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Diseases Skin examination Diagnosis Additional findings
Type Color Texture Size Distribution Dermoscopic Findings Histopathology
Cutaneous squamous cell carcinoma SCC in situ (Bowen's disease)
  • Patch
  • Plaque
  • Erythematous
  • Skin colored
  • Scaly
  • Variable
  • Fair-skinned individuals: sun-exposed areas
  • In black individuals: legs, anus, and areas of chronic inflammation
  • Presence of dotted and/or glomerular vessels
  • White to yellowish surface scales
  • Red-yellowish background
  • Keratinocytic dysplasia of the epidermis
  • No infiltration into dermis
  • Pleomorphic keratinocytes
  • Hyperchromatic nuclei
  • Slow growth over the years
Invasive squamous cell carcinoma
  • Papules
  • Plaques
  • Nodules
  • Skin colored
  • Indurated + hyperkeratotic (well differentiated)
  • Soft + ulceration (poorly differentiated)
  • 0.5 to 1.5 cm
  • Fair-skinned individuals: sun-exposed areas
  • In black individuals: legs, anus, and areas of chronic inflammation
  • White circles
  • White structureless areas
  • Masses of keratin
  • Hairpin and linear-irregular vessels
  • Keratinocytic dysplasia of the epidermis
  • No infiltration into dermis
  • Pleomorphic keratinocytes
  • Hyperchromatic nuclei
  • May be painful or pruritic
Keratoacanthoma
  • Macules
  • Papules
  • May have telangiectasias
  • Skin-colored
  • Mildly erythematous
  • Prominent keratinous core in the center of the nodule
  • 1 to 2.5 cm
  • Sun-exposed areas
  • Face, neck, hands, and arms
  • White circles
  • Keratin
  • Blood spots
  • White structureless zones
  • Well-differentiated squamous epithelium
  • Central keratin core
  • Epidermal hyperplasia + large eosinophilic keratinocytes
  • Dermal inflammatory infiltrate
  • Rapid growth (within weeks)
Merkel cell carcinoma
  • Intracutaneous nodule
  • Shiny
  • Flesh-colored or bluish-red
  • Firm
  • < 1 cm
  • Sun-exposed areas
  • Head and neck
  • Upper limbs and shoulder
  • Lower limbs and hip
  • Trunk
  • Milky red areas
  • Linear
  • Irregular vessels
  • Polymorphous vessels
  • Uniform cells with large basophilic nuclei
  • Single-cell necrosis
  • Frequent mitoses
  • Lymphovascular invasion
  • Perineural invasion
  • Epidermal involvement via pagetoid spread
  • Older individuals with light skin tones
  • Rapidly growing
Basal cell carcinoma Nodular basal cell carcinoma
  • Papule
  • Flesh-colored
  • Small bump
  • Variable
  • Face
  • Focused, bright red, and branching arborizing vessels
  • Loosely arranged blue-gray dots
  • Nest-like infiltration with basaloid cells
  • May have a "rolled" border
Superficial basal cell carcinoma
  • Patch
  • Erythematous
  • Scaly
  • 1 to > 10 cm
  • Sun-exposed areas
  • Head (cheek and nose)
  • Trunk
  • Superficial fine telangiectasia
  • Shiny white to red, translucent or opaque structureless areas
  • Multiple small erosions
  • Large, hyperchromatic, oval nuclei
  • Minimal cytoplasm
  • Small basaloid nodules
  • Higher incidence in men
Sclerosing basal cell carcinoma (morpheaform)
  • Papule
  • Plaque
  • Flesh-colored
  • Slightly erythematous
  • Firm
  • Indurated
  • Indistinct borders
  • Variable
  • Sun-exposed areas
  • Whitish backround
  • Few fine arborizing vessels
  • Multiple brown dots
  • Ulceration
  • Thin columns + small nodules
  • Highly collagenized stroma
  • Expression of smooth muscle protein alpha-actin in tumor stroma
Prurigo nodules[1]
  • Dome-shaped nodules
  • Flesh-colored
  • Erythematous
  • Brown/black
  • Firm
  • Few millimeters to several centimeters
  • Extensor surfaces of the arms and legs and on the trunk
  • Upper back, abdomen, and sacrum
  • White "starburst pattern" surrounding red/brown/yellow crusts
  • Erosions
  • Hyperkeratosis
  • Thick and compact orthohyperkeratosis
  • Irregular epidermal hyperplasia
  • Focal parakeratosis with irregular acanthosis
  • Nonspecific dermal infiltrate containing WBCs
  • Nodules range in number from few to hundreds
  • Worsened by heat, sweating, or irritation from clothing
Melanoma Melanoma in situ (Lentigo Maligna)
  • Macule
  • Variable (from light to dark brown, black, pink, red, or white)
  • Smooth
  • Around 1 cm
  • Sun-damaged skin of the head or neck
  • Asymmetric, pigmented follicular openings
  • Gray angulated lines
  • Gray areas, dots, and globules
  • Circle within a circle
  • atypical spindle shaped melanocytes
  • Arranged in single cells or in small nests along the dermoepidermal junction
  • Darkening of pigmentation, sharpening of borders, or emergence of nodular areas are signs of progression to lentigo maligna melanoma
Lentigo maligna melanoma
  • Macule
  • Brown/tan
  • Freckle-like
  • Variable
  • Chronically sun-damaged areas
  • Asymmetric, pigmented follicular openings
  • Gray angulated lines
  • Gray areas, dots, and globules
  • Circle within a circle
  • "Star-burst giant cells" in epidermis
  • "Swallow's nest" sign along the dermal-epidermal junction
  • Minimal cytoplasm
  • Pale nucleus with small nucleoli
  • Usually in older individuals
Superficial spreading melanoma[2]
  • Macule
  • Plaque with irregular borders
  • Variably pigmented (red, blue, black, gray, and white)
  • Thin
  • 1 mm to > 1 cm
  • Anywhere but usually:
    • Back (men and women)
    • Lower extremities (women)
  • Asymmetry of shape
  • > 2 colors
  • Asymmetry of structures
  • Asymmetric
  • Poorly circumscribed
  • Lack cellular maturation
  • Lateral (radial) growth before vertical (invasive) growth
Nodular melanoma[3]
  • Polypoid nodule
  • Dark color
  • Lump
  • 6mm to > 1 cm
  • Trunk
  • Head
  • Neck
  • Pigment network or pseudonetwork
  • Aggregated brown or black globules
  • Blue pigmentation within lesion
  • Small dotted or comma vessels
  • Cells proliferate downwards through the skin
  • Dermal growth in isolation or in association with an epidermal component
  • Two-thirds arise in normal skin, the rest in existing moles
  • Rapidly enlarging
Acral lentiginous melanoma[4]
  • Macules
  • Patches
  • Dark brown to black
  • Raised areas
  • Ulceration
  • Bleeding
  • Variable
  • Palmar
  • Plantar
  • Subungual
  • Mucosal surfaces
  • Parallel-ridge pattern
  • Irregular diffuse pigmentation
  • Asymmetric proliferation of single melanocytes at dermoepidermal junction
  • Most common among dark skinned individuals
Amelanotic melanoma
  • Skin color
  • Slightly elevated borders
  • Lesions not pigmented since they don't produce melanin
Common nevus[5]
  • Dome-shaped nodules
  • Hypopigmented
  • Smooth surface
  • Terminal hairs often present
  • 1 cm to > 20 cm
  • Comma-shaped or curved vessels
  • Structureless light brown background
  • Residual brown thick circles around the hair follicles
Blue nevus
  • Macules
  • Papules
  • Blue
  • Variable
  • Head and neck,
  • Dorsal aspect of the distal extremities
  • Sacral area
  • Structureless blue pigmentation
  • Structureless blue and white or blue and brown on some occasions
Spitz nevus Nonpigmented Spitz nevus
  • Nodules
  • Pink
  • Variable
  • Cheek
  • Coiled vessels
  • White network over a pink to reddish background
  • Most commonly develops in children, adolescents, and young adults.
Reed-like Spitz
  • Papule
  • Heavily pigmented
  • Variable
  • Structureless black to gray center
  • Hypopigmented follicular openings
  • Peripheral streaks
  • Pseudopods
  • Globules
  • Most commonly develops in children, adolescents, and young adults.
Solar lentigo
  • Multiple spots
  • Brown
  • Around 5mm
  • Faint pigmented fingerprint structures
  • Structureless pattern
  • Light brown pseudonetwork with well-defined borders and a "moth-eaten" edge
  • melanin deposition in keratinocytes
  • linear arrangement of melanocytes at the dermoepidermal junction.
  • Associated with UV exposure and skin aging
Sebaceous hyperplasia
  • Papules
  • Skin-colored to brownish
  • Umbilicated
  • 2 - 6 mm
  • Forehead
  • Nose
  • Cheeks
  • Structureless yellow to whitish center surrounded by short linear "crown vessels"
  • Usually in middle-aged or older patients
Lichen planus-like keratosis
  • Papule
  • Plaque
  • Gray to brown
  • Variable
  • Shows a coarse or fine, gray to blue, granular pigmentation
  • Diffuse brownish gray granules
Seborrheic keratosis
  • Variable
Actinic keratosis less pigmentation, and tend to be somewhat smaller in size. Erythema Hyperkeratosis painful

SCC in situ: Frequently, there is associated thickening of the epidermis (acanthosis), as well as hyperkeratosis and parakeratosis of the stratum corneum. In contrast to SCC in situ, actinic keratoses demonstrate only partial-thickness epidermal dysplasia.

References

  1. Errichetti E, Piccirillo A, Stinco G (2015). "Dermoscopy of prurigo nodularis". J Dermatol. 42 (6): 632–4. doi:10.1111/1346-8138.12844. PMID 25808786.
  2. Argenziano G, Ferrara G, Francione S, Di Nola K, Martino A, Zalaudek I (2009). "Dermoscopy--the ultimate tool for melanoma diagnosis". Semin Cutan Med Surg. 28 (3): 142–8. doi:10.1016/j.sder.2009.06.001. PMID 19782937.
  3. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F; et al. (2003). "Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet". J Am Acad Dermatol. 48 (5): 679–93. doi:10.1067/mjd.2003.281. PMID 12734496.
  4. Phan A, Dalle S, Touzet S, Ronger-Savlé S, Balme B, Thomas L (2010). "Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population". Br J Dermatol. 162 (4): 765–71. doi:10.1111/j.1365-2133.2009.09594.x. PMID 19922528.
  5. Witt C, Krengel S (2010). "Clinical and epidemiological aspects of subtypes of melanocytic nevi (Flat nevi, Miescher nevi, Unna nevi)". Dermatol Online J. 16 (1): 1. PMID 20137743.