Melanoma pp 143-158 | Cite as

Dermoscopy of Melanocytic Lesions

  • Zachary J. Wolner
  • Oriol Yélamos
  • Konstantinos Liopyris
  • Ashfaq A. MarghoobEmail author


Dermoscopy can improve the diagnostic accuracy and sensitivity, without decreased specificity, for melanoma when compared to naked eye examination alone. Furthermore, dermoscopy reduces the number of unnecessary biopsies of benign lesions for every malignant diagnosis. In addition, dermoscopy monitoring of melanocytic lesions enables the diagnosis of thinner melanomas. These improvements in screening and management of lesions can result in reduced morbidity, earlier diagnosis of melanoma, and increased cost-effectiveness. Several dermoscopy features including atypical pigment network, angulated lines, negative pigment network, atypical dots, atypical globules, irregular streaks, shiny white lines, irregular blotch, blue-white veil, regression structures, polymorphous vasculature, and peripheral tan structureless areas have been shown to be specific to melanoma. While incorporating dermoscopy into clinical practice is associated with a learning curve, new users may utilize diagnostic and management algorithms, such as triage amalgamated dermoscopy algorithm (TADA) or two-step algorithm, to triage lesions for further evaluation and to improve their sensitivity for diagnosing melanoma.


Melanoma Melanocytic nevus Pigmented Nevi Dermoscopy Dermatoscopy Epiluminescence Two-step TADA 



Funding: This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Conflict of interest: The authors have no conflicts of interest to declare.

Permissions: Natalia Jaimes, M.D., has granted us permission to use select schematics throughout this chapter. Natalia Jaimes, M.D., and we retain the copyright to any line drawing included in this submission.


  1. 1.
    Carli P, De Giorgi V, Crocetti E, Mannone F, Massi D, Chiarugi A, et al. Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997–2001. Br J Dermatol. 2004;150(4):687–92. Scholar
  2. 2.
    Vestergaard M, Macaskill P, Holt P, Menzies S. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669–76. Scholar
  3. 3.
    Salerni G, Teran T, Puig S, Malvehy J, Zalaudek I, Argenziano G, et al. Meta-analysis of digital dermoscopy follow-up of melanocytic skin lesions: a study on behalf of the international Dermoscopy society. J Eur Acad Dermatol Venereol. 2013;27(7):805–14. Scholar
  4. 4.
    Menzies SW, Ingvar C, McCarthy WH. A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma. Melanoma Res. 1996;6(1):55–62. Scholar
  5. 5.
    Argenziano G, Soyer HP. Dermoscopy of pigmented skin lesions--a valuable tool for early diagnosis of melanoma. Lancet Oncol. 2001;2(7):443–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Gewirtzman AJ, Saurat JH, Braun RP. An evaluation of dermoscopy fluids and application techniques. Br J Dermatol. 2003;149(1):59–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Benvenuto-Andrade C, Dusza SW, Agero AL, Scope A, Rajadhyaksha M, Halpern AC, et al. Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions. Arch Dermatol. 2007;143(3):329–38. Scholar
  8. 8.
    Wang SQ, Dusza SW, Scope A, Braun RP, Kopf AW, Marghoob AA. Differences in dermoscopic images from nonpolarized dermoscope and polarized dermoscope influence the diagnostic accuracy and confidence level: a pilot study. Dermatol Surg. 2008;34(10):1389–95. Scholar
  9. 9.
    Nehal KS, Oliveria SA, Marghoob AA, Christos PJ, Dusza S, Tromberg JS, et al. Use of and beliefs about baseline photography in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States. Melanoma Res. 2002;12(2):161–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol. 2006;24(12):1877–82. Scholar
  11. 11.
    Bafounta M, Beauchet A, Aegerter P, Saiag P. Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol. 2001;137(10):1343–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol. 2002;3(3):159–65.CrossRefPubMedGoogle Scholar
  13. 13.
    Tromme I, Sacré L, Hammouch F, Legrand C, Marot L, Vereecken P, et al. Availability of digital dermoscopy in daily practice dramatically reduces the number of excised melanocytic lesions: results from an observational study. Br J Dermatol. 2012;167(4):778–86. Scholar
  14. 14.
    Argenziano G, Cerroni L, Zalaudek I, Staibano S, Hofmann-Wellenhof R, Arpaia N, et al. Accuracy in melanoma detection: a 10-year multicenter survey. J Am Acad Dermatol. 2012;67(1):54–9. Scholar
  15. 15.
    Tromme I, Legrand C, Devleesschauwer B, Leiter U, Suciu S, Eggermont A, et al. Cost-effectiveness analysis in melanoma detection: a transition model applied to dermoscopy. Eur J Cancer. 2016;67:38–45. Scholar
  16. 16.
    Haenssle H, Hoffmann S, Holzkamp R, Samhaber K, Lockmann A, Fliesser M, et al. Melanoma thickness: the role of patients' characteristics, risk indicators and patterns of diagnosis. J Eur Acad Dermatol Venereol. 2015;29(1):102–8. Scholar
  17. 17.
    Yadav S, Vossaert K, Kopf A, Silverman M, Grin-Jorgensen C. Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy). Am J Dermatopathol. 1993;15(4):297–305.CrossRefPubMedGoogle Scholar
  18. 18.
    Ahnlide I, Zalaudek I, Nilsson F, Bjellerup M, Nielsen K. Preoperative prediction of histopathologic 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(4):751–61. Scholar
  19. 19.
    Sahin MT, Ozturkcan S, Ermertcan AT, Gunes AT. A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face. J Dermatol. 2004;31(11):884–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Pan Y, Chamberlain AJ, Bailey M, Chong AH, Haskett M, Kelly JW. Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J Am Acad Dermatol. 2008;59(2):268–74. Scholar
  21. 21.
    Gonzalez-Alvarez T, Carrera C, Bennassar A, Vilalta A, Rull R, Alos L, et al. Dermoscopy structures as predictors of sentinel lymph node positivity in cutaneous melanoma. Br J Dermatol. 2015;172(5):1269–77. Scholar
  22. 22.
    Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, 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(6):1093–106. Scholar
  23. 23.
    Carrera C, Marchetti MA, Dusza SW, Argenziano G, Braun RP, Halpern AC, et al. Validity and reliability of dermoscopic criteria used to differentiate nevi from melanoma: a web-based International Dermoscopy Society Study. JAMA Dermatol. 2016;152(7):798–806. Scholar
  24. 24.
    Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the internet. J Am Acad Dermatol. 2003;48(5):679–93. Scholar
  25. 25.
    Zalaudek I, Docimo G, Argenziano G. Using dermoscopic criteria and patient-related factors for the management of pigmented melanocytic nevi. Arch Dermatol. 2009;145(7):816–26. Scholar
  26. 26.
    Marghoob AA, Usatine RP, Jaimes N. Dermoscopy for the family physician. Am Fam Physician. 2013;88(7):441–50.PubMedGoogle Scholar
  27. 27.
    Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Delfino M. Epiluminescence microscopy: criteria of cutaneous melanoma progression. J Am Acad Dermatol. 1997;37(1):68–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Massi D, De Giorgi V, Soyer HP. Histopathologic correlates of dermoscopic criteria. Dermatol Clin. 2001;19(2):259–68. Scholar
  29. 29.
    Menzies SW, Kreusch J, Byth K, Pizzichetta MA, Marghoob A, Braun R, et al. Dermoscopic evaluation of amelanotic and hypomelanotic melanoma. Arch Dermatol. 2008;144(9):1120–7. Scholar
  30. 30.
    Haenssle HA, Korpas B, Hansen-Hagge C, Buhl T, Kaune KM, Rosenberger A, et al. Seven-point checklist for dermatoscopy: performance during 10 years of prospective surveillance of patients at increased melanoma risk. J Am Acad Dermatol. 2010;62(5):785–93. Scholar
  31. 31.
    Tschandl P, Rosendahl C, Kittler H. Dermatoscopy of flat pigmented facial lesions. J Eur Acad Dermatol Venereol. 2015;29(1):120–7. Scholar
  32. 32.
    Vanden Daelen A, Ferreira I, Marot L, Tromme I. A digital Dermoscopy follow-up illustration and a histopathologic correlation for angulated lines in Extrafacial Lentigo Maligna. JAMA Dermatol. 2016;152(2):200–3. Scholar
  33. 33.
    Lallas A, Tschandl P, Kyrgidis A, Stolz W, Rabinovitz H, Cameron A, et al. Dermoscopic clues to differentiate facial lentigo maligna from pigmented actinic keratosis. Br J Dermatol. 2016;174(5):1079–85. Scholar
  34. 34.
    Botella-Estrada R, Requena C, Traves V, Nagore E, Guillen C. Chrysalis and negative pigment network in Spitz nevi. Am J Dermatopathol. 2012;34(2):188–91. Scholar
  35. 35.
    Pizzichetta MA, Canzonieri V, Soyer PH, Rubegni P, Talamini R, Massone C. Negative pigment network and shiny white streaks: a dermoscopic-pathological correlation study. Am J Dermatopathol. 2014;36(5):433–8. Scholar
  36. 36.
    Bassoli S, Ferrari C, Borsari S, Giusti F, Magnoni C, Pellacani G, 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(6):650–5. Scholar
  37. 37.
    Pizzichetta MA, Talamini R, Marghoob AA, Soyer HP, Argenziano G, Bono R, et al. Negative pigment network: an additional dermoscopic feature for the diagnosis of melanoma. J Am Acad Dermatol. 2013;68(4):552–9. Scholar
  38. 38.
    Malvehy J. Handbook of dermoscopy. London: Informa Healthcare; 2006.CrossRefGoogle Scholar
  39. 39.
    Salopek TG, Kopf AW, Stefanato CM, Vossaert K, Silverman M, Yadav S. Differentiation of atypical moles (dysplastic nevi) from early melanomas by dermoscopy. Dermatol Clin. 2001;19(2):337–45.CrossRefPubMedGoogle Scholar
  40. 40.
    Marchell R, Marghoob AA, Braun RP, Argenziano G. Dermoscopy of pigmented Spitz and reed nevi: the starburst pattern. Arch Dermatol. 2005;141(8):1060. Scholar
  41. 41.
    Alon S, Katrin K, Harold SR. Histopathologic tissue correlations of dermoscopic structures. An Atlas of Dermoscopy. 2nd ed. New York: CRC Press; 2012. p. 10–32.Google Scholar
  42. 42.
    Costa J, Ortiz-Ibanez K, Salerni G, Borges V, Carrera C, Puig S, et al. Dermoscopic patterns of melanoma metastases: interobserver consistency and accuracy for metastasis recognition. Br J Dermatol. 2013;169(1):91–9. Scholar
  43. 43.
    Balagula Y, Braun R, Rabinovitz H, Dusza S, Scope A, Liebman T, et al. The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. J Am Acad Dermatol. 2012;67(2):194.e1–8. Scholar
  44. 44.
    Rosendahl C, Tschandl P, Cameron A, Kittler H. Diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions. J Am Acad Dermatol. 2011;64(6):1068–73. Scholar
  45. 45.
    Pehamberger H, Steiner A, Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions. J Am Acad Dermatol. 1987;17(4):571–83.CrossRefPubMedGoogle Scholar
  46. 46.
    Terushkin V, Oliveria SA, Marghoob AA, Halpern AC. Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: an update. J Am Acad Dermatol. 2010;62(5):794–803. Scholar
  47. 47.
    Soyer HP, Kenet RO, Wolf IH, Kenet BJ, Cerroni L. Clinicopathological correlation of pigmented skin lesions using dermoscopy. Eur J Dermatol. 2000;10(1):22–8.PubMedGoogle Scholar
  48. 48.
    Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Sammarco E, Delfino M. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis. Arch Dermatol. 1998;134(12):1563–70.CrossRefPubMedGoogle Scholar
  49. 49.
    Soyer HP, Argenziano G, Zalaudek I, Corona R, Sera F, Talamini R, et al. Three-point checklist of dermoscopy. A new screening method for early detection of melanoma. Dermatology. 2004;208(1):27–31. Scholar
  50. 50.
    Henning JS, Dusza SW, Wang SQ, Marghoob AA, Rabinovitz HS, Polsky D, et al. The CASH (color, architecture, symmetry, and homogeneity) algorithm for dermoscopy. J Am Acad Dermatol. 2007;56(1):45–52. Scholar
  51. 51.
    Rosendahl C, Cameron A, McColl I, Wilkinson D. Dermatoscopy in routine practice—‘chaos and clues’. Aust Fam Physician. 2012;41(7):482–7.PubMedGoogle Scholar
  52. 52.
    Stolz W, Riemann A, Cognetta A, Pillet L. ABCD rule of dermoscopy: a new practical method for early recognition of malignant melanoma. Eur J Dermatol. 1994;4:521–7.Google Scholar
  53. 53.
    Marghoob AABR, Malvehy J, editors. Atlas of dermoscopy. 2nd ed. London: Informa Healthcare; 2012.Google Scholar
  54. 54.
    Lallas A, Moscarella E, Longo C, Kyrgidis A, de Mestier Y, Vale G, et al. Likelihood of finding melanoma when removing a Spitzoid-looking lesion in patients aged 12 years or older. J Am Acad Dermatol. 2015;72(1):47–53. Scholar
  55. 55.
    Argenziano G, Longo C, Cameron A, Cavicchini S, Gourhant JY, Lallas A, et al. Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma. Br J Dermatol. 2011;165(6):1251–5. Scholar
  56. 56.
    Zalaudek I, Kittler H, Hofmann-Wellenhof R, Kreusch J, Longo C, Malvehy J, et al. “White” network in Spitz nevi and early melanomas lacking significant pigmentation. J Am Acad Dermatol. 2013;69(1):56–60. Scholar
  57. 57.
    Altamura D, Menzies SW, Argenziano G, Zalaudek I, Soyer HP, Sera F, et al. Dermatoscopy of basal cell carcinoma: morphologic variability of global and local features and accuracy of diagnosis. J Am Acad Dermatol. 2010;62(1):67–75. Scholar
  58. 58.
    Rogers T, Marino ML, Dusza SW, Bajaj S, Usatine RP, Marchetti MA, et al. A clinical aid for detecting skin cancer: the Triage Amalgamated Dermoscopic Algorithm (TADA). J Am Board Fam Med. 2016;29(6):694–701. Scholar
  59. 59.
    Argenziano G, Zalaudek I, Ferrara G, Johr R, Langford D, Puig S, et al. Dermoscopy features of melanoma incognito: indications for biopsy. J Am Acad Dermatol. 2007;56(3):508–13. Scholar
  60. 60.
    Benvenuto-Andrade C, Marghoob AA. Ten reasons why dermoscopy is beneficial for the evaluation of skin lesions. Expert Rev Dermatol. 2006;1(3):369–74. Scholar
  61. 61.
    Carli P, De Giorgi V, Argenziano G, Palli D, Giannotti B. Pre-operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images. J Eur Acad Dermatol Venereol. 2002;16(4):339–46.CrossRefPubMedGoogle Scholar
  62. 62.
    Binder M, Schwarz M, Winkler A, Steiner A, Kaider A, Wolff K, et al. Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol. 1995;131(3):286–91.CrossRefPubMedGoogle Scholar
  63. 63.
    Skvara H, Teban L, Fiebiger M, Binder M, Kittler H. Limitations of dermoscopy in the recognition of melanoma. Arch Dermatol. 2005;141(2):155–60. Scholar
  64. 64.
    Marghoob AA, Scope A. The complexity of diagnosing melanoma. J Invest Dermatol. 2009;129(1):11–3. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Zachary J. Wolner
    • 1
  • Oriol Yélamos
    • 1
  • Konstantinos Liopyris
    • 1
  • Ashfaq A. Marghoob
    • 1
    Email author
  1. 1.Division of Dermatology, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA

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