Thursday, November 26, 2009
Vessels
Check here for the vessel type you are seeing and then click on the examples to see if it matches up with your presumed diagnosis.
1 Morpholgy of vessels The following two diagrams are courtesy of Dr Cliff Rosendahl, Alan Cameron and Harald Kittler. They are a schematic representation of vessels seen in both pigmented and non pigmented skin lesions.
Vessels Dots Melanocytic lesions, Amelanotic melanoma, Psoriasis, Stasis dermatitis
Vessels Clods Basal cell carcinoma (1) Hemangiomas
Vessels Lines, straight
Vessels Lines, looped Seborrhoeic keratoses, SCC, Keratoacanthoma
Vessels Lines, curved Dermal nevi, Congenital nevi,
Vessels Lines, convoluted BCC
Vessels Lines, serpentine Many lesions BCC
Vessels Lines, helical Melanoma
Vessels Lines, coiled SCC in situ (1) (2) Rarely Seborrhoeic keratoses
2 Arrangement of vessels
Arrangement, no specific arrangement
Arrangement, clustered
Arrangement, serpiginious Clear cell acanthoma
Arrangement, radial Sebaceous hyperplasia, Keratoacanthoma
Arrangement, reticular
Arrangement, branched Particularly BCC, Keratoacanthoma (1) Dermal nevi, Rapidly growing tumours
Definition of vessels straight= no bend
looped= one bend, 180 degrees
curved= one bend, less than 180 degrees
Serpentine= much more than one bend, any degree, not convoluted compactly
Coiled=more than one bend, convoluted compactly
Spiral= more than one bend, not convoluted compactly but convoluted along a central axis
Description of vessels: 1. Monomorphic or polymorphic Monomorphic= a single type of vessel dominates by far=1 pattern
Polymorphic= more than one type of vessel => 1 pattern (Dot and helical Melanoma)
2. Which type of vessel?
3. Arrangement of vessels?
4. Descriptive modifiers that may be used: thin-thick (thick=thicker than normal nail fold capillaries) short-long (long= crossing a significant part of the lesion) Modifiers should be used rarely and only for obvious abberations from "normal"
Sometimes you are forced to try to diagnose a lesion based on its vascular pattern. This is the least specific way to diagnose lesions dermatoscopically but some types of vessels are more specific that others. The Menzies arborising or Kittler linear serpentine are highly specific for BCC but note that the vessels are well focussed and the outline is sharp.The following are some good examles from the SCCANZ blog.
1 Morpholgy of vessels The following two diagrams are courtesy of Dr Cliff Rosendahl, Alan Cameron and Harald Kittler. They are a schematic representation of vessels seen in both pigmented and non pigmented skin lesions.
Vessels Dots Melanocytic lesions, Amelanotic melanoma, Psoriasis, Stasis dermatitis Vessels Clods Basal cell carcinoma (1) Hemangiomas
Vessels Lines, straight
Vessels Lines, looped Seborrhoeic keratoses, SCC, Keratoacanthoma
Vessels Lines, curved Dermal nevi, Congenital nevi,
Vessels Lines, convoluted BCC
Vessels Lines, serpentine Many lesions BCC
Vessels Lines, helical Melanoma
Vessels Lines, coiled SCC in situ (1) (2) Rarely Seborrhoeic keratoses
2 Arrangement of vessels
Arrangement, no specific arrangement Arrangement, clustered
Arrangement, serpiginious Clear cell acanthoma
Arrangement, radial Sebaceous hyperplasia, Keratoacanthoma
Arrangement, reticular
Arrangement, branched Particularly BCC, Keratoacanthoma (1) Dermal nevi, Rapidly growing tumours
Definition of vessels straight= no bend
looped= one bend, 180 degrees
curved= one bend, less than 180 degrees
Serpentine= much more than one bend, any degree, not convoluted compactly
Coiled=more than one bend, convoluted compactly
Spiral= more than one bend, not convoluted compactly but convoluted along a central axis
Description of vessels: 1. Monomorphic or polymorphic Monomorphic= a single type of vessel dominates by far=1 pattern
Polymorphic= more than one type of vessel => 1 pattern (Dot and helical Melanoma)
2. Which type of vessel?
3. Arrangement of vessels?
4. Descriptive modifiers that may be used: thin-thick (thick=thicker than normal nail fold capillaries) short-long (long= crossing a significant part of the lesion) Modifiers should be used rarely and only for obvious abberations from "normal"
Sometimes you are forced to try to diagnose a lesion based on its vascular pattern. This is the least specific way to diagnose lesions dermatoscopically but some types of vessels are more specific that others. The Menzies arborising or Kittler linear serpentine are highly specific for BCC but note that the vessels are well focussed and the outline is sharp.The following are some good examles from the SCCANZ blog.
Wednesday, November 25, 2009
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