When Do You Not Use Dermoscopy?

There are a few circumstances in which dermoscopy is not necessary and where our color wheel algorithm should not be used. This is largely when it is clinically obvious that the lesion is malignant (remember the ABCDEs we discussed in Chapter 1). Typically, these tend to be more advanced lesions (but not always!) and will have multiple dermoscopic features that may not be useful in diagnosis. Furthermore, any lesions that are too thick or scaly are not indicated for dermoscopy, as you cannot appreciate features adequately.

Examples

Figure 19.1 shows an example of a clinically elevated, multicolored lesion. Any lesion that is clinically elevated and multicolored needs to be biopsied. This lesion does exhibit the associated basal cell carcinoma patterns, but sometimes lesions that are clinically obvious are dermoscopically confusing due to excessive ulceration, bleeding, or thickening of the tumor.

Figure 19.2 shows an example of a clinically elevated, multicolored lesion. Any lesion that is clinically elevated and multicolored needs to be biopsied. This lesion does exhibit the associated squamous cell carcinoma patterns, such as dotted vessels, but the dark surrounding pigmentation could be confused with melanoma. However, remember our ultimate goal is to determine whether or not to biopsy—this lesion will certainly need to be biopsied. Also, keep
in mind that clinically obvious lesions are not synonymous with advanced lesions. This lesion is still a pigment squamous cell in situ.

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