Saturday, July 12, 2008

The Analysis

This is a trial website to work out how best to illustrate Harald Kittler's algorithm for dermatoscopic diagnosis. There are links under the relevant diagnostic trees to sections of where we hope to have examples of each of the diagnostic features but this will take a little while to populate. Many thanks to Harald for allowing us to copy some of his artwork.



For more than one pattern go to this post

If one pattern choose the pattern from the algorithm path below. Lines take precedence over the others with pseudopods next and the others in the sequence below with structureless last!


4  If  lines reticular (net like) then look at colour and thickness.

1 Pattern Reticular 1 Colour

Thin and brown    Solar lentigo , Clark nevus
Thick and brown Reticulate seborrhoeic keratosis Clark nevus Congenital nevus superficial
Black                   Ink spot lentigo (1) Reed nevus

5 Lines reticular with more than one colour. If any black eccentric (ie at the edges) think of melanoma.

1 Pattern Reticular more than 1 Colour

Dark brown or black centric Clark nevus
Dark brown and light brown speckled Congenital nevus superficial Nevus spilus Clark nevus Solar lentigo
Dark brown or black eccentric Clark nevus Melanoma in situ
Variegate Congenital nevus superficial Clark nevus Melanoma in situ


8   One pattern, Lines branched usually brown or black. The Ink spot lentigo is the easiest to recognise.

1 Pattern Branched

Branched Brown Congenital nevus Clark nevus
Branched Black Ink spot lentigo

10  One pattern, Lines parallel. Check to see if in the ridges or furrows. Remember haemorrhage can give a parallel ridged pattern and not just melanoma!

1 Pattern Parallel

Ridges Brown Melanoma in situ Acral nevus Melanotic macule
Ridges Black, purple and red Hemorrhage Exogenous pigmentation
Parallel Furrows Acral nevus
Parallel perpendicular to ridges Acral nevus

12  One pattern, Lines radial. Here if peripheral , are they all the way round or only part of the way? If within a lesion then it is the Kittlerian description of the spoke wheel sign in a BCC

1 Pattern Radial

Radial peripheral circumferential Reed nevus
Radial peripheral segmental Melanoma Basal cell carcinoma
Radial central and multifocal Basal cell carcinoma (1)

14  One pattern, Lines curved  Solar lentigo or early flat seborrhoeic keratosis.

1 Pattern Curved

Lines Curved Solar lentigo

16  One pattern, Pseudopods. If definite then even a couple of pseudopods can mean a melanoma. Usually peripheral but not always. Sometimes within a lesion where a melanoma is starting.

1 Pattern Pseudopods

Pseudopods circumferential Reed nevus
Pseudopods segmental Melanoma

18  One pattern, Circles. Usually all about the colour. Gray circles are the ones to watch out for as they mean either melanoma, LPLK , Pigmented solar k or Pigmented IEC (Bowens)

1 Pattern Circles

Circles 1 colour brown Seborrhoeic keratosis Dermatofibroma Solar lentigo Clark nevus
Circles 1 colour red Solar keratosis
Circles > 1 colour brown and or yellow Seborrhoeic keratosis
Circles > 1 colour Gray or black in part Melanoma in situ LPLK Pigmented solar keratosis

20  One pattern, Clods. Again all about colour


1 Pattern Clods 1 Colour

Clods 1 colour Red Hemangiomas Vascular malformations Hemorrhage fresh in Stratum corneum
Clods 1 colour Purple Hemangioma Vascular malformations
Clods 1 colour Orange Basal cell carcinoma Seborrhoeic keratosis
Clods 1 colour Yellow and or White Seborrhoeic keratosis
Clods 1 colour Skin coloured Congenital nevus Unna or Miescher nevus Seborrhoeic keratosis acanthotic
Clods 1 colour Brown Congenital nevus superficial and deep Spitz nevus Unna or Meischer nevus
Clods 1 colour Black Hemangioma thrombosed Hemorrhage old in stratum corneum
Clods 1 colour Blue Basal Cell carcinoma (1)

1 Pattern Clods with more than 1 Colour

Clods >1Colour Yellow or white dominant Seborrhoeic keratosis
Clods >1colour Orange dominant Basal cell carcinoma Seborrhoeic keratosis
Clods >1colour Red or purple dominant Hemangiomas Vascular malformations

Clods >1colour Melanin dominant Colours symmetric Congenital nevus superficial and superficial and deep
Clods >1colour Melanin dominant Colours asymmetric Basal cell carcinoma Melanoma


24 One pattern, Dots. Again colour but watch for the gray dots which indicate LPLK, Pigmented solar k, or regressed melanoma. Dots as lines are also a feature of Pigmented IEC.

1 Pattern Dots (Look at the colour)

Dots Gray LPLK Pigmented solar keratosis Melanoma Pigmented Bowen's disease (pIEC)
Dots Brown Clark nevus Pigmented Bowen's disease (pIEC)
Dots Red Clark nevus Clear cell acanthoma Bowen's disease (IEC) Inflammatory process eg Psoriasis

26  One pattern, Structureless. Not very specific of anything but go on the colour. Blue nevus is probably the best example of the genre!


1 Pattern Structureless 1 Colour

Structureless 1 colour Black Hemorrhage old Hemangioma thrombosed
Structureless 1 colour Blue Blue nevus
Structureless 1 colour Red Hemorrhage fresh

Rarely melanocytic lesions (Clark nevus, Reed nevus, Melanoma) can be black and structureless)

1 Pattern Structureless > 1 Colour

Structureless >1colour White yellow or orange dominant Seborrhoeic keratosis acanthotic Basal cell carcinoma Amelanotic melanoma
Structureless >1colour Red dominant Hemorrhage fresh

Structureless >1colour Melanin dominant Colours symmetric Congenital nevus superficial Congenital nevus combined Blue nevus Clark nevus Spitz nevus Reed nevus
Structureless >1colour Melanin dominant Colours asymmetric Melanoma primary Melanoma metastatic

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