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Journal of the American Academy of Dermatology
Volume 63, n° 3
pages 361-374 (septembre 2010)
Doi : 10.1016/j.jaad.2009.11.698
Continuing Medical Education

How to diagnose nonpigmented skin tumors: A review of vascular structures seen with dermoscopy : Part I. Melanocytic skin tumors
 

Iris Zalaudek, MD a, , Jürgen Kreusch, MD, PhD b, Jason Giacomel, MBBS c, Gerardo Ferrara, MD d, Caterina Catricalà, MD e, Giuseppe Argenziano, MD, PhD f
a Division of Dermatology, Medical University of Graz, Graz, Austria 
b private practice, Lübeck, Germany 
c Mends St Medical Centre, South Perth, Australia 
d Pathologic-Anatomy Unit, Gaetano Rummo Hospital, Benevento, Italy 
e Department of Dermatologic Oncology, Santa Maria and San Gallicano Dermatologic Institute, Rome, Italy 
f Department of Dermatology, Second University of Naples, Naples, Italy 

Reprint requests: Iris Zalaudek, MD, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria.
Abstract

Dermoscopy is a noninvasive tool that can be helpful in the diagnosis of nonpigmented skin tumors. This is because dermoscopy permits the visualization of key vascular structures that are usually not visible to the naked eye. Much work has concentrated on the identification of specific morphologic types of vessels that allow a classification into melanocytic versus nonmelanocytic and benign versus malignant nonpigmented skin tumors. Among a broad spectrum of different types of vascular patterns, six main morphologies can be identified. These are comma-like, dotted, linear-irregular, hairpin, glomerular, and arborizing vessels. With some exceptions, comma, dotted, and linear irregular vessels are associated with melanocytic tumors, while the latter three vascular types are generally indicative of keratinocytic tumors. Aside from vascular morphology, the architectural arrangement of vessels within the tumor and the presence of additional dermoscopic clues are equally important for the diagnosis. This article provides a general overview of the dermoscopic evaluation of nonpigmented skin tumors and is divided into two parts. Part I discusses the dermoscopic vascular patterns of benign and malignant melanocytic skin tumors. Part II discusses the dermoscopic vascular patterns of benign and malignant nonmelanocytic nonpigmented skin tumors. In each part, additional special management guidelines for melanocytic and nonmelanocytic nonpigmented skin tumors, respectively, will be discussed.

Learning objectives

After completing this learning activity, participants should be able to categorize different vascular structures and the architectural arrangement of vessels within tumors and additional dermoscopic clues of nonpigmented skin tumors, recognize the diagnostic significance of vessels associated with nevi and melanoma, and appropriately manage nonpigmented melanocytic skin tumors.

The full text of this article is available in PDF format.

Key words : amelanotic melanoma, Clark nevus, dermal nevus, dermoscopy, hypomelanotic melanoma, Spitz nevus, Spitz tumor, vessels

Abbreviations used : AHM, AK, BCC, BD, CCA, CMN, DM, IEC, KA, NPSL, NPST, PPV, PST, SCC, SH, SK



 Dr Zalaudek is supported by the Elise Richter Program (V9-B05) of the Austrian Science Fund (FWF).
 Conflicts of interest: The authors, editors, planners, and peer reviewers have no relevant financial relationships.



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