Table 5.
Dermoscopic Characteristics of Melanomas
| Diagnosis (Level 1 or 2) Feature included as a learning objective (>70% positive responses) |
Round 1: % Positive Responses* (n = 33) |
Round 2: % Positive Responses* (n = 30) |
|---|---|---|
| Overview of melanoma patterns (level 1) | ||
| Blue structures (blue-white veil, blue-gray structures) | 100.0% | — |
| Shiny white lines/structures (crystalline structures) | 100.0% | — |
| Atypical pigment network | 97.0% | — |
| Atypical/irregular streaks (radial streaming, pseudopods) | 97.0% | — |
| Atypical/irregular dots/globules | 93.9% | — |
| Regression structures (white scar-like area and/or peppering) | 93.9% | — |
| Negative pigment network | 87.9% | — |
| Atypical vascular pattern/structures, polymorphous vessels (2 + types of blood vessels) | 87.9% | — |
| Peripheral brown/tan structureless area | 78.8% | — |
| Angulated lines (extrafacial)/polygons/zig-zag pattern | 75.8% | — |
| Atypical/off-center blotch(es) | 69.7% | ↑ 90.0% |
| Acral melanoma (level 2) | ||
| Parallel ridge pattern | 93.9% | — |
| Ulceration | 90.9% | — |
| Irregular diffuse pigmentation or blotch | 84.8% | — |
| Multicomponent pattern, asymmetry of structures/colors | 84.8% | — |
| Atypical fibrillar pattern | 72.7% | — |
| Neovascularization, milky red | 72.7% | — |
| Lentigo maligna melanoma (level 2) | ||
| Annular-granular pattern (gray dots around follicular openings) | 90.9% | — |
| Asymmetric pigmentation around follicular openings/asymmetric follicular openings | 87.9% | — |
| Rhomboidal structures (angulated lines)/zig-zag pattern | 81.8% | — |
| Dark blotches ± obliterated hair follicles | 75.8% | — |
| Circle within a circle (isobar) | 60.6% | ↓ 56.7% |
| Melanoma of the nail (level 2) | ||
| Pigmentation of periungual skin (micro-Hutchinson’s sign) | 90.9% | — |
| Triangular shape of pigment band (band diameter wider at proximal end) | 87.9% | — |
| Longitudinal brown/black broken lines with irregular spacing, width, coloration, or parallelism | 81.8% | — |
| Band width >3 mm or two thirds of nail plate width | 78.8% | — |
| Brown to black dots/globules associated with longitudinal lines | 60.6% | ↓ 50.0% |
| Amelanotic/hypomelanotic melanoma (level 2) | ||
| Milky red areas | 81.8% | — |
| Shiny white lines (crystalline structures) | 81.8% | — |
| Atypical vascular pattern, polymorphous vessels (2 + types of blood vessels) | 81.8% | — |
| Scar-like depigmentation | 75.8% | — |
*
% of panelists who indicated on a 5-point Likert scale that they “strongly agree” (5) or “agree” (4) with the feature being included in dermoscopy training for primary care providers.