Dermoscopy in Skin of Color: Adapted Criteria

Overview / Definition Dermoscopy, also known as dermatoscopy or epiluminescence microscopy, is a non-invasive imaging technique that enhances the visualization of skin lesions through magnification and illumination. In patients with skin of color, the dermoscopic features of lesions can differ significantly from those seen in lighter skin types, necessitating the adaptation of dermoscopic criteria for accurate diagnosis. Epidemiology The prevalence of skin of color varies globally, with significant populations found in Africa, Asia, and among Hispanic and African American communities in the United States. Skin cancers, particularly melanoma, are often underdiagnosed in these populations due to differences in presentation and lower awareness of skin cancer risks. Melanoma is less common in individuals with skin of color but tends to be diagnosed at a later stage. Non-melanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, also present differently in darker skin types. Pathophysiology / Mechanism The pathophysiology of skin lesions in individuals with skin of color can be influenced by several factors, including melanin content, skin thickness, and the presence of underlying inflammatory conditions. Increased melanin may obscure certain dermoscopic features, making traditional evaluation methods less effective. Melanin provides some protection against ultraviolet radiation, leading to lower incidences of melanoma. However, the detection of melanoma is often delayed due to atypical presentations. Clinical Presentation Skin lesions in darker skin types may present with varied pigmentation and morphology. Common conditions include: Melanoma: Often presents as an irregularly pigmented lesion with asymmetry. Basal cell carcinoma: May appear as a pearly or translucent nodule or non-healing ulcer. Squamous cell carcinoma: Can present as a rough, scaly patch or a growing bump. Diagnosis / Workup Diagnosis in skin of color requires an awareness of spec