Differentiating dysplastic nevi from melanoma remains one of the main objectives of dermoscopy. Melanomas tend not to manifest any of the benign patterns described for nevi and instead usually display chaotic dermoscopic morphologies. Melanomas located on the face, chronically sun-damaged skin, volar surfaces, nails, and mucosal surfaces have additional features that can assist in their identification. However, some melanomas lack any defined dermoscopic structures. These so-called featureless melanomas can be identified via digital surveillance. This article reviews the melanoma-specific structures as a function of anatomic location (ie, melanomas on nonglabrous skin, face, volar surfaces, mucosae, and nails).
Key points
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Melanomas usually display an asymmetric and chaotic dermoscopic morphology.
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Most melanomas will reveal at least one of the following melanoma-specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots/globules, irregular blotch, blue-white veil, regression structures, atypical vessels, and peripheral tan structureless areas.
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Melanomas located on the face and on chronically sun-damaged skin are associated with polygonal lines. In addition, melanomas located on the face can also reveal annular-granular pattern with perifollicular granularity, asymmetric perifollicular openings, and rhomboidal structures.
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Melanomas on volar skin are associated with a parallel-ridge pattern or homogeneous pigment involving both the ridges and furrows, and melanomas of the nail unit may reveal a micro-Hutchinson sign and are linked with irregular bands with disruption of parallelism.
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Melanomas on mucosal surfaces are associated with blue, gray, or white colors.
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Featureless melanomas can be identified via digital surveillance (short-term digital dermoscopic monitoring).
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