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July 2015

The Recognition Process in DermoscopyAnalytic Approach vs Heuristic Approach

Author Affiliations
  • 1Department of Dermatology, Sheba Medical Center, Ramat Gan and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  • 2Department of Dermatology, University Hospital Zürich, Switzerland
JAMA Dermatol. 2015;151(7):704-706. doi:10.1001/jamadermatol.2014.4810

The 2-step algorithm in dermosopy was initially developed for the diagnosis of melanoma: The first step aims to decide whether the lesion is a melanocytic or nonmelanocytic neoplasm; the clinician seeks the presence of diagnostic criteria for a melanocytic neoplasm (network, aggregated globules or streaks) or for a specific nonmelanocytic neoplasm (eg, basal cell carcinoma [BCC]). If the lesion does not fit any of the specific diagnoses, then, by default, one has to suspect that the lesion is nonetheless melanocytic in origin so as not to miss featureless melanoma. If the lesion is deemed to be melanocytic, one proceeds to the second step to decide whether it is a nevus or melanoma. Several diagnostic algorithms, including the ABCDE (asymmetry, border, color, diameter, elevation) rule, Menzies’ scoring method, the 7-point checklist, pattern analysis and CASH (color, architecture, symmetry, and homogeneity) algorithm, have been published. While the 2-step algorithm is imperfect,1 it can be easily taught to novices as a starting point for developing a personalized approach to diagnosis. The 2-step algorithm has further evolved with the advent of polarized dermoscopy and has incorporated vascular criteria into the first and second steps.2 The reproducibility among experts of the criteria used in the 2-step algorithm has also been tested.3

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