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Dermatology Diploma > Dermoscopy > Flashcards

Dermoscopy Flashcards

1
Q

Describe how the description of local features varies from global features with regards to dermoscopy?

A
  • Pigment network vs Reticular pattern
  • Dots and Globules vs Globular Pattern
  • Streaks/Pseudopods vs Starburst Pattern
  • Blotches vs Homogenous Pattern
  • Regression vs Multicomponent

There is also a Non-Specific pattern naevus.

(Local features various aspects of the naevus whereas the global features describe the overall impression)

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2
Q

Describe the colour changes that are seen in dermoscopy?

A
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3
Q

How does pigment network vary from typical to atypical naevi?

What lesions is it seen in?

A

Typical naevi have a regular uniform pattern.

Ayptical naevi are non-uniform, with heterogenous holes & end abruptly.

  • Aquired melanocytic naevi
  • Thin malignant melanomas.
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4
Q

How do globular patterns of pigmented lesions change between naevi and atypical naevi/malignant melanoma?

What lesions have globular patterns?

A

central = naevi

peripheral = malignant melanoma/Atypical

  • Melanocytic naevi = especially compound and intradermal naevi
  • Cobblestone effects is a form of globular pattern and is seen in larger lesions:
    • Congenital melanocytic naevi
    • Seborrheic Keratoses
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5
Q

Describe how the starburst pattern (global) or streaks/peudopods (local) vary between typical and atypical lesions?

What lesions are these often seen in?

A

Symmetical peripheral arrangement = benign naevi & Spitz/Reed’s naevi

Irregular and patchy = malignant melanoma

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6
Q

Describe how a homogenous pattern (global) or blotches (local) change between typical naevi and ayptical naevi/malignant melanoma?

A

Central blotch/homogenous colour = typical naevus

Irregular or peripheral placed blotches = melanoma

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7
Q

In what 2 lesions is a blue/white veil seen?

A

Melanoma and Spitz/Reed Naevi

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8
Q

What pattern is this?

A

Multicomponent Pattern

(There are 3 or more components)

It is highly suggestive of melanoma

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9
Q

What pattern is this and how is it managed?

A

Non-specific pattern

Always consider a malignant melanoma.

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10
Q

What pattern is this?

Where is it seen?

How do you know when it is melanom?

A

Parallel Pattern

Seen acrally

Parralel Ridge Pattern is seen in melanoma - it is thicker and has eccrine gland openings on it.

Parralel Furrow Pattern is seen in typical naevi.

(Ridge is wrong)

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11
Q

What type of naevi is this?

A

Junctional melanocytic naevi

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12
Q

How do aquired melanocytic naevi change with age?

A
  • In children and teenagers - there is a peripheral rim of brown globules as a sign of growth. (Pseudopods)
  • Regular reticular and homogenous pattern in 30s+.
  • Regress with age.
  • Disappear in 70s and above.
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13
Q

What type of naevus is this?

A

Compound melanocytic naevus

(Usually have a raised central portion with a typical globular pattern)

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14
Q

What type of naevus is this?

What are its typical dermoscopic features?

A

Intradermal melanocytic naevi

  • Globular pattern
  • Comma-like blood vessels
  • Cobblestone pattern
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15
Q

What is this?

What can happen to the central part?

A

Blue Naevus

The central part can undergo focal fibrosis. (aka Sclerosing blue naevi)

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16
Q

What is this?

A

Reed Naevus

Seen in adults - legs of females.

It has a starburst pattern.

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17
Q

What is this?

A

Spitz Naevus

  • More commmon in children
  • Amelanocytic version of the Reed naevus.
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18
Q

What type of naevi are these?

A

Atypical Naevi (aka Clark’s naevi)

(Containing similar patterns to melanoma)

NOTE: Establish the predominant pattern of the individual or if they have many atypical naevi on examination.

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19
Q

What percentage of melanoma come from aquired naevi?

Describe how you can tell if a melanoma might be growing from a naevus on dermoscopy?

A

50%

  • Look for the dermoscopic island - a well circumscribed area of uniform dermoscopic pattern that differs from the rest of the lesion - this is most likely the melanoma
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20
Q

Describe the 3 Point Checklist

A
  • Assymmetry of colours and structures
  • Atypical or irregular pigment network
  • Blue-White Veil

A score of 2 out of 3 means that a biopsy needs to be performed.

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21
Q

What are the 10 most common dermoscopic features of malignant melanoma?

A
  1. ​Atypical pigment network
  2. Negative (inverse) pigment network
  3. Focal Streaks (pseudopods/radial streamin
  4. Eccentric blotch
  5. Atypical dots/globules
  6. Blue-white veil
  7. Crystalline (chrysalis) structures
  8. Regression structures
  9. Atypical vascular structures (Polymorphous vessels)
  10. Multiple colours
22
Q

Analyse this melanoma using the 3 point checklist

A
  • Assymetrical colours and structures
  • Atypical pigment network
  • No blue with veil

THEREFORE

2/3

23
Q

Analyse this melanoma using the 3 point checklist

A
  • Asymmetrical colours and structures (blotches, atypical streaks, peripheral globules)
  • Atypical pigment network
  • Possible blue-grey veil

This is a multicomponent pattern

3/3

24
Q

Describe this using the 3 Point Checklist

A
  • Normal colour and structure
  • Irregular pigment network
  • Blue-Grey Veil

2/3

25
Q

Dermoscopically, how can you determine if hypopigmented or amelanotic lesion is a melanoma?

A
  • Looks like a BCC/SCC
  • Foci of pigment remnants - look for blue or gray areas.
  • Atypical vascular pattern - presence of polymorphous blood vessels (dotted, hairpin and irregular linear vessels.)
  • More than one shade of pink.
  • White shiny lines - only seen on polarised dermatoscopes.
26
Q

What percentage of nodular melanomas are invasive melanomas?

A

10-15%

27
Q

How do nodular melanomas present?

A

Rapidly growing papules or nodules that ulcerate or bleed.

28
Q

Why are nodular melanomas difficult to diagnose at an early stage on dermatoscope?

A

The normal features of a superficial spreading malignant melanoma are lacking.

29
Q

What are the typical dermoscopic features of a nodular melanoma?

A
  • Blue gray structures
  • White polarized lines (chrystalline structures).
  • Irregularity of colour
  • Atypical vascular pattern
30
Q

How are the “rete ridges”on the face different?

How does this affected dermoscopy of pigmented lesions?

A

Rete Ridges are flat on the face and thus a “pseudonetwork” = a broad mesh with wider holes.

The pseudonetwork does not distinguish between melanocytic and non-melanocytic lesions

31
Q

What is a way of distinguishing between benign pigmented lesions vs lentigo maligna?

A

Lentigo maligna = poorly defined borders.

Benign pigmented lesions ahve well defined borders.

32
Q

What are the 5 suspicious dermoscopy findings in lentigo maligna?

A
  • Asymmetric follicular openings (Signet Ring Structures)- 1st change in lentigo maligna. It is due to the descent of the melanoma cells into individual hair follicles
  • Annular-granular pattern
  • Dark rhomboidal structures
  • Dark homogeneous areas
  • Pink-reddish areas - indicates invasion and tumour progression.
33
Q

What are the 3 benign pigmented patterns in acral skin?

A
  1. Parallel furrow pattern - Most common (50%)
  2. Lattice-like pattern
    • Arch areas of the sole and/or at the peripheral areas of palms and soles
  3. Fibrilar pattern
    • Parallel fine lines crossing the skin markings in a slanting direction
    • Most common on high pressure areas of feet
34
Q

What sort of benign acral pattern is this?

A

Parallel Furrow Pattern

35
Q

What sort of benign acral pattern is this?

A

Lattice-like pattern

(Most commonly seen on the arches of the feet)

36
Q

What sort of benign acral pattern is this?

A

Fibrilar pattern

(Most commonly seen on the high pressure areas of the feet)

37
Q

What are the 2 Dermoscopic features of acral malignant melanoma?

A
  1. Parallel ridge pattern
  2. Irregular diffuse pigmentation
38
Q

What sort of acral pattern is this for malignant melanoma?

A

Parallel ridge pattern

(Eccrine glands are in the ridge)

39
Q

What sort of acral pattern is this for malignant melanoma?

A

Diffuse Irregular Pattern

40
Q

What sign is seen here?

What other interesting thing about this nail makes it a malignant melanoma?

A

Hutchinson’s sign - periungual pigmentation on the proximal nail fold.

The pigmentation gets wider towards the base meaning that the lesion is enlargening.

41
Q

How can you tell the difference between a benign melanocytic naevus and a Malignant Melanoma in a nail?

A

Malignant Melanomas in a nail are heterogenous in colour, thickness and spacing with a subtle disruption of parallelism, only noticed with dermoscopy.

42
Q

What are the 4 features of a pigmented seborrhoeic keratoses?

A
  • Comedo-like openings
  • Milia like cysts
  • Cerebriform pattern
  • Fingerprint-like structures
43
Q

What is the hallmark feature of a non-pigmented sebhorreic keratosis?

A

Hairpin vessels - thin elongated vessels surrounded by whitish halo

44
Q

What are the features of a dermatofibroma?

A

A central white scar-like area and peripheral thin pseudonetwork

45
Q

What are the dermoscopic features of BCC?

A
  • Arborising vessels
  • Blue-Gray Ovoid nests and globules
  • Leaf-like structures
  • Spoke-wheel areas
  • Multiple erosions/ulceration
46
Q

What features of a BCC do you see here?

A

Arborising vessels

Blue ovoid nests

Spoke Wheel Areas

47
Q

What are the dermoscopic features of a sebaceous hyperplasia?

A
  • Sebaceous gland lobules with peripheral telangiectasias.
  • Crown vessels - the telangiectasia do not cross over the lobules.
  • Central punctum
48
Q

What are the dermoscopic features of cherry haemangiomas on dermoscopy?

A

Dark or black on thrombosed lesions called (Lakes or Lacunae)

49
Q

What are the dermoscopic features of a pyogenic granuloma?

Does it need biopsy?

A

Reddish or pinkish homogeneous areas intersected by white lines

(“white rail lines”)

Yes it needs biopsy because it can look like a nodular amelanotic melanoma.

50
Q

What are the features of an Angiokeratomas on dermoscopy?

A
  • Dark Lacunae (Lakes) with a white-veil background.
  • Erythema on the periphery
51
Q

What are the features of an solar keratosis & IEC on dermoscopy?

A=Solar Keratosis

B,C & D =Bowen’s Disease

A
  • Solar Keratosis = a white or yellowish halo surrounding the hair follicular openings over a background of erythema with a variable degree of scale.
    • Often called a Strawberry Pattern
  • IEC = erythematous scaly areas with glomerular vessels and, sometimes, dotted vessels

Dermatology Diploma (39 decks)

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