A practical review of dermoscopy for pediatric dermatology part II: Vascular tumors, infections, and inflammatory dermatoses

Abstract

In Part II of this review of pediatric dermoscopy, we will focus on the use of dermoscopy for non-melanocytic tumors, skin infections, and inflammatory rashes. Dermoscopy is a valuable tool in confirming the vascular nature of a growth and can help determine if an infantile hemangioma is at risk of ulceration. In addition, dermoscopy helps evaluate solitary papules when the diagnosis is in question. Sometimes, when our naked eye examination is unable to distinguish between entities, dermoscopy improves diagnostic accuracy to allow for appropriate management. 1 2 | VA SCUL AR AND LYMPHATI C LE S I ON S 2.1 | Infantile hemangiomas and angiokeratomas Infantile hemangiomas are benign vascular tumors that appear within the first few weeks of life. They are marked by an initial proliferative phase, followed by spontaneous involution. 2,6 Dermoscopically, hemangiomas appear as well-demarcated, round-ovoid structures composed of red lacunae, or lakes of blood, separated by white septae. 3 Dermoscopy is useful in helping to subclassify hemangiomas as superficial, deep, or mixed. 3 The lacunae in superficial hemangiomas are bright red in color, whereas those in deeper hemangiomas are marked by a blue or violaceous hue (Figure 1). 2,3 The dermoscopic findings of hemangiomas are the same as in cherry angiomas. Spider angiomas have a central red lobular appearance with arborizing thin red lines, which are easily blanchable with the dermatoscope. 4 Dermoscopy also aids in the management of infantile hemangiomas. The white color associated with impending ulceration is much easier to see with dermoscopy and in some cases might allow for expedited treatment initiation when this cannot be appreciated with the naked eye. 5 Angiokeratomas are characterized by lacunae. However, the lacunae tend to have a more violaceous hue and may have more color variability within a single lesion (red, maroon, and blue). Black lacunae are also possible and represent areas of local thrombosis.

Dermoscopic Features Summarization and Comparison of Four Types of Cutaneous Vascular Anomalies

“…However, it can be difficult to manage as a result of the atypical clinical presentation and the progression being similar to malignancy. Dermoscopy is a non-invasive tool that has been applied clinically to support the diagnosis and differential diagnosis of skin tumors ( 22 – 25 ), here we present the dermoscopic differential diagnosis of four types of cutaneous vascular anomalies from other skin disorders ( 25 – 31 ) ( Table 2 ). With dermoscopy, predominant vascular structures and other recognizable concomitant features can be observed.…”

“…Four types of cutaneous vascular anomalies IH Red/red-blue/red-white background, clustered red lacunae; polymorphous vascular structures: red globular and helical vessels; clustered serpentine vessels (25).…”

A lesion on the abdomen in an infant

“…Dermoscopy allows for enhanced visualization of structures below the stratum corneum to the level of the superficial dermis and allows for more accurate diagnosis of both melanocytic and non-melanocytic lesions. 1 To date, the utility of dermoscopy in diagnosing vascular lesions in skin of color has not been well described.…”

“…2 In darker phototypes, dermoscopy may be particularly useful in distinguishing these red lacunae from brown globules (which are seen in melanocytic lesions), and from red structureless areas with white collarettes (which are seen in pyogenic granulomas). 1 Dermoscopy of superficial port wine stain can show a uniform "lawn" of dotted and occasionally tortuous vessels, sometimes with an overlying gray-white veil if there is a deeper component. 3 In some cases, the color of lacunae on dermoscopy may help clarify the depth of the lesion (superficial IHs tend to have bright red lacunae, while the lacunae of deeper IHs may have a more blue or violaceous hue).…”

“…However, melanin can impart a blue hue; thus, one must take into consideration the patient's phototype and other clinical clues (ie, nodularity and height) when assessing depth. 1 Serial dermoscopic examination can also help to identify subtle changes in hemangiomas; a superficial white cast portending ulceration can often be more easily appreciated with a dermatoscope. 4 Infantile hemangioma is more commonly diagnosed in Caucasians compared with other ethnicities, and girls are more commonly affected than boys.…”