
        • Canzonieri V.
        • Soyer P.H.
        • et al.
        Negative pigment network and shiny white streaks: a dermoscopic-pathological correlation study.
        Am J Dermatopathol. 2014; 36: 433-438
        • Pizzichetta M.A.
        • Talamini R.
        • Marghoob A.A.
        • et al.
        Negative pigment network: an additional dermoscopic feature for the diagnosis of melanoma.
        J Am Acad Dermatol. 2013; 68: 552-559
        • Bassoli S.
        • Ferrari C.
        • Borsari S.
        • et al.
        Negative pigment network identifies a peculiar melanoma subtype and represents a clue to melanoma diagnosis: a dermoscopic study of 401 melanomas.
        Acta Derm Venereol. 2013; 93: 650-655
        • Shitara D.
        • Nascimento M.
        • Ishioka P.
        • et al.
        Dermoscopy of naevus-associated melanomas.
        Acta Derm Venereol. 2015; 95: 671-675
        • Schiffner R.
        • Schiffner-Rohe J.
        • Vogt T.
        • et al.
        Improvement of early recognition of lentigo maligna using dermatoscopy.
        J Am Acad Dermatol. 2000; 42: 25-32
        • Slutsky J.B.
        • Marghoob A.A.
        The zig-zag pattern of lentigo maligna.
        Arch Dermatol. 2010; 146: 1444
        • Jaimes N.
        • Marghoob A.A.
        • Rabinovitz H.
        • et al.
        Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin.
        J Am Acad Dermatol. 2015; 72: 1027-1035
        • Vanden Daelen A.
        • Ferreira I.
        • Marot L.
        • et al.
        A digital dermoscopy follow-up illustration and a histopathologic correlation for angulated lines in extrafacial lentigo maligna.
        JAMA Dermatol. 2016; 152: 200-203
      1. Yélamos O, Navarrete-Dechent C, Marchetti MA, et al. Clinical and dermoscopic features of cutaneous BAP1 inactivated melanocytic tumors: results of a multicenter case-control study by the International Dermoscopy Society (IDS). J Am Acad Dermatol. https://doi.org/10.1016/j.jaad.2018.09.014. Published online September 20, 2018.

        • Braun R.P.
        • Rabinovitz H.S.
        • Oliviero M.
        • et al.
        Dermoscopy of pigmented skin lesions.
        J Am Acad Dermatol. 2005; 52: 109-121
        • Ishihara Y.
        • Saida T.
        • Miyazaki A.
        • et al.
        Early acral melanoma in situ: correlation between the parallel ridge pattern on dermoscopy and microscopic features.
        Am J Dermatopathol. 2006; 28: 21-27
        • Okamoto N.
        • Aoto T.
        • Uhara H.
        • et al.
        A melanocyte–melanoma precursor niche in sweat glands of volar skin.
        Pigment Cell Melanoma Res. 2014; 27: 1039-1050
        • Lallas A.
        • Tschandl P.
        • Kyrgidis A.
        • et al.
        Dermoscopic clues to differentiate facial lentigo maligna from pigmented actinic keratosis.
        Br J Dermatol. 2016; 174: 1079-1085
        • Tschandl P.
        • Rosendahl C.
        • Kittler H.
        Dermatoscopy of flat pigmented facial lesions.
        J Eur Acad Dermatol Venereol. 2015; 29: 120-127
        • Gomez-Martin I.
        • Moreno S.
        • Andrades-Lopez E.
        • et al.
        Histopathologic and immunohistochemical correlates of confocal descriptors in pigmented facial macules on photodamaged skin.
        JAMA Dermatol. 2017; 153: 771-780
        • Nascimento M.M.
        • Shitara D.
        • Enokihara M.M.
        • et al.
        Inner gray halo, a novel dermoscopic feature for the diagnosis of pigmented actinic keratosis: clues for the differential diagnosis with lentigo maligna.
        J Am Acad Dermatol. 2014; 71: 708-715
        • Yelamos O.
        • Merkel E.A.
        • Sholl L.M.
        • et al.
        Nonoverlapping clinical and mutational patterns in melanomas from the female genital tract and atypical genital nevi.
        J Invest Dermatol. 2016; 136: 1858-1865
      2. NIH Consensus conference. Diagnosis and treatment of early melanoma.
        JAMA. 1992; 268: 1314-1319
        • Lin J.
        • Koga H.
        • Takata M.
        • et al.
        Dermoscopy of pigmented lesions on mucocutaneous junction and mucous membrane.
        Br J Dermatol. 2009; 161: 1255-1261
        • Ferrari A.
        • Agozzino M.
        • Ardigo M.
        • et al.
        Dermoscopic and confocal microscopy patterns of vulvar mucosal melanotic macules.
        J Am Acad Dermatol. 2014; 70: e81-e82
        • Ferrari A.
        • Buccini P.
        • Covello R.
        • et al.
        The ringlike pattern in vulvar melanosis: a new dermoscopic clue for diagnosis.
        Arch Dermatol. 2008; 144: 1030-1034
        • Blum A.
        • Simionescu O.
        • Argenziano G.
        • et al.
        Dermoscopy of pigmented lesions of the mucosa and the mucocutaneous junction: results of a multicenter study by the International Dermoscopy Society (IDS).
        Arch Dermatol. 2011; 147: 1181-1187
        • Matsushita S.
        • Kageshita T.
        • Ishihara T.
        Comparison of dermoscopic and histopathological findings in a mucous melanoma of the lip.
        Br J Dermatol. 2005; 152: 1324-1326
        • Rogers T.
        • Pulitzer M.
        • Marino M.L.
        • et al.
        Early diagnosis of genital mucosal melanoma: how good are our dermoscopic criteria?.
        Dermatol Pract Concept. 2016; 6: 43-46
        • Betti R.
        • Menni S.
        • Crosti C.
        Melanoma of the glans penis.
        Eur J Dermatol. 2005; 15: 113-115
        • Cooper C.
        • Arva N.C.
        • Lee C.
        • et al.
        A clinical, histopathologic, and outcome study of melanonychia striata in childhood.
        J Am Acad Dermatol. 2015; 72: 773-779
        • Braun R.P.
        • Baran R.
        • Le Gal F.A.
        • et al.
        Diagnosis and management of nail pigmentations.
        J Am Acad Dermatol. 2007; 56: 835-847
        • Braun R.P.
        • Baran R.
        • Saurat J.H.
        • et al.
        Surgical pearl: dermoscopy of the free edge of the nail to determine the level of nail plate pigmentation and the location of its probable origin in the proximal or distal nail matrix.
        J Am Acad Dermatol. 2006; 55: 512-513
        • Lallas A.
        • Apalla Z.
        • Ioannides D.
        • et al.
        Dermoscopy in the diagnosis and management of basal cell carcinoma.
        Future Oncol. 2015; 11: 2975-2984
        • Segura S.
        • Puig S.
        • Carrera C.
        • et al.
        Dendritic cells in pigmented basal cell carcinoma: a relevant finding by reflectance-mode confocal microscopy.
        Arch Dermatol. 2007; 143: 883-886
        • Menzies S.W.
        • Westerhoff K.
        • Rabinovitz H.
        • et al.
        Surface microscopy of pigmented basal cell carcinoma.
        Arch Dermatol. 2000; 136: 1012-1016
        • Zalaudek I.
        • Giacomel J.
        • Argenziano G.
        • et al.
        Dermoscopy of facial nonpigmented actinic keratosis.
        Br J Dermatol. 2006; 155: 951-956
        • Rosendahl C.
        • Cameron A.
        • Argenziano G.
        • et al.
        Dermoscopy of squamous cell carcinoma and keratoacanthoma.
        Arch Dermatol. 2012; 148: 1386-1392
        • Cameron A.
        • Rosendahl C.
        • Tschandl P.
        • et al.
        Dermatoscopy of pigmented Bowen’s disease.
        J Am Acad Dermatol. 2010; 62: 597-604
        • Braun R.P.
        • Scope A.
        • Marghoob A.A.
        The “blink sign” in dermoscopy.
        Arch Dermatol. 2011; 147: 520
        • Minagawa A.
        Dermoscopy-pathology relationship in seborrheic keratosis.
        J Dermatol. 2017; 44: 518-524
        • Yadav S.
        • Vossaert K.A.
        • Kopf A.W.
        • et al.
        Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy).
        Am J Dermatopathol. 1993; 15: 297-305
        • Stoecker W.V.
        • Gupta K.
        • Stanley R.J.
        • et al.
        Detection of asymmetric blotches (asymmetric structureless areas) in dermoscopy images of malignant melanoma using relative color.
        Skin Res Technol. 2005; 11: 179-184
        • Kilinc Karaarslan I.
        • Teban L.
        • Dawid M.
        • et al.
        Changes in the dermoscopic appearance of melanocytic naevi after photochemotherapy or narrow-band ultraviolet B phototherapy.
        J Eur Acad Dermatol Venereol. 2007; 21: 526-531
        • Guillod J.F.
        • Skaria A.M.
        • Salomon D.
        • et al.
        Epiluminescence videomicroscopy: black dots and brown globules revisited by stripping the stratum corneum.
        J Am Acad Dermatol. 1997; 36: 371-377
        • Zalaudek I.
        • Argenziano G.
        • Ferrara G.
        • et al.
        Clinically equivocal melanocytic skin lesions with features of regression: a dermoscopic-pathological study.
        Br J Dermatol. 2004; 150: 64-71
        • Botella-Estrada R.
        • Requena C.
        • Traves V.
        • et al.
        Chrysalis and negative pigment network in Spitz nevi.
        Am J Dermatopathol. 2012; 34: 188-191
        • Balagula Y.
        • Braun R.P.
        • Rabinovitz H.S.
        • et al.
        The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions.
        J Am Acad Dermatol. 2012; 67 (194.e1-8)
        • Shitara D.
        • Ishioka P.
        • Alonso-Pinedo Y.
        • et al.
        Shiny white streaks: a sign of malignancy at dermoscopy of pigmented skin lesions.
        Acta Derm Venereol. 2014; 94: 132-137
        • Verzi A.E.
        • Quan V.L.
        • Walton K.E.
        • et al.
        The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: a retrospective, case-control study.
        J Am Acad Dermatol. 2018; 78: 913-919
        • Cuellar F.
        • Vilalta A.
        • Puig S.
        • et al.
        New dermoscopic pattern in actinic keratosis and related conditions.
        Arch Dermatol. 2009; 145: 732
        • Liebman T.N.
        • Scope A.
        • Rabinovitz H.
        • et al.
        Rosettes may be observed in a range of conditions.
        Arch Dermatol. 2011; 147: 1468
        • Liebman T.N.
        • Rabinovitz H.S.
        • Dusza S.W.
        • et al.
        White shiny structures: dermoscopic features revealed under polarized light.
        J Eur Acad Dermatol Venereol. 2012; 26: 1493-1497
        • Gonzalez-Alvarez T.
        • Armengot-Carbo M.
        • Barreiro A.
        • et al.
        Dermoscopic rosettes as a clue for pigmented incipient melanoma.
        Dermatology. 2014; 228: 31-33
        • Zaballos P.
        • Rodero J.
        • Serrano P.
        • et al.
        Pyogenic granuloma clinically and dermoscopically mimicking pigmented melanoma.
        Dermatol Online J. 2009; 15: 10
        • Suppa M.
        • Micantonio T.
        • Di Stefani A.
        • et al.
        Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location.
        J Eur Acad Dermatol Venereol. 2015; 29: 1732-1741
        • Massi D.
        • De Giorgi V.
        • Carli P.
        • et al.
        Diagnostic significance of the blue hue in dermoscopy of melanocytic lesions: a dermoscopic-pathologic study.
        Am J Dermatopathol. 2001; 23: 463-469
        • Wolner Z.
        • Yélamos O.
        • Liopyris K.
        • et al.
        Enhancing skin cancer diagnosis with dermoscopy.
        Dermatol Clin. 2017; 35: 417-437
        • Tan J.M.
        • Lambie D.
        • Sinnya S.
        • et al.
        Histopathology and reflectance confocal microscopy features of photodamaged skin and actinic keratosis.
        J Eur Acad Dermatol Venereol. 2016; 30: 1901-1911
        • Ahnlide I.
        • Zalaudek I.
        • Nilsson F.
        • et al.
        Preoperative prediction of histopathological outcome in basal cell carcinoma: flat surface and multiple small erosions predict superficial basal cell carcinoma in lighter skin types.
        Br J Dermatol. 2016; 175: 751-761
        • Kittler H.
        • Rosendahl C.
        • Cameron A.
        • et al.
        Dermatoscopy: An Algorithmic Method Based on Pattern Analysis.
        Facultas.wuv Universitäts, Vienna, Austria2016

      Linked Article