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. 皮膚鏡檢查越來越多地被臨床醫生（皮膚科醫生、家庭醫生、足病醫生、整骨醫學醫生等）用來指導臨床管理決策。提供給病理學家的皮膚鏡檢查結果或影像為臨床醫生的診斷和管理思考過程提供了重要的見解。然而，由於在皮膚病理學中皮膚鏡檢查的訓練有限，要求表中提供的皮膚鏡檢查描述和影像對病理學家的價值不大。大多數皮膚鏡檢查結構與組織病理學有直接的相關性，因此皮膚鏡檢查可以作為臨床醫生與病理學家之間的優秀溝通橋樑。在這個持續醫學教育系列的第一篇文章中，我們回顧了皮膚鏡檢查的特徵及其組織病理學的相關性。
AK 光敏性角化病 BCC 基底細胞癌 DEJ 真皮表皮交界處 IDS 國際皮膚鏡學會 LM 惡性雀斑 LPLK 類扁平苔蘚角化病 SCC 鱗狀細胞癌 SK 脂溢性角化病
Learning objectives
After completing this learning activity, participants should be able to discuss the separation between dermatology and dermatopathology; identify why dermoscopy can act as the link between dermatology and pathology; describe the colors in dermoscopy and its relevance in terms of histologic analysis; describe the dermoscopic findings and the histological correlates of melanocytic lesions; and describe the dermoscopic findings and the histological correlates of nonmelanocytic lesions.
Disclosures
Editors
The editors involved with this CME activity and all content validation/peer reviewers of the journal-based CME activity have reported no relevant financial relationships with commercial interest(s).
Authors
The authors involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s).
Planners
The planners involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s). The editorial and education staff involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s).
Dermatology and histopathology have traditionally been linked. Biopsy specimens of the skin are easy to obtain, and dermatologists couple their clinical skills with histopathology and use clinical information to tailor their histopathologic differential diagnosis. In the United States, the creation of dermatopathology in the 1970s uncoupled dermatology and histopathology.1 While this has led to more specialized physicians who are able to solve challenging cases with greater expertise, this separation can also lead to noncongruent diagnoses that ultimately require clinicopathologic correlation. 皮膚科與組織病理學傳統上是相互聯繫的。皮膚的活檢標本容易獲取，皮膚科醫生將其臨床技能與組織病理學結合，並利用臨床信息來調整其組織病理學的鑑別診斷。在美國，1970 年代的皮膚病理學的創立使皮膚科與組織病理學脫鉤。雖然這導致了更多專業的醫生能夠以更高的專業知識解決具有挑戰性的案例，但這種分離也可能導致不一致的診斷，最終需要臨床病理學的相關性。
Dermoscopy is a noninvasive, handheld diagnostic instrument that is equipped with a magnification lens (generally between ×10-20) and a polarized or nonpolarized light source that allows en face visualization of epidermal and dermal structures that are invisible to the naked eye. Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, and physician assistants)2, 3 to inform clinical management decisions. While dermoscopic descriptions or images may be provided to pathologists as part of a requisition form, this information is likely to be of limited value to the pathologist because most have received limited to no training in dermoscopy. In addition, many clinicians using dermoscopy remain unaware of the dermoscopy–histopathologic correlates. Acquiring this knowledge has the potential to not only improve the clinician's diagnostic accuracy but also provide prognostic information, help determine the type of biopsy specimen to obtain, and guide the management of skin cancers. Most dermoscopic structures have direct histopathologic correlates, and therefore dermoscopy offers the ideal bridge to improve clinicopathologic communication. 皮膚鏡是一種非侵入性的手持診斷儀器，配備有放大鏡（通常在×10-20 之間）和偏振或非偏振光源，能夠進行表面可視化，觀察肉眼無法看見的表皮和真皮結構。皮膚鏡在臨床醫生（皮膚科醫生、家庭醫生和醫師助理）中越來越多地被使用，以幫助臨床管理決策。雖然皮膚鏡的描述或影像可能作為申請表的一部分提供給病理學家，但這些信息對病理學家的價值可能有限，因為大多數病理學家在皮膚鏡方面的訓練有限或幾乎沒有。此外，許多使用皮膚鏡的臨床醫生仍然對皮膚鏡與組織病理學的相關性缺乏了解。獲得這些知識不僅有潛力提高臨床醫生的診斷準確性，還能提供預後信息，幫助確定應取得的活檢標本類型，並指導皮膚癌的管理。大多數皮膚鏡結構都有直接的組織病理學相關性，因此皮膚鏡提供了改善臨床病理溝通的理想橋樑。
In the last decade, the description of dermoscopic structures by multiple independent researchers has led to redundant terminology. In an effort to standardize the nomenclature, in 2016 the International Dermoscopy Society (IDS) published a terminology consensus manuscript based on the most commonly used terms.4, 5 In this continuing medical education series we use the consensus terminology and present both the descriptive and metaphoric terms agreed upon by the consensus members. 在過去十年中，多位獨立研究者對皮膚鏡結構的描述導致了冗餘的術語。為了標準化命名法，國際皮膚鏡學會（IDS）於 2016 年發表了一份基於最常用術語的術語共識手稿。在這個持續的醫學教育系列中，我們使用共識術語，並呈現共識成員一致同意的描述性和隱喻性術語。
Dermoscopic structures and colors and their histopathologic correlates 皮膚鏡結構與顏色及其組織病理相關性
Key points 重點
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Colors seen in dermoscopy depend on the type of chromophores in the skin and their location 在皮膚鏡檢查中看到的顏色取決於皮膚中色素的類型及其位置
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Melanin appears in multiple colors (black, brown, gray, or blue) depending on its superficial or deep location 黑色素根據其表層或深層位置呈現多種顏色（黑色、棕色、灰色或藍色）
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Dermoscopic structures with high specificity for melanocytic neoplasms include network, negative network, angulated lines, aggregated globules, streaks, and parallel patterns on volar surfaces 對於黑色素細胞腫瘤具有高特異性的皮膚鏡結構包括網狀、負網狀、角度線、聚集小球、條紋和掌面上的平行圖案
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When these structures are atypical (differences in size, shape, color, or distribution), a diagnosis of melanoma is favored 當這些結構不典型（在大小、形狀、顏色或分佈上存在差異）時，較傾向於診斷為黑色素瘤
Colors in dermoscopy 皮膚鏡中的顏色
Colors under the lens of dermoscopy depend on the type and location of the chromophores in the skin.6, 7, 8, 9, 10 The most relevant colors when evaluating cutaneous neoplasms with dermoscopy include black, brown, blue, gray, yellow, orange, red, and white. Most of these colors come from increases of normal components of the skin, such as melanin (brown, black, gray, or blue), blood (red), sebum or keratin (yellow), or collagen (white). However, some colors associated with select dermoscopic structures are associated with specific pathologic features, such as balloon cell changes (white globules),11 blood thrombosis (black lacunae), or cell xanthomization (homogeneous yellow to orange areas).12Melanin is the most common chromophore, and the color will vary from black to brown to blue-gray depending on its concentration and location. Melanin in the stratum corneum or in the superficial epidermis will have a black color; when present in the lower epidermis and near the dermoepidermal junction (DEJ), it will be brown; when present in the papillary dermis it will have a grayish hue; when present in the reticular dermis it will appear blue.7, 8, 9 Colors can provide valuable insight into the depth of a melanocytic lesion and thereby provide possible prognostic information. For example, when grossing a suspected melanoma, sectioning through a blue area (pigment in the reticular dermis) will likely reveal the thickest section of the tumor. 在皮膚鏡下的顏色取決於皮膚中色素的類型和位置。評估皮膚腫瘤時，最相關的顏色包括黑色、棕色、藍色、灰色、黃色、橙色、紅色和白色。這些顏色大多來自皮膚正常成分的增加，例如黑色素（棕色、黑色、灰色或藍色）、血液（紅色）、皮脂或角質（黃色）或膠原蛋白（白色）。然而，某些與特定皮膚鏡結構相關的顏色則與特定的病理特徵有關，例如氣球細胞變化（白色小球）、血液凝塊（黑色空隙）或細胞黃瘤化（均勻的黃色至橙色區域）。黑色素是最常見的色素，其顏色會根據其濃度和位置而變化，從黑色到棕色再到藍灰色。 角質層或表皮淺層中的黑色素將呈現黑色；當存在於下表皮並靠近真表皮交界處（DEJ）時，則會呈現棕色；當存在於乳頭狀真皮時，則會呈現灰色調；當存在於網狀真皮時，則會呈現藍色。顏色可以提供有關黑色素病變深度的寶貴見解，從而提供可能的預後信息。例如，在切割懷疑的黑色素瘤時，穿過藍色區域（網狀真皮中的色素）可能會揭示腫瘤的最厚切面。
Colors are subject to varying perception because of inherent variation from person to person.13 Therefore, while the evaluation of color in dermoscopy is important when evaluating a lesion, it can at times distract from diagnostic dermoscopic structures. Evaluating grayscale (black and white) dermoscopic images can remove potential distracting or biasing colors and make dermoscopic structures more conspicuous (Fig 1).14 顏色因個體差異而受到不同的感知影響。因此，在評估病變時，雖然在皮膚鏡檢查中對顏色的評估很重要，但有時會分散對診斷性皮膚鏡結構的注意。評估灰階（黑白）皮膚鏡影像可以去除潛在的干擾或偏見顏色，使皮膚鏡結構更加明顯（圖 1）。
Fig 1. Melanoma arising in a nevus. A, Color dermoscopy showing a pigmented lesion with pigment network and central negative network (arrowhead). B, Black and white dermoscopy enhances the identification of the negative network (arrowhead). C, Histologically, the negative network area revealed the presence of a melanoma arising in a nevus. 圖 1. 在痣中產生的黑色素瘤。A、彩色皮膚鏡顯示有色素病變，具有色素網絡和中央負網絡（箭頭）。B、黑白皮膚鏡增強了對負網絡的識別（箭頭）。C、從組織學上看，負網絡區域顯示在痣中產生的黑色素瘤的存在。
Dermoscopic structures with high specificity for melanocytic neoplasms 具有高特異性的黑色素細胞腫瘤皮膚鏡結構
Dermoscopy can help differentiate melanocytic from nonmelanocytic lesions through structures that are highly specific for melanocytic neoplasms.15, 16 The description of these features and their histopathologic correlates are described below and summarized in Table I. While these structures are usually associated with melanocytic neoplasms, they can be encountered in nonmelanocytic lesions (Table II).24 皮膚鏡可以通過對黑色素細胞腫瘤高度特異的結構，幫助區分黑色素細胞病變與非黑色素細胞病變。這些特徵及其組織病理學相關的描述如下所述，並在表 I 中總結。雖然這些結構通常與黑色素細胞腫瘤相關，但在非黑色素細胞病變中也可能遇到（表 II）。
Table I. Dermoscopic structures that are relatively specific for melanocytic neoplasms 表 I. 相對特異於黑色素細胞腫瘤的皮膚鏡結構
Schematic illustration 示意圖
Metaphorical term 隱喻術語
Descriptive term 描述性術語
Histopathologic correlate 組織病理學相關性
Clinical association 臨床關聯
Pigment network 色素網絡
Lines, reticular 線條，網狀
Lines are caused by pigmented keratinocytes or melanocytes along the dermoepidermal junction; spaces between the lines (holes) correspond to the suprapapillary plate 線條是由色素角質細胞或黑色素細胞在真皮表皮交界處造成的；線條之間的空隙（孔）對應於上乳頭板
Lines, reticular, hypopigmented, around brown clods 線條、網狀、低色素、圍繞棕色塊狀物
Remains to be elucidated, but preliminary work suggests that it corresponds to hypopigmented elongated rete ridges bridging and surrounding large nests of melanocytes within the dermal papillae 尚待釐清，但初步研究顯示，這與位於真皮乳頭內部的大型黑色素細胞巢周圍的低色素延長網狀脊相對應
Spitz nevus, melanoma 斯皮茨痣，黑色素瘤
Angulated lines 角度線
Lines, angulated or polygonal 線條、角度或多邊形
Confluent atypical melanocytes along an attenuated dermoepidermal junction and melanophages in the papillary dermis 在變薄的真皮表皮交界處沿線的融合型非典型黑色素細胞及在乳頭狀真皮中的黑色素吞噬細胞
Lentigo maligna, melanoma on sun-exposed skin 惡性雀斑，日曬皮膚上的黑色素瘤
Globules 球狀體
Clods, round or oval, aggregated or circumferential (rim of globules) 塊狀物，圓形或橢圓形，聚集或環繞（小球的邊緣）
Nests of nevomelanocytes at the dermoepidermal junction or dermis 在真皮表皮交界處或真皮中的黑素細胞巢
Dermal population of densely pigmented melanocytes 皮膚中密集色素黑色素細胞的族群
Blue nevus, melanoma 藍痣，黑色素瘤
Reprinted with permission by dermoscopedia contributors – Ash Marghoob, Rainer Hofmann, Ralph Braun. Benign nevi pattern. dermoscopedia. January 17, 2018, 19:40 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Benign_nevi_pattern&oldid=9996. Accessed October 27, 2018. 經 dermoscopedia 貢獻者許可重印 – Ash Marghoob、Rainer Hofmann、Ralph Braun。良性痣模式。dermoscopedia。2018 年 1 月 17 日，19:40 UTC。可於以下網址獲得：https://dermoscopedia.org/w/index.php?title=Benign_nevi_pattern&oldid=9996。查閱日期：2018 年 10 月 27 日。
Table II. Dermoscopic features with high specificity for melanocytic neoplasms that can rarely also be seen in nonmelanocytic lesions and their histopathologic correlates 表 II. 具有高特異性的皮膚鏡特徵，主要用於黑色素細胞腫瘤，但在非黑色素細胞病變中也偶爾可見及其組織病理相關性
Dermal pigmented tumor nests with melanocytes and melanophages 真皮色素腫瘤巢含黑色素細胞和黑色素吞噬細胞
Reprinted with permission of dermoscopedia contributors – Ralph Braun, Katrin Kerl. Dermoscopic structures. dermoscopedia. October 24, 2018, 20:20 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004. Accessed October 27, 2018. 經過 dermoscopedia 貢獻者的許可重印 – Ralph Braun, Katrin Kerl。皮膚鏡結構。dermoscopedia。2018 年 10 月 24 日，20:20 UTC。可在以下網址獲得：https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004。查閱日期：2018 年 10 月 27 日。
Pigment network (lines, reticular) 色素網絡（線條，網狀）
Pigment network corresponds to brown lines forming a reticular pattern in a grid-like arrangement.4 Histologically, the lines correspond to increased pigmentation along elongated rete ridges because of an increased density of melanocytes and pigmented keratinocytes per unit area.25 Conversely, the lighter “holes” among the pigmented lines correspond to the suprapapillary plates (Fig 2).25 Regular pigment network is common in melanocytic nevi but can also be seen in nonmelanocytic lesions, such as dermatofibromas or accessory nipples (Table II).17, 20 Atypical pigment network lines varying in size, color, thickness, or distribution are more commonly found in dysplastic nevi and superficial spreading melanoma.4 Histologically, atypical pigment network reveals disarrangement of the rete ridges with pleomorphic melanocytes and changes in melanin distribution within the epithelium.26 色素網絡對應於形成網狀圖案的棕色線條，呈現格狀排列。在組織學上，這些線條對應於沿著延長的網狀脊增加的色素沉著，因為每單位面積的黑色素細胞和有色角質細胞的密度增加。相反，色素線條之間較淺的“孔洞”對應於超乳頭板（圖 2）。規則的色素網絡在黑色素細胞痣中很常見，但也可以在非黑色素細胞病變中看到，例如皮膚纖維瘤或附屬乳頭（表 II）。不典型的色素網絡線條在大小、顏色、厚度或分佈上變化，通常在發育不良的痣和表淺擴散型黑色素瘤中更常見。在組織學上，不典型的色素網絡顯示網狀脊的排列混亂，伴隨著多形性黑色素細胞和表皮內黑色素分佈的變化。
Fig 2. Junctional nevus. The presence of pigment network on dermoscopy (A) corresponds histologically to the presence of nevomelanocytes and pigmented keratinocytes along the dermal-epidermal junction (B). 圖 2. 交界痣。在皮膚鏡下出現的色素網絡（A）在組織學上對應於真皮-表皮交界處存在的痣黑素細胞和色素角質細胞（B）。
Negative network (lines, reticular, hypopigmented, around brown clods) 負網絡（線狀、網狀、低色素、圍繞棕色塊）
Negative network consists of serpiginous hypopigmented lines that surround hyperpigmented, elongated-to-curvilinear globular structures.27 One study suggested that the negative network corresponds to hypopigmented elongated rete ridges bridging and surrounding large nests of melanocytes within the dermal papillae.6 However, another study could not corroborate these findings.27 Negative network occurs in Spitz nevi and in melanomas,28 specifically melanomas arising in nevi (Fig 1).29, 30 陰性網絡由環繞著高色素、呈長條至曲線狀的球狀結構的蛇行低色素線組成。一項研究建議陰性網絡對應於低色素的延長網狀脊，這些脊橋接並環繞著真皮乳頭內的大型黑色素細胞巢。然而，另一項研究無法證實這些發現。陰性網絡出現在斯皮茨痣和黑色素瘤中，特別是發生在痣中的黑色素瘤（圖 1）。29, 30
Angulated lines (lines, angulated or polygonal) 角度線（線，角度或多邊形）
Angulated lines are linear lines forming a zigzag pattern. These lines can coalesce into polygons with the most common being a rhomboid. When present in the face, these structures are called rhomboidal structures4 and are highly suggestive of lentigo maligna.31, 32 Outside the face they are called polygons and are suggestive of lentiginous melanomas of chronically sun-exposed skin.33 Histologically, angulated lines correspond to a flattened DEJ with fewer and more attenuated rete ridges, proliferation of confluent atypical junctional melanocytes, and dermal melanophages.34 However, it remains elusive as to why these structures occur in a linear, zigzag, polygonal fashion. We speculate that this may somehow be related to skin markings but have no direct evidence for this yet. 角度線是形成鋸齒形圖案的線性線條。這些線條可以合併成多邊形，最常見的是菱形。當出現在臉部時，這些結構被稱為菱形結構，並且高度暗示惡性雀斑。31, 32 在臉部以外，它們被稱為多邊形，並且暗示慢性日曬皮膚的雀斑型黑色素瘤。從組織學上看，角度線對應於扁平的表皮-真皮交界處，具有較少且更細長的網狀脊，融合的非典型交界黑色素細胞增生，以及真皮黑色素吞噬細胞。然而，這些結構為何以線性、鋸齒形、多邊形的方式出現仍然難以捉摸。我們推測這可能與皮膚標記有某種關聯，但目前尚無直接證據。
Globules (clods, small, round or oval) 小球（塊狀物，小的，圓形或橢圓形）
Globules are round to oval, usually brown to black structures that are found clustered together in aggregates of ≥3 or are found located along the periphery of a melanocytic lesion (Fig 3).4, 9, 10 Brown and black globules correspond with melanocytic nests at the DEJ or in the papillary dermis, whereas blue globules represent deeper nests located in the reticular dermis.7 Globules distributed along the perimeter of a melanocytic neoplasm correspond with the lesion's radial growth phase.4, 7 Irregular globules with increased variability in their sizes, shapes, or colors should raise suspicion for melanoma.4 Occasionally, one can see white globules that correspond with melanocytic nests displaying balloon cell changes.11 Irregular globules distributed eccentrically at the periphery of a pink to tan papulo-nodule should raise the suspicion for BAP1-inactivated melanocytic tumors.35 球狀體是圓形至橢圓形的結構，通常呈棕色至黑色，通常成群聚集在一起，數量≥3，或位於黑色素細胞病變的邊緣（圖 3）。棕色和黑色球狀體對應於在基底膜交界處或乳頭狀真皮中的黑色素細胞巢，而藍色球狀體則代表位於網狀真皮中的較深巢穴。分佈在黑色素細胞腫瘤周邊的球狀體對應於病變的放射性生長階段。不規則的球狀體在大小、形狀或顏色上變異性增加時，應引起對黑色素瘤的懷疑。偶爾可以看到白色球狀體，對應於顯示氣球細胞變化的黑色素細胞巢。在粉紅色至棕褐色的丘疹結節邊緣不規則分佈的球狀體應引起對 BAP1 失活的黑色素細胞腫瘤的懷疑。
Fig 3. On dermoscopy, globules (A) can reveal nests of nevomelanocytes located in the dermal epidermal junction or in the dermis (B). 圖 3. 在皮膚鏡檢查中，球狀物(A)可以顯示位於真皮表皮交界處或真皮中的色素母細胞巢(B)。
Streaks (lines, radial—always at the periphery) 條紋（線，放射狀—總是在邊緣）
Streaks, encompassing radial streaming and pseudopods, are radial projections that are located at the periphery of the lesion. These projections emanate from the tumor and project toward normal skin. In radial streaming the projections are linear, whereas in pseudopods the projections have small terminal knobs. While there may be differences in the rate of growth of tumors with radial streaming versus pseudopods, both structures correspond on histopathology to confluent junctional nests of pigmented melanocytes at the periphery (Fig 4).25 When streaks are located symmetrically around the entire lesion, they favor a Reed nevus. Conversely, if the streaks are located asymmetrically they favor a superficial spreading melanoma.36 條紋，包括放射狀流動和偽足，是位於病變邊緣的放射性突起。這些突起源自腫瘤，並朝向正常皮膚延伸。在放射狀流動中，突起是線性的，而在偽足中，突起則有小的末端結節。雖然放射狀流動與偽足的腫瘤生長速率可能存在差異，但這兩種結構在組織病理學上都對應於邊緣的色素黑色素細胞融合性交界巢（圖 4）。當條紋對稱地分佈在整個病變周圍時，則傾向於瑞德痣。相反地，如果條紋不對稱地分佈，則傾向於表淺擴散型黑色素瘤。
Fig 4. Reed nevus. A, Dermoscopically the lesion presented with a regular starburst pattern presenting with pseudopods (arrowhead). B, Histologically, pseudopods corresponds to confluent nests of melanocytes at the periphery. 圖 4. 瑞德痣。A、在皮膚鏡下，病變呈現出規則的星爆圖案，並帶有偽足（箭頭）。B、在組織學上，偽足對應於周邊的融合黑色素細胞巢。
Homogenous blue pattern (structureless blue) 均勻藍色圖案（無結構藍色）
Homogenous blue pattern is a structureless pattern that is characterized only by the presence of blue throughout the lesion.4 This pattern reveals a dermal population of densely pigmented melanocytes and can be seen in blue nevi, combined nevi, pigmented nodular melanoma, and primary or metastatic melanoma.7 Therefore, when evaluating a homogenous blue lesion, the clinical history is paramount; a stable, longstanding lesion favors a blue nevus, whereas a new lesion in a patient with a history of melanoma should raise the concern for metastatic melanoma. 均質藍色模式是一種無結構的模式，其特徵僅在於病變中藍色的存在。這種模式顯示出真皮中密集色素沉著的黑色素細胞，並可見於藍色痣、混合痣、色素性結節黑色素瘤以及原發性或轉移性黑色素瘤。因此，在評估均質藍色病變時，臨床病史至關重要；穩定且持久的病變傾向於藍色痣，而在有黑色素瘤病史的患者中出現的新病變則應引起對轉移性黑色素瘤的擔憂。
Dermoscopic structures present in melanocytic neoplasms located in special sites 位於特殊部位的黑色素細胞腫瘤中存在的皮膚鏡結構
In volar, facial, mucosal, and nail lesions, unique microanatomy produces different dermoscopic patterns. Descriptions of the dermoscopic features and their histopathologic correlates are described below and summarized in Table III. 在掌側、面部、黏膜和指甲病變中，獨特的微解剖結構產生不同的皮膚鏡模式。以下描述了皮膚鏡特徵及其組織病理學相關性，並在表三中進行了總結。
Table III. Dermoscopic structures present in melanocytic neoplasms located in special sites 表 III. 位於特殊部位的黑色素細胞腫瘤中存在的皮膚鏡結構
Empty Cell
Schematic illustration 示意圖
Metaphorical term 隱喻術語
Descriptive term 描述性術語
Histopathologic correlate 組織病理學相關性
Clinical association 臨床關聯
Volar skin 掌側皮膚
Parallel furrow pattern 平行溝紋模式
Lines, parallel, thin, in the furrows 線條，平行，細小，在溝槽中
Pigmented keratinocytes and melanocytes in the furrows (crista limitants) 色素角質細胞和黑色素細胞在溝槽中（邊界脊）
Acral nevus 掌蹠痣
Parallel ridge pattern 平行脊紋模式
Lines, parallel, thick, on the ridges 線條，平行，粗厚，在脊上
Melanocytes in the rete ridges associated with the acrosyringia (crista intermedia) 與頂汗腺（中脊）相關的網狀脊中的黑色素細胞
Acral melanoma 掌蹠黑色素瘤
Face 臉
Pseudonetwork 偽網絡
Structureless, brown, interrupted by follicular openings 無結構的棕色，間斷著毛囊開口
Pigmented cells in the epidermis and the dermal-epidermal junction interrupted by follicular openings 表皮中的色素細胞和被毛囊開口中斷的真皮-表皮交界處
Facial nevus 面部痣
Concentric circles (circles within circles) 同心圓（圓中之圓）
Circles, concentric; the pigmented ring can be seen within and surrounding the adnexal opening 圓圈，同心；色素環可以在附屬器開口內部及周圍看到
Junctional proliferation of atypical melanocytes along the dermal-epidermal junction with varying degrees of follicular and dermal invasion 在真皮-表皮交界處，異常黑色素細胞的交界增生伴隨著不同程度的毛囊和真皮侵襲
Lentigo maligna 惡性雀斑
Grey circles 灰色圓圈
Circles, gray; small gray rings within follicular openings 圓圈，灰色；毛囊開口內的小灰色環圈
Circles, incomplete; pigment rings that do not uniformly surround an adnexal opening 圓圈，不完整；不均勻圍繞附屬開口的色素環
Rhomboids/zig zag pattern 菱形/之字形圖案
Lines, angulated or polygonal, surrounding adnexal openings 線條，角度或多邊形，圍繞附屬器開口
Blotches with obliteration of follicles 斑塊伴毛囊消失
Structureless zone, brown black, with loss of visible adnexal openings 無結構區域，棕黑色，伴隨可見附屬器開口的喪失
Mucosa 黏膜
Dotted/globular patterns 點狀/球狀圖案
Dots or clods, round or oval, brown 圓形或橢圓形的棕色點或塊
Aggregates of melanin in the upper lamina propria 上層固有層中的黑色素聚集
Mucosal nevus, mucosal melanosis 黏膜痣，黏膜黑色素沉著
Homogenous pattern 均質模式
Structureless area, brown 無結構區域，棕色
Flattened rete ridges and acanthosis 扁平的網狀突起和棘皮症
Ring-like pattern 環狀圖案
Circles, or half-circles, brown 圓形或半圓形，棕色
Hyperpigmented epithelial cells and broadened rete ridges which skip the papillae 高色素化的上皮細胞和擴大的網狀突起，跳過乳頭
Fish scale–like pattern (variant of ring-like pattern) 魚鱗狀圖案（環狀圖案的變體）
Parallel, reticular-like or hyphal pattern 平行、網狀或菌絲狀圖案
Lines, slightly angulated, brown 線條，略微傾斜，棕色
Hyperpigmentation of the tip of the rete ridges which are distributed obliquely 網狀突起尖端的色素沉著，呈斜向分佈
Homogenous pattern with the presence of blue, gray, or white colors 均勻的圖案中出現藍色、灰色或白色
Structureless areas with blue, gray, or white color 無結構的區域呈藍色、灰色或白色
Suspicious for mucosal melanoma 懷疑為黏膜黑色素瘤
Mucosal melanoma 黏膜黑色素瘤
Regular pigmented bands 定期色素帶
Parallel lines originating from the proximal nail fold, without variation in colors, thickness or spacing 從近端指甲摺疊處起始的平行線，顏色、厚度或間距均無變化
Most likely reveals a benign condition in the nail matrix 最有可能顯示指甲基質中的良性病變
Brown: nevus; gray: lentigo 棕色：痣；灰色：日曬斑
Nails 指甲
Irregular pigmented bands 不規則色素帶
Lines origination from the proximal nail fold showing multiple colors (black, brown, gray), variation in the thickness and spacing of lines, and loss of parallelism 來自近端指甲摺的線條顯示多種顏色（黑色、棕色、灰色）、線條的厚度和間距變化，以及平行性喪失
Most likely reveals a melanoma in the nail matrix 最有可能顯示指甲基質中的黑色素瘤
Nail matrix melanoma 指甲基質黑色素瘤
Reprinted with permission of dermoscopedia contributors – Ralph Braun, Katrin Kerl. Dermoscopic structures. dermoscopedia. October 24, 2018, 20:20 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004. Accessed October 27, 2018. 經過 dermoscopedia 貢獻者的許可重印 – Ralph Braun, Katrin Kerl。皮膚鏡結構。dermoscopedia。2018 年 10 月 24 日，20:20 UTC。可在以下網址獲得：https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004。查閱日期：2018 年 10 月 27 日。
Volar skin 掌側皮膚
In palmoplantar skin, melanin tends to be located mainly in the furrows or the ridges of the dermatoglyphics, resulting in 2 predominant patterns: the parallel furrow pattern and the parallel ridge pattern. The former consists of pigment located in the furrows and is frequently associated with benign melanocytic lesions (Fig 5, Table III). Histologically, it results from nevomelanocytes preferably transferring pigment to keratinocytes located in the crista limitans (furrows).37 The parallel ridge pattern consists of pigment located on the ridges and is associated mostly with melanoma (Fig 5, Table III). It has been shown that malignant melanocytes tend to be more abundant around the rete ridges associated with the acrosyringia (crista intermedia).37 Some have hypothesized that melanoma arises from stem cells residing around the acrosyringium and have further speculated that the microenvironment associated with the crista intermedia may be more conducive to the proliferation of these malignant cells.38 在掌跖皮膚中，黑色素主要位於皮膚紋理的溝槽或脊上，形成兩種主要的模式：平行溝槽模式和平行脊模式。前者是指黑色素位於溝槽中，通常與良性黑色素細胞病變有關（圖 5，表 III）。從組織學上看，這是由於神經黑色素細胞優先將黑色素轉移到位於邊界脊（溝槽）中的角質形成細胞。平行脊模式則是指黑色素位於脊上，主要與黑色素瘤有關（圖 5，表 III）。研究顯示，惡性黑色素細胞在與腺毛孔（中間脊）相關的網狀脊周圍往往更為豐富。有些人假設黑色素瘤源自於位於腺毛孔周圍的幹細胞，並進一步推測與中間脊相關的微環境可能更有利於這些惡性細胞的增殖。
Fig 5. Melanocytic lesions located in volar skin. A, Dermoscopic image showing a parallel furrow pattern. B, The presence of a pigment in the furrows (rectangle) corresponds histologically to the presence of melanocytes in the crista limitants (arrow) and is generally indicative of a nevus. C, Dermoscopic image showing a parallel ridge pattern. D, The presence of pigment in the ridges corresponds histologically to the presence of melanocytes in the crista intermedia (arrowhead) and should raise suspicion for melanoma. 圖 5. 位於掌側皮膚的黑色素細胞病變。A，皮膚鏡影像顯示平行溝紋模式。B，溝紋中的色素存在（矩形）在組織學上對應於邊界脊中的黑色素細胞（箭頭），通常指示為痣。C，皮膚鏡影像顯示平行脊狀模式。D，脊狀中的色素存在在組織學上對應於中間脊中的黑色素細胞（箭頭頭）並應引起對黑色素瘤的懷疑。
Facial skin 面部皮膚
The microanatomy of facial skin usually reveals a flattened DEJ interrupted by numerous adnexal openings. Because of the flattened DEJ, the reticular pattern is not common on the face. Instead, pigmented lesions on the face often have a more homogeneous appearance that is interrupted by adnexal openings, leading to a pseudonetwork pattern. In other words, the pseudonetwork pattern corresponds to a brown structureless area that is interrupted by follicular openings, which in combination leads to a pattern reminiscent of a network.4 Histologically, it corresponds to pigmented cells located in the epidermis and DEJ interrupted by follicular openings.6, 31 Several dermoscopic features that disrupt the pseudonetwork have been associated with lentigo maligna. The most relevant are blotches with obliteration of the follicles, concentric circles (or circles within circles), gray circles, asymmetric follicular openings (incomplete circles), and rhomboidal structures (Fig 6, Table III).31, 39, 40 These structures represent a proliferation of atypical melanocytes along the DEJ with varying degrees of follicular and dermal invasion.6, 31, 41 Gray circles can also be seen in pigmented actinic keratosis (AK) and generally present as gray to beige homogeneous areas surrounding the hair follicle but sparing the follicular opening.42 面部皮膚的微解剖通常顯示出一個扁平的真表皮-真皮交界（DEJ），並被眾多附屬開口所打斷。由於扁平的 DEJ，面部不常見網狀圖案。相反，面部的色素病變通常呈現出更均勻的外觀，並被附屬開口所打斷，形成一種偽網狀圖案。換句話說，偽網狀圖案對應於一個棕色的無結構區域，並被毛囊開口所打斷，這種組合導致了一種類似網絡的圖案。在組織學上，它對應於位於表皮和被毛囊開口打斷的 DEJ 中的色素細胞。幾個破壞偽網狀圖案的皮膚鏡特徵與惡性雀斑有關。 最相關的是有毛囊消失的斑塊、同心圓（或圓中有圓）、灰色圓圈、不對稱的毛囊開口（不完整的圓圈）以及菱形結構（圖 6，表 III）。這些結構代表著在基底膜交界處異常黑色素細胞的增生，並伴隨著不同程度的毛囊和真皮侵襲。灰色圓圈也可以在色素性日光角化症（AK）中看到，通常呈現為圍繞毛囊的灰色至米色均勻區域，但不影響毛囊開口。
Fig 6. Lentigo maligna. A, On dermoscopy, this lesion presents with concentric circles (arrowheads), asymmetric pigmented follicular openings (arrows) and angulated lines (asterisk). B, Histologically, the presence of these findings correlates with proliferation of atypical melanocytes along the dermoepidermal junction with follicular involvement. 圖 6. 惡性雀斑。A、在皮膚鏡檢查中，這個病變呈現同心圓（箭頭尖）、不對稱的色素性毛囊開口（箭頭）和角度線條（星號）。B、在組織學上，這些發現的存在與異常黑色素細胞在真皮表皮交界處的增生以及毛囊的參與相關。
Mucosal sites 黏膜部位
The mucosal sites include the glabrous portion of the lips, the mucosal aspect of the lips, and the glabrous portion of the male and female genitalia. Few studies are available to correlate the histology of dermoscopic structures seen on mucosal sites. Clinical examination of mucosal lesions with the naked eye can be challenging because both benign melanocytic lesions and early melanoma often manifest an atypical morphology.43, 44 黏膜部位包括嘴唇的光滑部分、嘴唇的黏膜面以及男性和女性生殖器的光滑部分。關於在黏膜部位觀察到的皮膚鏡結構的組織學相關研究相對較少。用肉眼檢查黏膜病變可能具有挑戰性，因為良性黑色素細胞病變和早期黑色素瘤通常表現出非典型的形態。43, 44
Four dermoscopic structures can be seen in benign mucosal melanocytic lesions: dots/globules, structureless areas, circles including half circles (the fish scale pattern), and lines. These structures are not discussed in the 2016 IDS consensus paper because mucosal sites were not evaluated in the consensus. The dotted globular pattern presents with multiple dots/globules of similar sizes and shapes and corresponds to aggregates of melanin in the upper lamina propria.45 A homogenous pattern consists of structureless areas on dermoscopy and corresponds to flattened rete ridges along with acanthosis.45 A ring-like pattern consists of brown pigmented circles, while a fish scale–like pattern contains brown half circles. Circles/half circles in the mucosae correspond to hyperpigmented epithelial cells located along broadened rete ridges, which skip the papillae.45, 46 A hyphal pattern consists of lines resembling fungal hyphae. Histologically, lines correspond to hyperpigmentation of the tip of the rete ridges, which are oriented obliquely.45 Lines can also adopt a parallel- or reticular-like appearance.46, 47 在良性黏膜黑色素細胞病變中可以看到四種皮膚鏡結構：點/小球、無結構區域、圓形（包括半圓形，魚鱗模式）和線條。這些結構在 2016 年 IDS 共識文件中未被討論，因為共識中未評估黏膜部位。點狀小球模式呈現多個大小和形狀相似的點/小球，對應於上層固有層中的黑色素聚集。均勻模式由皮膚鏡下的無結構區域組成，對應於扁平的網狀脊和角化過度。環狀模式由棕色著色圓形組成，而魚鱗狀模式則包含棕色半圓形。黏膜中的圓形/半圓形對應於位於擴大的網狀脊上的高色素上皮細胞，這些細胞跳過乳頭。菌絲模式由類似真菌菌絲的線條組成。在組織學上，線條對應於網狀脊尖端的高色素沉著，這些線條呈斜向排列。線條也可以呈現平行或網狀的外觀。
Dermoscopically, mucosal melanomas usually reveal multiple colors and dermoscopic structures that are distributed in a disorganized manner.48 Mucosal melanomas can also contain dermoscopic features that are normally associated with cutaneous melanomas of nonspecial sites, such as regression structures or a blue-whitish veil.49 To date, the best diagnostic model to differentiate benign melanocytic lesions from melanoma found that lesions with structureless areas in addition to blue, gray, or white color was associated with 100% sensitivity and 82% specificity for mucosal melanoma.48 However, these findings are limited by the fact that most mucosal melanomas in the study were advanced lesions. Several case reports have shown that early mucosal melanomas may not show these features.50, 51 在皮膚鏡檢查中，黏膜黑色素瘤通常顯示出多種顏色和以無序方式分佈的皮膚鏡結構。黏膜黑色素瘤也可能包含通常與非特殊部位的皮膚黑色素瘤相關的皮膚鏡特徵，例如退化結構或藍白色的面紗。迄今為止，區分良性黑色素細胞病變與黑色素瘤的最佳診斷模型發現，除了藍色、灰色或白色外，具有無結構區域的病變與黏膜黑色素瘤的敏感度為 100%和特異性為 82%。然而，這些發現受到限制，因為研究中大多數黏膜黑色素瘤為晚期病變。幾個案例報告顯示，早期黏膜黑色素瘤可能不會顯示這些特徵。50, 51
Nail unit 指甲單位
The differential diagnosis for melanonychia striata or longitudinal melanonychia includes traumatism, infection, melanocytic activation (drug-induced pigmentation, lentigo, postinflammatory pigmentation) or melanocytic proliferation (nevus, melanocytic hyperplasia, or melanoma).6, 52 Dermoscopy helps distinguish between these entities and can guide the most appropriate area within the nail matrix from which to obtain a biopsy specimen (proximal vs distal). The IDS consensus statement on dermoscopic terminology did not include features that are specific to the nail unit. 黑色甲縱紋或縱向黑色甲的鑑別診斷包括外傷、感染、黑色素細胞活化（藥物引起的色素沉著、日光性雀斑、炎症後色素沉著）或黑色素細胞增生（痣、黑色素細胞增生或黑色素瘤）。6, 52 皮膚鏡有助於區分這些實體，並可以指導從指甲基質中獲取活檢樣本的最合適區域（近端與遠端）。IDS 對皮膚鏡術語的共識聲明未包括特定於指甲單位的特徵。
Pigment granules within the pigmented nail band can help distinguish whether the melanonychia is caused by melanocyte activation or proliferation. The absence of granules within a grayish colored band is highly suggestive of melanocytic activation (epithelial hyperpigmentation). In contrast, the bands caused by melanocytic proliferation are usually brown to black in color, have brown/black granules (melanin inclusions), and usually also have multiple prominent linear lines within the band.53 When evaluating melanonychia caused by melanocytic proliferation, the primary objective is to differentiate nail matrix nevi from melanoma. Melanonychia revealing multiple colors, individual lines within the band displaying irregular spacing, or lines that fail to remain parallel (loss of parallelism) should raise concern for melanoma.53 When evaluating the pigmented nail band, it is also important to examine the cuticle, hyponychium, and nail plate. The presence of pigment in the proximal nail fold (Hutchinson sign and micro-Hutchinson sign), pigmentation on the hyponychium, and nail dystrophy are associated with melanoma.53 色素顆粒在色素指甲帶內可以幫助區分黑甲是由黑色素細胞的活化還是增生所引起。灰色帶內缺乏顆粒高度暗示黑色素細胞的活化（上皮性黑色素沉著）。相對而言，由黑色素細胞增生引起的帶通常呈棕色至黑色，具有棕色/黑色顆粒（黑色素包涵物），並且通常在帶內也有多條顯著的線條。在評估由黑色素細胞增生引起的黑甲時，主要目標是區分指甲基母痣與黑色素瘤。顯示多種顏色的黑甲、帶內顯示不規則間距的單獨線條，或無法保持平行的線條（平行性喪失）應引起對黑色素瘤的擔憂。在評估色素指甲帶時，檢查指甲邊緣、指甲下緣和指甲板也很重要。近端指甲摺（哈欽森徵象和微哈欽森徵象）內的色素存在、指甲下緣的色素沉著以及指甲發育不良與黑色素瘤有關。
Dermoscopy of the free edge of the nail plate can guide where a biopsy specimen should be obtained from the nail matrix. Melanocytic lesions located in the proximal nail matrix will reveal increased pigment on the upper part of the free edge of the nail plate on dermoscopy. Conversely, pigment located in the lower part of the nail's free edge corresponds to a melanocytic lesion located in the distal nail matrix (Fig 7).54 指甲板自由邊緣的皮膚鏡檢查可以指導從指甲基質取得活檢樣本的位置。位於指甲基質近端的黑色素細胞病變在皮膚鏡檢查中會顯示指甲板自由邊緣上部的色素增加。相反，位於指甲自由邊緣下部的色素對應於位於指甲基質遠端的黑色素細胞病變（圖 7）。
Fig 7. Subungual melanoma. A, Dermoscopic image showing a pigmented band revealing irregular lines along the nail plate. B, Free-edge dermoscopy showing pigment predominantly in the lower portion of the nail plate, suggesting that the melanocytic lesion is located in the distal nail matrix. C and D, Histologic results of the nail matrix confirmed the presence of a melanoma. 圖 7. 甲下黑色素瘤。A、皮膚鏡影像顯示一條色素帶，沿著指甲板顯示不規則的線條。B、自由邊緣皮膚鏡檢查顯示色素主要位於指甲板的下部，暗示黑色素細胞病變位於遠端指甲基質。C 和 D、指甲基質的組織學結果確認了黑色素瘤的存在。
Dermoscopic structures with high specificity for nonmelanocytic neoplasms 具有高特異性的非黑色素細胞腫瘤的皮膚鏡結構
Several dermoscopic features are relatively specific to nonmelanocytic neoplasms, such as basal cell carcinoma (BCC), seborrheic keratosis (SK), and dermatofibroma (Table IV). The presence of one of these structures or a combination of these structures cannot only help in rendering a more accurate diagnosis but can also help in differentiating aggressive tumors from less aggressive tumors and help predict tumor subtypes. This is discussed in greater detail in the second article in this continuing medical education series. 幾個皮膚鏡特徵相對特定於非黑色素細胞腫瘤，例如基底細胞癌（BCC）、脂溢性角化症（SK）和皮膚纖維瘤（表 IV）。這些結構之一或這些結構的組合的存在不僅可以幫助提供更準確的診斷，還可以幫助區分侵襲性腫瘤與較不侵襲性腫瘤，並幫助預測腫瘤亞型。這在本持續醫學教育系列的第二篇文章中有更詳細的討論。
Table IV. Dermoscopic structures with high specificity for nonmelanocytic neoplasms 表 IV. 具有高特異性的非黑色素細胞腫瘤的皮膚鏡結構
Clinical association 臨床關聯
Schematic illustration 示意圖
Dermoscopic structures 皮膚鏡結構
Definition 定義
Histopathologic correlation 組織病理學相關性
BCC
Blue-gray ovoid nests, multiple blue-gray globules and dots 藍灰色橢圓形巢狀結構、多個藍灰色小球和點狀物
Clods, dots, blue/gray, not aggregated 塊狀物、點、藍色/灰色，未聚集
Large (ovoid nests) or small (globules) basal cell carcinoma nodules in the dermis; dots are small BCC nests at the DEJ or in superficial dermis 在真皮中可見大型（卵形巢狀）或小型（球狀）基底細胞癌結節；點狀為位於表皮-真皮交界處或淺層真皮的小型基底細胞癌巢狀
Leaflike areas 葉狀區域
Lines, radial, connected to a common base 線條，放射狀，連接到一個共同的基底
Pigmented BCC nests connected to each other at the DEJ 色素性基底細胞癌巢在真皮表皮交界處相互連接
Reprinted with permission from dermoscopedia contributors – Ralph Braun, Katrin Kerl. Dermoscopic structures. dermoscopedia. October 24, 2018, 20:20 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004. Accessed October 27, 2018. 經過皮膚鏡百科的貢獻者 – Ralph Braun、Katrin Kerl 的許可重印。皮膚鏡結構。皮膚鏡百科。2018 年 10 月 24 日，20:20 UTC。可在以下網址獲得：https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004。查閱日期：2018 年 10 月 27 日。
Blue-gray globules usually appear as multiple nonaggregated oval structures. Blue-gray dots usually appear as dots distributed in a random buckshot scattered pattern. Blue-gray globules correspond to small BCC tumor nests in the dermis and blue-gray dots represent small BCC aggregates at the DEJ or in superficial dermis. Ovoid nests are well-circumscribed larger blue-gray globules that correspond histologically to large BCC tumor islands in the dermis (Fig 8, A and B).4, 6, 55 The blue-gray color of these BCC tumor islands is caused by melanocyte colonization and melanization of the BCC tumor islands.56 藍灰色小球通常呈現為多個不聚集的橢圓形結構。藍灰色點通常呈現為隨機散佈的點狀圖案。藍灰色小球對應於真皮中的小基底細胞癌（BCC）腫瘤巢，而藍灰色點則代表在基底膜交界處或淺層真皮中的小基底細胞癌聚集。橢圓形巢是邊界清晰的較大藍灰色小球，組織學上對應於真皮中的大基底細胞癌腫瘤島（圖 8，A 和 B）。這些基底細胞癌腫瘤島的藍灰色是由於黑色素細胞的殖民和基底細胞癌腫瘤島的黑色素化所造成的。
Fig 8. Basal cell carcinomas showing dermoscopic features with high specificity for basal cell carcinoma. A, Dermoscopic image revealing a large ovoid nest (arrowhead). B, Histologically, this corresponded to a large BCC dermal tumor nest. C, Dermoscopic image showing a leaflike structure (arrow). D, Histologically, this corresponded to a basal cell carcinoma tumor cord connected to the epidermis and is diagnostic of superficial basal cell carcinoma. 圖 8. 基底細胞癌顯示出具有高特異性的皮膚鏡特徵。A，皮膚鏡影像顯示一個大型卵形巢（箭頭標記）。B，組織學上，這對應於一個大型基底細胞癌真皮腫瘤巢。C，皮膚鏡影像顯示一個葉狀結構（箭頭）。D，組織學上，這對應於一個連接到表皮的基底細胞癌腫瘤索，並且是淺表性基底細胞癌的診斷依據。
Leaflike areas (lines, radial, connected to a common base), and spoke wheel areas (lines, radial, converging to a central dot or clod) 葉狀區域（線條、放射狀、連接到共同基底），以及輻輪區域（線條、放射狀、匯聚到中心點或塊）
Leaflike areas are brown to blue-gray projections that are connected radially at a common base, resulting in structures that resemble the shape of leaves (Fig 8, C and D).4 A variant of the leaflike structure is the spoke wheel area, which consists of radial projections that are connected at a common central darker base. At times the radial projections are poorly defined, resulting in globular structures displaying a central dark hub (concentric structures). Histologically, all of these structures correspond to pigmented BCC nests at the DEJ and in the superficial papillary dermis.6, 55 In the absence of pigment network, the presence of any of these structures is diagnostic for BCC.57 葉狀區域是棕色至藍灰色的突起，從共同的基部放射性連接，形成類似葉子的形狀結構（圖 8，C 和 D）。葉狀結構的一種變體是輻條輪區域，由放射狀突起組成，這些突起在共同的中央較深色基部相連。有時，這些放射狀突起定義不清，導致顯示中央深色中心的球狀結構（同心結構）。在組織學上，所有這些結構對應於在基底膜交界處和表層乳頭真皮中的色素性基底細胞癌巢。6, 55 在缺乏色素網的情況下，任何這些結構的存在都是基底細胞癌的診斷依據。
Strawberry pattern (structureless, red, interrupted by follicular openings) 草莓圖案（無結構、紅色、被毛囊開口打斷）
The strawberry pattern consists of an erythematous pseudonetwork interrupted by keratin-filled follicular openings (Table IV).4, 58 This pattern is characteristic of nonpigmented AK.58 Histologically, this reveals partial thickness keratinocyte atypia, keratin in follicular ostia, and an increase in vasculature. 草莓圖案由紅斑性偽網絡組成，並被充滿角質的毛囊開口所打斷（表 IV）。這種圖案是非色素性角化病的特徵。組織學上，這顯示出部分厚度的角質細胞異型性、毛囊口的角質以及血管的增加。
White circles 白色圓圈
White circles are bright white circles surrounding an orange/yellow keratin plug (Table IV).59 Histologically, they correspond to acanthosis and hypergranulosis of the infundibular epidermis. White circles are associated with well-differentiated squamous cell carcinoma (SCC) and keratoacanthomas.59 白色圓圈是圍繞著橙色/黃色角質栓的明亮白色圓圈（表 IV）。在組織學上，它們對應於毛囊表皮的棘層增生和過度顆粒化。白色圓圈與分化良好的鱗狀細胞癌（SCC）和角質囊腫有關。
Dark dots/globules or round circles in linear arrangement (dots, clods, peripheral, arranged in lines) 黑點/小球或圓形圍繞線性排列（點、塊、周邊、排列成線）
Pigmented SCC in situ often reveals brown to gray oval to round circular structures. These structures are often distributed linearly. Histologically, they represent clusters of atypical basal pigmented keratinocytes.60 色素性原位鱗狀細胞癌通常顯示棕色至灰色的橢圓形至圓形結構。這些結構通常呈線性分佈。在組織學上，它們代表著不典型的基底色素角質細胞的聚集。
Milia-like cysts (dots or clods, white, clustered or disseminated) 類米粒囊腫（點狀或塊狀，白色，成群或散佈）
Milia-like cysts are white to yellow round structures that shine brightly4 under nonpolarized dermoscopy. Toggling between the polarized and nonpolarized light causes these structures to “blink.”61 Histologically, they correspond to intraepidermal keratin cysts (Fig 9).4, 6, 62 Multiple milia-like cysts are typical of SKs but can also be seen in melanocytic nevi, melanomas, and BCCs.62 類米粒囊腫是白色至黃色的圓形結構，在非偏振皮膚鏡下閃閃發光。切換偏振光和非偏振光會使這些結構“閃爍”。在組織學上，它們對應於表皮內角質囊腫（圖 9）。多個類米粒囊腫是皮膚角化症的典型特徵，但也可以在黑色素痣、黑色素瘤和基底細胞癌中看到。
Fig 9. Seborrheic keratosis. A, Dermoscopic image revealing comedo-like openings (arrow) and milia-like cysts (arrowhead). B, The former corresponds to epidermal invaginations filled with keratin (arrow), whereas the latter corresponds to intraepidermal keratin cysts (arrowhead). 圖 9. 脂漏性角化症。A、皮膚鏡影像顯示類粉刺的開口（箭頭）和類米粒的囊腫（箭頭尖）。B、前者對應於充滿角蛋白的表皮內凹陷（箭頭），而後者對應於表皮內的角蛋白囊腫（箭頭尖）。
Comedo-like openings and crypts (clods, brown, yellow, or orange, rarely black) 粉刺樣開口和隱窩（塊狀、棕色、黃色或橙色，罕見黑色）
Comedo-like openings are round to oval, brown to black epidermal invagination. When the invagination is larger and more elongated, it is called a crypt.4 Histologically, they correspond to epidermal invaginations filled with keratin (Fig 9).6, 62 They are typically seen in SKs but can also be present in papillomatous lesions, such as intradermal nevi. 粉刺樣開口呈圓形至橢圓形，顏色從棕色到黑色的表皮內陷。當內陷較大且更為延長時，稱為隱窩。從組織學上看，它們對應於充滿角蛋白的表皮內陷（圖 9）。它們通常在皮膚角化症中可見，但也可能出現在乳頭狀病變中，例如真皮痣。
Central white patch (structureless zone, white, central) 中央白斑（無結構區域，白色，中央）
Central white patch is a white structureless area located in the center of a lesion (Table IV).4 A central white patch in combination with a peripheral network is characteristic of dermatofibromas. Histopathologically, this feature corresponds to fibrosis in the papillary dermis.17 中央白斑是位於病變中心的無結構白色區域（表 IV）。中央白斑與周邊網絡結合的特徵是皮膚纖維瘤的特徵。在組織病理學上，這一特徵對應於乳頭真皮中的纖維化。
Nonspecific dermoscopic structures 非特異性皮膚鏡結構
Several dermoscopic features are seen in melanocytic and nonmelanocytic lesions. The description of these features and their histopathologic correlates is described below and summarized in Table V. 在黑色素細胞和非黑色素細胞病變中可以看到幾個皮膚鏡特徵。這些特徵的描述及其組織病理學相關性如下所述，並在表五中總結。
Table V. Nonspecific dermoscopic structures 表 V. 非特異性皮膚鏡結構
Schematic illustration 示意圖
Metaphorical term 隱喻術語
Descriptive term 描述性術語
Histopathologic correlate 組織病理學相關性
Clinical association 臨床關聯
Blotch 斑點
Structureless zone, brown or black 無結構區域，棕色或黑色
Aggregates of melanin in the stratum corneum or throughout all layers of the skin 角質層或皮膚各層的黑色素聚集體
Aggregates of melanocytes or melanin granules; if black, in papillary dermis; if brown, in reticular dermis 黑色素細胞或黑色素顆粒的聚集；如果是黑色，則位於乳頭狀真皮；如果是棕色，則位於網狀真皮
Structureless zone, blue with a white “ground glass” haze found over a raised area that does not occupy the entire lesion 無結構區域，藍色帶有白色“磨砂玻璃”霧氣，位於一個隆起的區域上，並不佔據整個病變
Heavily pigmented dermal melanocytes combined with compact orthokeratosis 重度色素沉著的真皮黑色素細胞結合緊密的正角化
Reprinted with permission of dermoscopedia contributors – Ralph Braun, Katrin Kerl. Dermoscopic structures. dermoscopedia. October 24, 2018, 20:20 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004. Accessed October 27, 2018. 經過 dermoscopedia 貢獻者的許可重印 – Ralph Braun, Katrin Kerl。皮膚鏡結構。dermoscopedia。2018 年 10 月 24 日，20:20 UTC。可在以下網址獲得：https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004。查閱於 2018 年 10 月 27 日。
Dots (dots, any color) 點（任何顏色的點）
Dots are round structures that are similar to, but smaller than, globules. Their size is about the size of the diameter of a terminal hair follicle.4 Brown, black, gray, and blue dots are most common in cutaneous neoplasms.6, 9 Black dots correlate with pigment in the superficial epidermis or in the stratum corneum, and occur frequently in small, heavily pigmented compound or junctional nevi (Fig 10, A and B). Brown dots correlate with small melanocytic nests in the epidermis or in the DEJ. Blue-gray dots correspond to free pigment in the papillary dermis or inside dermal melanophages (the equivalent to peppering, see below) (Fig 10, C and D). Blue-gray dots correspond to small BCC tumor nests. Red dots are equivalent to dotted vessels and can be present in multiples entities, such as Spitz nevi, keratinocyte carcinomas, and melanomas.16, 25, 63 點是圓形結構，類似但比小球體小。它們的大小約為末端毛囊直徑的大小。棕色、黑色、灰色和藍色的點在皮膚腫瘤中最為常見。黑點與表層表皮或角質層中的色素相關，並且經常出現在小型、色素沉著嚴重的複合性或交界痣中（圖 10，A 和 B）。棕色點與表皮或基底膜（DEJ）中的小型黑色素細胞巢相關。藍灰色點對應於乳頭狀真皮中的自由色素或真皮黑色素吞噬細胞內（相當於點狀色素，見下文）（圖 10，C 和 D）。藍灰色點對應於小型基底細胞癌（BCC）腫瘤巢。紅點相當於點狀血管，並且可以出現在多種實體中，例如斯皮茨痣、角質細胞癌和黑色素瘤。
Fig 10. Examples of dots on dermoscopy and their histopathologic correlates. A, In this melanocytic nevus, black dots on the network correspond to small nests located in the upper epidermis (B). C, In this melanoma, blue-gray dots, also known as peppering or granularity, correspond to melanophages (arrowhead, D) and can be associated with scar-like depigmentation (asterisk), which corresponds to dermal fibrosis (asterisk, D). 圖 10. 皮膚鏡下點狀的例子及其組織病理學相關性。A，在這個黑色素細胞痣中，網絡上的黑點對應於位於上表皮的小巢（B）。C，在這個黑色素瘤中，藍灰色的點，也稱為胡椒狀或顆粒狀，對應於黑色素吞噬細胞（箭頭，D），並且可能與類似疤痕的脫色（星號）相關，這對應於真皮纖維化（星號，D）。
Blotches (structureless zone, brown or black) 斑塊（無結構區域，棕色或黑色）
Blotches are dark brown to black structureless areas that obscure the ability to see any underlying structures.4, 9 A regular, centrally located blotch can be found in melanocytic nevi. However, blotches that appear in multiples or that are off-centered are considered irregular and increase the suspicion for melanoma.4, 64 Histologically, they represent hyperpigmentation with abundant melanin throughout the epidermis, with or without presence of pigment in the underlying dermis.63 Sometimes, blotches are caused by a heavy concentration of melanin in the stratum corneum, as can occur after an intense burst of ultraviolet exposure. When melanin is confined to the stratum corneum it is called a lamella,65 which can be stripped off with a piece of tape, thereby allowing the observer to see the underlying dermoscopic structures.66 Blotches can also be seen in SKs and BCCs. 斑塊是深棕色至黑色的無結構區域，遮蔽了觀察任何潛在結構的能力。4, 9 在黑色素細胞痣中可以找到一個規則的、位於中央的斑塊。然而，出現多個或偏心的斑塊被視為不規則，並增加了對黑色素瘤的懷疑。4, 64 從組織學上看，它們代表著表皮中豐富的黑色素過度沉積，無論底層真皮中是否存在色素。有時，斑塊是由於角質層中黑色素的高濃度所引起，這可能發生在強烈的紫外線暴露後。當黑色素局限於角質層時，稱為薄層，可以用一片膠帶剝離，從而使觀察者能夠看到底層的皮膚鏡結構。斑塊也可以在皮膚角化病和基底細胞癌中看到。
Granularity/peppering (dots, gray) and scarlike depigmentation (structureless zone, white) 顆粒感/斑點（點狀、灰色）和疤痕樣脫色（無結構區域、白色）
These 2 structures correspond with histologic regression. They can occur together or independent of each other.4 Peppering or granularity appears as fine blue-gray dots on dermoscopy. They correspond to free melanin in the dermis or inside melanophages. Peppering can be seen in melanomas, in lichen planus–like keratoses (LPLKs),4 and focally in melanocytic nevi.67 Scar-like areas are porcelain-white structureless areas lacking shiny white structures or vessels and are lighter in color than perilesional skin.4 Histologically, these areas contain dermal fibroplasia (Fig 10, C and D)25 and therefore are not optimal areas for step sectioning when grossing a suspected melanoma because they may reveal fibrosis and may lead to tumor thickness underestimation. 這兩種結構與組織學退化相對應。它們可以一起出現或彼此獨立出現。透視下的點狀或顆粒狀表現為細小的藍灰色點。它們對應於真皮中的自由黑色素或黑色素吞噬細胞內的黑色素。點狀現象可以在黑色素瘤、類扁平苔蘚角化症（LPLKs）中看到，並且在黑色素細胞痣中局部出現。類疤痕區域是缺乏光亮白色結構或血管的瓷白色無結構區域，顏色比病灶周圍的皮膚淺。從組織學上看，這些區域包含真皮纖維增生（圖 10，C 和 D），因此在對可疑黑色素瘤進行切片時，這些區域並不是最佳的切片區域，因為它們可能顯示纖維化，並可能導致腫瘤厚度的低估。
Shiny white structures (lines, dots, clods, white and shiny) 閃亮的白色結構（線條、點、塊、白色且閃亮）
Shiny white structures are only seen with polarized dermoscopy and encompass shiny white streaks, blotches, strands, and rosettes. 光滑的白色結構僅在偏光皮膚鏡下可見，並包含光滑的白色條紋、斑點、絲狀物和玫瑰花狀結構。
Shiny white streaks 光亮的白色條紋
Shiny white streaks are short white lines that are often oriented orthogonally to each other.4, 68 Histopathologically they correspond to altered dermal collagen resulting from stromal alterations (Fig 11).27, 69 They are only visible with polarized dermoscopy and may require the operator to rotate the dermoscope over the lesion as the birefringent properties depend on the angle of the collagen (angular dependence). Shiny white streaks are associated with Spitz nevi, atypical nevi, melanomas, LPLKs, and BCCs.68, 69, 70, 71 光亮的白色條紋是短的白色線條，通常彼此正交排列。4, 68 在組織病理學上，它們對應於由於基質改變而導致的改變的真皮膠原蛋白（圖 11）。27, 69 這些條紋僅在偏光皮膚鏡下可見，並可能需要操作員在病變上旋轉皮膚鏡，因為雙折射特性取決於膠原蛋白的角度（角度依賴性）。光亮的白色條紋與斯皮茨痣、非典型痣、黑色素瘤、LPLK 和基底細胞癌有關。68, 69, 70, 71
Fig 11. Invasive melanoma. A, Dermoscopic image showing a blue-whitish veil and shiny white streaks. B, The blue-whitish veil is associated with a proliferation of pigmented dermal melanocytes together with compact orthokeratosis, whereas shiny white streaks are associated with dermal fibrosis. 圖 11. 侵襲性黑色素瘤。A，皮膚鏡影像顯示藍白色的面紗和光亮的白色條紋。B，藍白色的面紗與色素性真皮黑色素細胞的增生以及緊密的正角化有關，而光亮的白色條紋則與真皮纖維化有關。
Rosettes 玫瑰花狀排列
Rosettes present as 4 round bright white dots arranged in a 4-leaf clover pattern. Rosettes occur in sun-damaged skin and have been described in AKs, SCCs, and rarely in melanomas.72, 73, 74, 75 Histologically, they correspond with hyperkeratosis of the follicular openings.74, 75 玫瑰花結呈現為四個圓形明亮白點，排列成四葉草的圖案。玫瑰花結出現在日曬損傷的皮膚中，並已在角化病、鱗狀細胞癌中描述，且在黑色素瘤中則較少見。從組織學上看，它們與毛囊開口的角化過度相對應。
Shiny white blotches and strands 光亮的白色斑點和條紋
Shiny white blotches and strands are small to large white homogenous to linear areas. The white blotches can vary in size and shape. The strands tend to be long linear white areas. These linear strands are often arranged parallel to each other and they rarely intersect.23 These structures are common in BCCs and are rarely found in melanomas and LPLKs.23, 74 Although shiny white blotches and strands are thought to correspond to fibrosis of underlying stroma, the exact histopathologic correlate remains to be elucidated. 光亮的白色斑塊和線條是小到大的白色均質到線狀區域。白色斑塊的大小和形狀可以有所不同。這些線條往往是長的線性白色區域。這些線性線條通常平行排列，並且很少相交。這些結構在基底細胞癌中很常見，而在黑色素瘤和淋巴母細胞瘤中則很少見。雖然光亮的白色斑塊和線條被認為與基底基質的纖維化相對應，但確切的組織病理學相關性仍有待闡明。
Blue-whitish veils occur in raised/palpable areas of a lesion and appear as irregular bluish blotches with overlying white ground-glass haze, occupying only part of the lesion.9, 36 A blue-whitish veil should raise concern for melanoma, but can also be seen in Reed nevi, Spitz nevi, and nonmelanocytic lesions, such as pyogenic granuloma, BCCs, and SKs.36, 76, 77 In melanocytic neoplasms, it represents heavily pigmented melanocytes and/or melanophages in the dermis with acanthosis and compact orthokeratosis (Fig 11).9, 25, 78 藍白色的面紗出現在病變的隆起/可觸及區域，並呈現為不規則的藍色斑塊，上面覆蓋著白色的磨砂玻璃霧，僅佔據病變的一部分。藍白色的面紗應引起對黑色素瘤的關注，但也可以在瑞德痣、斯皮茨痣以及非黑色素細胞病變中看到，例如化膿性肉芽腫、基底細胞癌和皮膚角化症。在黑色素細胞腫瘤中，它代表著真皮中重度色素沉著的黑色素細胞和/或黑色素吞噬細胞，伴隨有棘層增生和緊密的正角化（圖 11）。
Scale 鱗片
Common terms, such as scale or erosions, were not included in the 2016 dermoscopy terminology consensus because they are clinically identifiable without dermoscopy. Scale is common in AKs, SCC, porokeratosis, and inflammatory skin diseases. They correspond to homogenous opaque yellow to brown structures and histologically correspond to hyperkeratosis and parakeratosis.79, 80 常見的術語，如鱗屑或侵蝕，未被納入 2016 年皮膚鏡術語共識，因為它們在臨床上可以在不使用皮膚鏡的情況下識別。鱗屑在日光性角化病、鱗狀細胞癌、孔性角化症和炎症性皮膚疾病中很常見。它們對應於均勻的不透明黃色至棕色結構，並在組織學上對應於角化過度和旁角化。79, 80
Erosions and ulcerations 侵蝕和潰瘍
Erosions are small brown-red to orange-yellow crusts that histologically reveal epidermal loss.55 Multiple small erosions are suggestive of superficial BCC, but can also occur in SCC and after trauma.81 Ulcerations are larger red-to-orange structureless areas with loss of the entire epidermis to the depth of the papillary dermis. A single ulceration is characteristic of nodular BCC but can also be seen in melanoma, SCC, and after trauma.55 侵蝕是小型棕紅色至橙黃色的痂，組織學上顯示表皮喪失。多個小型侵蝕暗示表淺性基底細胞癌，但也可能出現在鱗狀細胞癌和創傷後。潰瘍是較大的紅色至橙色無結構區域，整個表皮喪失至乳頭狀真皮的深度。單一潰瘍是結節性基底細胞癌的特徵，但也可見於黑色素瘤、鱗狀細胞癌和創傷後。
Vessels 血管
While certain vessel morphologies are associated with specific disease entities (Table VI), there are no observable direct histopathology correlates for these vessels visible on routine step sections and therefore they are not detailed in this review. The morphology of the vessel seen with dermoscopy depends on the thickness of the lesion. For example, in flat lesions, the vessels are seen as red dots on dermoscopy, whereas in raised lesions the vessels can adopt a looped morphology resulting in comma or hairpin vessels.6, 82 雖然某些血管形態與特定疾病實體相關（表 VI），但在常規切片中無法觀察到這些血管的直接組織病理學相關性，因此在本綜述中未詳細說明。透過皮膚鏡觀察到的血管形態取決於病變的厚度。例如，在平坦病變中，血管在皮膚鏡下呈現為紅點，而在隆起病變中，血管則可能呈現環狀形態，導致出現逗號或髮夾形血管。6, 82
Table VI. Vessels identified on dermoscopy and typical clinical associations4, 6 表 VI. 在皮膚鏡下識別的血管及其典型臨床關聯 4, 6
Schematic illustration 示意圖
Metaphorical term 隱喻術語
Descriptive term 描述性術語
Clinical association 臨床關聯
Arborizing vessels 樹狀血管
Branched vessels, large 分支血管，大型
Basal cell carcinoma (nodular) 基底細胞癌（結節型）
Lacunae 空隙
Clods, red, purple, black 塊狀物、紅色、紫色、黑色
Angioma (red, purple lacunae, angiokeratoma (blue, black lacunae) 血管瘤（紅色、紫色腔隙）、血管角化瘤（藍色、黑色腔隙）
Reprinted with permission of dermoscopedia contributors – Ralph Braun, Katrin Kerl. Dermoscopic structures. dermoscopedia. October 24, 2018, 20:20 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004. Accessed October 27, 2018. 經過 dermoscopedia 貢獻者的許可重印 – Ralph Braun, Katrin Kerl。皮膚鏡結構。dermoscopedia。2018 年 10 月 24 日，20:20 UTC。可在以下網址獲得：https://dermoscopedia.org/w/index.php?title=Dermoscopic_structures&oldid=14004。查閱日期：2018 年 10 月 27 日。
Conclusion 結論
In conclusion, the first article in this continuing medical education series highlights the dermoscopic features for which histopathologic correlates exist. Understanding and appreciating these correlates can improve a clinician's diagnostic accuracy and can guide the clinician in selecting the most appropriate area from which to obtain a biopsy specimen. In addition, appreciating these correlates can also help inform pathologists and aid dermatopathologists in deciding the most appropriate areas within the lesion to section. 總結來說，本系列持續醫學教育的第一篇文章突顯了存在組織病理學相關的皮膚鏡特徵。理解和欣賞這些相關性可以提高臨床醫生的診斷準確性，並指導臨床醫生選擇最合適的區域以獲取活檢樣本。此外，欣賞這些相關性也可以幫助病理學家，並協助皮膚病理學家決定在病變內最合適的切片區域。
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.
M.M. Nascimento, D. Shitara, M.M. Enokihara, et al.
Inner gray halo, a novel dermoscopic feature for the diagnosis of pigmented actinic keratosis: clues for the differential diagnosis with lentigo maligna
Dermoscopy of pigmented lesions of the mucosa and the mucocutaneous junction: results of a multicenter study by the International Dermoscopy Society (IDS)
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
The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: a retrospective, case-control study
Preoperative prediction of histopathological outcome in basal cell carcinoma: flat surface and multiple small erosions predict superficial basal cell carcinoma in lighter skin types
La dermatoscopia es una técnica no invasiva que ha demostrado mejorar la precisión diagnóstica en el carcinoma basocelular (CBC). Desde la descripción inicial llevada a cabo por Menzies et al., basada fundamentalmente en hallazgos asociados a la presencia de pigmento, se ha generado una importante cantidad de bibliografía útil en la práctica clínica diaria. De una forma práctica, podemos clasificar las estructuras dermatoscópicas asociadas al diagnóstico de CBC en estructuras pigmentadas, vasculares y no pigmentadas/no vasculares. Una de las aplicaciones más recientes de la dermatoscopia en el CBC trata de pronosticar el subtipo histológico mediante el examen dermatoscópico y permite fundamentalmente diferenciar entre el CBC superficial y no superficial. Sin embargo, la dermatoscopia también nos permite sospechar variantes agresivas con mayor riesgo de recurrencia. La exploración dermatoscópica exhaustiva en el seguimiento de pacientes con daño actínico o historia de múltiples CBC posibilita la detección de lesiones muy incipientes, con repercusiones terapéuticas y pronósticas importantes.
Dermoscopy is a noninvasive technique that has been demonstrated to improve diagnostic accuracy in basal cell carcinoma (BCC). The first dermoscopic model for the diagnosis of BCC, based mainly on the identification of pigmented structures, was described by Menzies et al., and since then dermoscopy has generated an abundance of literature useful to routine clinical practice. From a practical perspective, dermoscopic structures associated with BCC can be classified as pigmented, vascular, or nonpigmented/nonvascular. One of the most recent applications of dermoscopy in BCC is as an aid to predicting histologic subtype and essentially differentiating between superficial and nonsuperficial BCC. It can also, however, help raise suspicion of more aggressive variants with a higher risk of recurrence. A thorough dermoscopic examination during follow-up of patients with actinic damage or a history of multiple BCCs can facilitate the detection of very incipient lesions and significantly impact treatment and prognosis.
Dermoscopy is a widely used non-invasive technique for diagnosing skin tumors. In melanocytic tumors, e.g., melanoma and basal cell carcinoma (BCC), the effectiveness of dermoscopic examination has been fully established over the past two decades. Moreover, dermoscopy has been used to diagnose non-melanocytic tumors. Here, we review novel findings from recent reports concerning dermoscopy of melanoma and non-melanoma skin cancers including BCC, sebaceous carcinoma, actinic keratosis, Bowen's disease, squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), extramammary Paget's disease (EMPD), and angiosarcoma.
Supported in part by National Institutes of Health/National Cancer Institute Cancer Center support grant P30 CA008748 and the Beca Excelencia Fundación Piel Sana (Dr Yélamos).
Dr Gerami has served as a consultant to and has received honoraria from Myriad Genomics, DermTech, and Castle Biosciences. Dr Marghoob has served as a consultant to and received honoraria from 3Gen. The other authors have no conflicts of interest to disclose.
