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Dermoscopy is a noninvasive tool that can be helpful in the diagnosis of nonpigmented skin tumors. This is because dermoscopy permits the visualization of key vascular structures that are usually not visible to the naked eye. Much work has concentrated on the identification of specific morphologic types of vessels that allow a classification into melanocytic versus nonmelanocytic and benign versus malignant nonpigmented skin tumors. Among a broad spectrum of different types of vascular patterns, six main morphologies can be identified. These are comma-like, dotted, linear-irregular, hairpin, glomerular, and arborizing vessels. With some exceptions, comma, dotted, and linear irregular vessels are associated with melanocytic tumors, while the latter three vascular types are generally indicative of keratinocytic tumors. Aside from vascular morphology, the architectural arrangement of vessels within the tumor and the presence of additional dermoscopic clues are equally important for the diagnosis. This article provides a general overview of the dermoscopic evaluation of nonpigmented skin tumors and is divided into two parts. Part I discusses the dermoscopic vascular patterns of benign and malignant melanocytic skin tumors. Part II discusses the dermoscopic vascular patterns of benign and malignant nonmelanocytic nonpigmented skin tumors. In each part, additional special management guidelines for melanocytic and nonmelanocytic nonpigmented skin tumors, respectively, will be discussed.

A B S T R A C T PurposePrimary care physicians (PCPs) constitute an appropriate target for new interventions and educational campaigns designed to increase skin cancer screening and prevention. The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard clinical examination improves the accuracy of PCPs to triage lesions suggestive of skin cancer. Patients and MethodsPCPs in Barcelona, Spain, and Naples, Italy, were given a 1-day training course in skin cancer detection and dermoscopic evaluation, and were randomly assigned to the dermoscopy evaluation arm or naked-eye evaluation arm. During a 16-month period, 73 physicians evaluated 2,522 patients with skin lesions who attended their clinics and scored individual lesions as benign or suggestive of skin cancer. All patients were re-evaluated by expert dermatologists at clinics for pigmented lesions. Referral accuracy of both PCP groups was calculated by their scores, which were compared to those tabulated for dermatologists. ResultsReferral sensitivity, specificity, and positive and negative predictive values were 54.1%, 71.3%, 11.3%, and 95.8%, respectively, in the naked-eye arm, and 79.2%, 71.8%, 16.1%, and 98.1%, respectively, in the dermoscopy arm. Significant differences were found in terms of sensitivity and negative predictive value (P ϭ .002 and P ϭ .004, respectively). Histopathologic examination of equivocal lesions revealed 23 malignant skin tumors missed by PCPs performing naked-eye observation and only six by PCPs using dermoscopy (P ϭ .002). ConclusionThe use of dermoscopy improves the ability of PCPs to triage lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations. J Clin Oncol 24:1877-1882. © 2006 by American Society of Clinical Oncology INTRODUCTIONSkin cancer is the most common malignancy in whites and accounts for about one third of all cancers diagnosed per year.1 Melanoma is often lethal but can usually be cured if diagnosed early. Nonmelanoma skin cancer (including basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) is seldom lethal, but if advanced, can cause severe disfigurement. Early detection and treatment, therefore, is the best strategy to reduce mortality and morbidity associated with melanoma and nonmelanoma skin cancers, respectively.The clinical diagnosis of skin cancer is based on several morphologic features pertaining to the shape, elevation, surface, and color of the tumor. The simple morphologic features summarized by the asymmetry, border irregularity, color variegation, and diameter Ͼ 5 mm (ABCD) rule are currently widely used for diagnosing skin cancer, particularly melanoma.2 However, ABCD criteria achieve only 65% to 80% sensitivity. 3 The ABCD rule fails to recognize melanomas that are small (Ͻ 6 mm) 4 or that exhibit regular shape and homogeneous color. On the other hand, a variety of benign pigmented skin lesions mimic melanoma clinically, resulting in unnecessary excisions.For diagnosis of skin cancer, dermoscopy has be...