10.5826/dpc.1304S1a308S
Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light phototypes. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of “dark skin” spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization.
text/xml
2160-9381
3537
en
Enzo Errichetti
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
systematic review
Dermoscopy of Cutaneous Neoplasms in Skin of Color – A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Review
2023-10-04
2023-05-13
2023-10-04
2023-11-27
e2023308S
Dermatol Pract Concept
Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light phototypes. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of “dark skin” spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization.
Enzo Errichetti
2023/10/04
10.5826/dpc.1304S1a308S
e2023308S
Institute of Dermatology, "Santa Maria della Misericordia" University Hospital, Udine, Italy
2160-9381
systematic review
en
e2023308S
Nakamura M, Huerta T, Williams K, Hristov AC, Tejasvi T. Dermoscopic Features of Mycosis Fungoides and Its Variants in Patients with Skin of Color: A Retrospective Analysis. Dermatol Pract Concept. 2021;11:e2021048.
Dermoscopy of Cutaneous Neoplasms in Skin of Color – A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force 
https://dpcj.org/index.php/dpc/article/download/3537/2350
    Dermoscopy of Cutaneous Neoplasms in Skin of
    Color – A Systematic review by the International
    Dermoscopy Society “Imaging in Skin of Color”
                      Task Force
         Nkechi Anne Enechukwu1, Biswanath Behera2, Delaney D Ding3, Aimilios
     Lallas4, Payal Chauhan5, Soumil Khare6, Martyna Sławińska7, Bengu Nisa Akay8,
   Balachandra S Ankad9, Yasmeen J Bhat10, Abhijeet Kumar Jha11, Feroze Kaliyadan12,
 Awatef Kelati13, Shekhar Neema14, Nisha V Parmar15, Jennifer Stein16, Richard P Usatine17,
      Keshavamurthy Vinay18, Adebola Olufunmilayo Ogunbiyi19, Enzo Errichetti20


 1 Nnamdi Azikiwe University/Nnamdi Azikiwe Teaching Hospital Nnewi, Anambra State, Nigeria
 2 Department of Dermatology and Venereology, AIIMS, Bhubaneswar, India
 3 University of Florida College of Medicine, Gainesville, FL, USA
 4 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
 5 Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
 6 Department of Dermatology, Venereology and Leprosy, AIIMS, Raipur, India
 7 Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
 8 Department of Dermatology, School of Medicine, Ankara University, Ankara, Turkey
 9 Department of Dermatology, Venereology and Leprosy, SN Medical College, Bagalkot, Karnataka, India
10 Department of Dermatology, Venereology and Leprology, Government Medical College, University of Kashmir, Srinagar, Jammu and
   Kashmir, India
11 Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India
12 Department of Dermatology, Sree Narayana Institute of Medical Sciences, Ernakulum, India
13 Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS),
   Casablanca, Morocco
14 Department of Dermatology, Venereology and Leprology, Armed Force Medical College, Pune, Maharashtra, India
15 Department of Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
16 The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
17 Department of Dermatology and Cutaneous Surgery, Department of Family and Community Medicine, University of Texas Health San
   Antonio, San Antonio, TX, USA
18 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
19 College of Medicine, University of Ibadan, Oyo State, Nigeria
20 Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy



Key words: dermoscopy, dermatoscopy, epiluminescence, tumors, neoplasia, skin of color, dark skin, black skin, ethnic skin, dark
phototype, african skin, systematic review
Citation: Enechukwu NA, Behera B, Ding DD, et al. Dermoscopy of Cutaneous Neoplasms in Skin of Color – a systematic review by
the International Dermoscopy Society “Imaging in Skin of Color” Task Force. Dermatol Pract Concept. 2023;13(4)S1:e2023308S. DOI:
https://doi.org/10.5826/dpc.1304S1a308S
Accepted: September 26, 2023; Published: October 2023
Copyright: ©2023 Enechukwu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S                                                                                1
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Emmanouil Karampinis MD,MSc, Phd, Second Dermatology Department, School of Health Sciences, Aristotle
University of Thessaloniki, Greece. Naxos Island, Cyclades, tel: 6980420401 Email: emankarampinis@gmail.com




    ABSTRACT           Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of
                       both benign and malignant skin tumors, yet literature data mainly comes from studies on light photo-
                       types. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assess-
                       ment even for skin of color. This systematic literature review evaluated published data in dark-skinned
                       patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies),
                       also providing a standardized and homogeneous terminology for reported dermoscopic findings. A
                       total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic
                       tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and
                       eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of
                       them showed a level of evidence of V (12 single case reports and six case series), with only two studies
                       featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined
                       that some neoplasms and phototypes are underrepresented in published analyses as they included only
                       small samples and mainly certain tones of “dark skin” spectrum (especially phototype IV). Therefore,
                       further studies considering such limitations are required for a better characterization.




Introduction                                                             Reviews and MetaAnalyses) guidelines. A search of the pa-
                                                                         pers published up to 30th June 2022 was carried out through
Cutaneous neoplasms are among the most relevant diseases                 the PubMed electronic database with the use of the following
in dermatologist’s clinical practice as they may cause signif-           search terms: “dermoscopy” OR “epiluminescence” OR “der-
icant issues, ranging from aesthetic/functional problems to              matoscopy” AND “skin of color” OR “dark skin” OR “black
fatal outcomes, hence a timely diagnosis is of utmost impor-             skin” OR “ethnic skin” OR “dark phototype” OR “african
tance [1,2]. In this regard, over the last decades, dermoscopy           skin” OR “indian skin”. Titles and abstracts were screened
has been showed to be helpful in assisting the early recog-              by two independent reviewers to identify articles reporting
nition of both benign and malignant skin tumors, mainly in               dermoscopic findings of both benign and malignant skin tu-
fair-skinned patients [1,2]. However, although some cutane-              mors; papers on mucosal and nail neoplasms were not con-
ous neoplasms are less frequent in skin of color (Fitzpatrick’s          sidered and non-English articles, reviews, personal opinions/
phototypes IV-VI) as the result of photoprotection provided              editorials and duplicates were excluded. A manual search
by the higher melanin content, there is growing evidence that            was also carried out by assessing the reference sections of all
skin tumors may benefit from dermoscopic assessment even                 significant studies or reviews on the topic.
for darker phototypes [3]. This is of relevant interest as clin-              Articles considered not relevant and those not mention-
ical diagnosis of such lesions may be particularly challenging           ing dermoscopic structures according to specific tumor were
in dark-skinned patients due to the lack of some clues, such             excluded after full-text reading. Only articles specifically
as lesion shade or surface changes (e.g., pigmentation and               dealing with Fitzpatrick’s phototypes IV-VI were included.
telangiectasias) [3,4].                                                  If information on the skin phototype was not provided, de-
    This review by the International Dermoscopy Society                  cision on inclusion was made based on a title/abstract/full
(IDS) Task Force on “Imaging in Skin of Color” systemat-                 text showing that the manuscript concerned “dark skin” or
ically evaluated for the first time literature data on dermos-           “skin of color” and for single cases also according to the at-
copy of both benign and malignant cutaneous neoplasms in                 tached figures. We also included papers from African, Indian
skin of color, also attempting to correlate reported dermo-              subcontinent, and Caribbean countries as most of patients
scopic terminology with a standardized methodology.                      from these areas belong to IV-VI skin phototypes. Of note,
                                                                         studies grouping light and dark phototypes with no specific

Materials and Methods                                                    subanalyses were ruled out.
                                                                              All of the retrieved studies were classified based on stan-
This systematic review was performed in accordance with                  dard definitions for diagnostic accuracy studies [5,6] and
the PRISMA (Preferred Reporting Items for Systematic                     their level of evidence was assigned according to The Oxford



2                                                                                 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
2011 Levels of Evidence [7]. Dermoscopic findings, histo-                 Dermoscopic setting (polarised vs non-polarised) was
pathological background (if available), dermoscopic setting           reported in 8/20 records (3 polarized; 3 non-polarized; 2
(polarized vs non-polarized/magnification degree), skin type          both), magnification in 7/20 records (6: x10 magnification;
of the patient (if specified), and number of cases were as-           1: x20 magnification), and dermoscopic-pathological cor-
sessed and summarized. Additionally, standardized termi-              relation in 4/20 records. Supplemental Table summarizes all
nology based on the IDS dermoscopic criteria for cutaneous            such data, along with analytical description of each of the
neoplasms validated for skin of color was specified for each          study evaluated in the review (number of patients, type of
dermoscopic finding reported in the literature [8].                   study and level of evidence), dermoscopic features, skin type
                                                                      of the patient, and corresponding terminology according to
                                                                      the IDS dermoscopic criteria for cutaneous neoplasms vali-
Results                                                               dated for skin of color. Table 1 also shows the general prev-
The initial PubMed search yielded 1287 publications which             alence (calculated from all data reported in the literature) of
were screened for relevance to the subject of review, while           dermoscopic findings of included tumors for which a stan-
10 studies were added after additional reference screening.           dardized terminology was available. Relevant findings for
A total of 29 items were admitted for full-text reading af-           each neoplasia are reported as follows; for practical purpose,
ter title and abstract screening and excluding duplicates. Of         we have grouped them according to the cellular/tissue origin.
these, nine papers were ruled out according to the exclusion          Figures 2-6 show dermoscopic clues of such conditions.
criteria, with final selection of 20 articles for the review pro-
cess. Figure 1 shows the flow chart summarizing the study             Melanocytic Neoplasms
selection procedure.                                                  Melanocytic Nevi
   The full-text review included six single case-reports, 12          Dermoscopy of melanocytic nevi has been reported to vary
case-series, and two case-control studies, thus a proportion          based on the histological subtype, localization, and skin tone
of 10% of the studies showed a level of evidence of IV, while         (in the spectrum of Fitzpatrick’s phototypes IV-VI) [9-13].
the rest of the studies displayed a level of evidence of V.           According to a case-control study by Lallas et at involving
Fourty-six different tumors were evaluated (also considering          300 patients (excluding facial and acral lesions), the main
relevant subtypes with clinical/dermoscopic peculiarities),           morphological patterns of common acquired melanocytic
including four melanocytic neoplasms, eight keratinocyte              nevi included reticular, globular and structureless, whereas
tumors, 15 adnexal cutaneous neoplasms, seven vascu-                  the most frequent pigment arrangements turned out to be
lar tumors, four connective tissue tumors, and eight cystic           uniform and “central hyperpigmentation” [9]. Such find-
­neoplasms/others; a total of 1724 instances were retrieved.          ings are consistent with data coming from other studies
Table 1 displays the number of studies and total number of            (a case-control study [10] and a case-series [11]) including a
included patients for each condition.                                 total of 455 lesions. Of note, structureless pattern and black,




         Figure 1. PRISMA flowchart displaying the selection process for study inclusion in the systematic review.



Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S                                                                            3
4
                                                                     Table 1. Total number of studies, patients and prevalence of standardized dermoscopic findings of cutaneous tumors in skin of color.
                                                                                                            Total number of instances
                                                                                              Total number [instances with dermoscopy
                                                                       Tumor                    of studies       prevalence data]                                  Dermoscopic findings* (total prevalence)**
                                                          Melanocytic neoplasms
                                                          Melanocytic nevi
                                                            Acral melanocytic nevi                 1                396 [396]           Common findings: -
                                                                                                                                        Less common findings: Lines, parallel, thin, in the furrows (43%); Lines, parallel, thin, in the furrows
                                                                                                                                        and crossing the ridges (13%); Lines, parallel, short, crossing ridges (7%); Structureless (10%);
                                                                                                                                        Lines, parallel, thick, on the ridges (1%)
                                                            Blue nevus                             1                  4 [4]             Common findings: Structureless, blue (100%)
                                                                                                                                        Less common findings:
                                                           Melanocytic nevi                       3                755 [755]           Common findings: Color: brown (76%)
                                                            (not considering specific sites                                             Less common findings: Lines, reticular (48%); Black color (20%); Structureless (16%); Lines,
                                                            or histological types)                                                      reticular (10%); Clods, small, round or oval (7%); Lines, reticular/structureless (7%); Grey color
                                                                                                                                        (7%); Blue-gray color (7%); Blue color (6%); Clods, small, round or oval + lines, reticular (3%);
                                                                                                                                        Lines, reticular + structureless (3%); Clods, small, round or oval/lines, reticular (3%); Clods, small,
                                                                                                                                        round or oval + structureless (1%); Lines reticular/clods, small, round or oval (1%); Pseudopods,
                                                                                                                                        circumferential or lines, radial, circumferential (0.6%); Red color (0.4%); White color (0.3%)
                                                          Melanoma (acrolentiginous,               2                  9 [9]             Common findings: Lines, parallel, thick, on the ridges (100%); Structureless, brown, blue, black
                                                          excluding nails)                                                              (89%); Lines, parallel, short, crossing ridges (51%)
                                                                                                                                        Less common findings: Erosion/ulceration (22%); Structureless zone, blue (11%); Irregular clods,
                                                                                                                                        small (11%); Lines, radial (always at periphery) (11%)
                                                          Keratinocytic tumors
                                                          Basal cell carcinoma (BCC)               4                109 [109]           Common findings: Dots, gray, blue or black (62%)
                                                                                                                                        Less common findings: Erosion/ulceration (46%); Lines, radial, connected to a common base (43%);
                                                                                                                                        Blue-white veil (29%); Lines, reticular, hypopigmented, around brown clods (28%); Structureless
                                                                                                                                        zone, red-white (22%); Lines, radial, converging to a central dot or clod (19%); Clods, blue to
                                                                                                                                        brown, large, clustered (18%); Dots or clods, white, clustered or disseminated (17%); Structureless
                                                                                                                                        zone, brown or black (11%); Clods, brown, yellow, or orange (rarely black) (11%); Branched
                                                                                                                                        vessels (11%); Clods, brown-blue, small (10%); Lines, reticular and thick (perilesional) (9%); Clods,
                                                                                                                                        blue, large, clustered (8%); Dots, blue and clods, blue, small (8%); Clods, white, shiny (8%); Circles,
                                                                                                                                        concentric (7%); Lines, radial (always at periphery) (6%); Structureless zone, white, central (5%);
                                                                                                                                        Looped vessels (3%); Follicular plugs (2%); Serpentine vessels (2%); Dot, non-specified color (2%);
                                                                                                                                        Structureless zone, blue (2%); Structureless zone, white (0.9%); Dots, brown (0.9%); Lines, white,
                                                                                                                                        perpendicularly (0.9%)
                                                          Keratoacanthoma                          1                  3[0]              Common findings: -




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
                                                                                                                                        Less common findings: -
                                                          Seborrheic keratosis(SK)
                                                            Classic SK                    2   30[0]       Common findings: -
                                                                                                          Less common findings: -
                                                            Dermatosis papulosa nigra     1   100 [100]   Common findings: Lines, curved and thick (59%)
                                                                                                          Less common findings: Clods, brown, yellow, or orange (rarely black) (27%); Dots or clods,
                                                                                                          white, clustered or disseminated (8%)
                                                          Squamous cell carcinoma in      4   11[11]      Common findings: Dots, gray, blue (in a peripheral clustered or linear arrangement) (64%)
                                                          situ (Bowen’s disease)                          Less common findings: Dots, brown, gray, blue (36%); Clods, brown (36%)
                                                                                                          Structureless zone, grey-white (36%); Coiled vessels, clustered (27%); Erosions/ulcerations (18%);
                                                                                                          Lines, radial (always at periphery) (18%); Coiled vessels (peripheral) (9%); Lines, blue-grey (radial)
                                                                                                          (9%); Looped vessels (9%); Lines, white (9%); Vessels (9%); Structureless, brown, and blue-grey
                                                                                                          (9%); Coiled vessels (9%); Clods (9%); Structureless, gray-black (9%)
                                                          Squamous cell carcinoma (SCC)
                                                            Pigmented                     1   3[3]        Common findings: -
                                                                                                          Less common findings: Circles, white (33%)




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
                                                            Non-pigmented                 1   4[4]        Common findings: Circles, white (75%); Erosions, ulcerations (75%); Dots, vessels (50%)
                                                                                                          Less common findings: Linear, irregular (25%); Clods, white, shiny (25%)
                                                            Not specified                 1   4[0]        Common findings: -
                                                                                                          Less common findings: -
                                                          Adnexal cutaneous neoplasms
                                                          Apocrine hidrocystoma           2   10[8]       Common findings: Structureless, gray (100%)
                                                                                                          Less common findings: Dots, brown (13%); Branched vessels (13%)
                                                          Dilated pore of Winer           1   2[2]        Common findings: Follicular plug (100%); Structureless zone, blue (100%)
                                                                                                          Less common findings: -
                                                          Eccrine hidrocystoma            1   6[6]        Common findings: Structureless area, brown (100%)
                                                                                                          Less common findings: -
                                                          Eccrine syringofibroadenoma     1   1[1]        Common findings: Clods, brown or skin colored, large and polygonal (100%); Structureless zone,
                                                                                                          gray, white, or yellow (100%); Dots, white (100%)
                                                                                                          Less common findings: -
                                                          Nevus comedonicus               1   1[1]        Common findings: Clods, brown, yellow, or orange (rarely black) (100%); Follicular plugs (100%)
                                                                                                          Less common findings: -
                                                          Nevus sebaceous                 1   7[7]        Common findings: -
                                                                                                          Less common findings: Structureless, yellow-gray (43%); Structureless, yellow, yellow- white (43%);
                                                                                                          Clods, large (43%); Lines, curved and thick, in combination with clods (29%); Dots or clods,
                                                                                                          white, clustered or disseminated (14%); Lines, curved and thick (14%); Looped vessels (14%);




5
                                                                                                          ­Linear vessels (14%)
                                                                                                                                                                                                Table 1 continues
6
                                                             Table 1. Total number of studies, patients and prevalence of standardized dermoscopic findings of cutaneous tumors in skin of color. (continued)
                                                                                                       Total number of instances
                                                                                         Total number [instances with dermoscopy
                                                                      Tumor                of studies       prevalence data]                                 Dermoscopicfindings* (total prevalence)**
                                                          Nodular hidradenoma            1            1[1]                         Common findings: Structureless, white-gray (100%); Erosions/ulcerations (100%); Dots, gray or
                                                                                                                                   blue (100%); Polymorphous vessels (100%)
                                                                                                                                   Less common findings: -
                                                          Pilomatrixoma                  1            1[1]                         Common findings: Structureless, brown/yellow (100%); Lines, reticular (100%)
                                                                                                                                   Less common findings: -
                                                          Poroma                         1            4[4]                         Common findings: Branched vessels (100); Structureless area, white (100%); Structureless, yellow/
                                                                                                                                   yellow-brown (50%); Linear vessels (50%); Looped vessels (50%); Polymorphous
                                                                                                                                   vessels (50%)
                                                                                                                                   Less common findings: Structureless zone, brown or blue-gray (25%)
                                                          Reactive eccrine               1            2[2]                         Common findings: Structureless, gray/gray-white (100%); Clods, large and polygonal (100%)
                                                          syringofibroadenoma                                                      Less common findings: -
                                                          Sebaceous adenoma              1            1[1]                         Common findings: Structureless, yellow/yellow-brown (100%); Clods, small, round or oval
                                                                                                                                   (blue-grey) (100%); Dots, brown (100%); Linear vessels (100%)
                                                                                                                                   Less common findings: -
                                                          Sebaceous hyperplasia          2            28[26]                       Common findings: Structureless yellow/yellow-brown (100%)
                                                                                                                                   Less common findings: Linear vessels, radial (46%); Dots, gray or blue (31%);
                                                                                                                                   Branched vessels (4%)
                                                          Trichoblastoma                 1            1[1]                         Common findings: Structureless, brown (100%) Dots or clods, white (100%); Structureless, white
                                                                                                                                   (100%)
                                                                                                                                   Less common findings: -
                                                          Trichoepithelioma (familial)   1            4[4]                         Common findings: Structureless zone, brown + dots or clods, white, clustered or disseminated
                                                                                                                                   (100%); Dots, brown (100%); Linear vessels (75%); Structureless zone, white (50%); Branched
                                                                                                                                   vessels (50%)
                                                                                                                                   Less common findings: Linear vessels, radial (25%)
                                                          Trichoepithelioma (solitary)   1            6[6]                         Common findings: Structureless, brown/white (100%); Dots or clods, white, clustered or
                                                                                                                                   disseminated (100%)
                                                                                                                                   Less common findings: Dots, brown (33%); Linear vessels (17%))
                                                          Vascular tumors
                                                          Angiofibroma
                                                            Facial                       3            9[5]                         Common findings: Dots, yellow/white (100%); Structureless, brown, red-brown (80%);
                                                                                                                                   Dots, brown (80%)
                                                                                                                                   Less common findings: -




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
                                                            Penile                       1            4[0]                         Common findings: -
                                                                                                                                   Less common findings: -
                                                          Angiokeratoma                 1   1[1]       Common findings: Clods, red-purple (100%); Lines, white (100%)
                                                                                                       Less common findings: -
                                                          Cherry angioma                1   10[10]     Common findings: Clods, red or purple (100%)
                                                                                                       Less common findings: Lines, reticular (peripheral), brown (20%)
                                                          Infantile hemangioma          1   1[1]       Common findings: Clods, red or purple (100%); Lines, white (100%)
                                                                                                       Less common findings:
                                                          Lymphangioma circumscriptum   1   3[0]       Common findings: -
                                                                                                       Less common findings: -
                                                          Pyogenic granuloma            1   39[0]      Common findings: -
                                                                                                       Less common findings: -
                                                          Connective tissue tumors
                                                          Dermatofibroma                4   112[112]   Common findings: Lines, reticular (71%); Structureless zone, white (63%)
                                                                                                       Less common findings: Lines: peripheral (41%); Structureless zone, white: central (36%);
                                                                                                       Structureless zone, brown (32%); Vessels (27%); Structureless zone, white: multifocal (27%);
                                                                                                       Structureless zone, brown: central (24%); Vessels: curved (21%); Vessels: dots (21%); Clods, small,




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
                                                                                                       round or oval (16%); Lines, white, perpendicularly (16%); Lines: multifocal (16%); Lines: uniform
                                                                                                       (14%); Vessels: linear (12%); Erosions/ulcerations (5%); Lines, radial (5%); Structureless zone,
                                                                                                       brown: peripheral (5%); Lines, reticular and thin (peripheral) (5%); Structureless zone, brown
                                                                                                       (central) (3%); Structureless zone, brown: eccentric (3%); Clods, brown, yellow, orange (rarely
                                                                                                       black) (3%); Lines, reticular, hypopigmented, around brown clods (3%); Dots or clods, white,
                                                                                                       clustered or disseminated (2%); Lines, reticular and thick or reticular lines that vary in color (1%);
                                                                                                       Structureless zone, blue-white (central) (1%); Lines, reticular and thin (1%); Structureless zone,
                                                                                                       white (central) (1%)
                                                          Dermatofibrosarcoma           2   2[1]       Common findings: Lines, reticular and thick or reticular lines that vary in color (100%); Lines,
                                                          protuberans                                  white, perpendicularly (100%); Serpentine vessels (100%)
                                                                                                       Less common findings: -
                                                          Fibrokeratoma                 1   5[0]       Common findings: -
                                                                                                       Less common findings: -
                                                          Neurofibroma                  1   4[0]       Common findings: -
                                                                                                       Less common findings: -
                                                                                                                                                                                             Table 1 continues




7
8
                                                              Table 1. Total number of studies, patients and prevalence of standardized dermoscopic findings of cutaneous tumors in skin of color. (continued)
                                                                                                               Total number of instances
                                                                                                 Total number [instances with dermoscopy
                                                                         Tumor                     of studies       prevalence data]                                                  Dermoscopic findings* (total prevalence)**
                                                           Cystic neoplasms and others
                                                           Epidermal cyst                        2                  11[4]                               Common findings: -
                                                                                                                                                        Less common findings: Structureless, yellow (25%); Structureless, gray (25%); Structureless zone,
                                                                                                                                                        brown (25%)
                                                           Milia                                 1                  3[0]                                Common findings: -
                                                                                                                                                        Less common findings: -
                                                           Trichilemmal cyst                     1                  5[5]                                Common findings: -
                                                                                                                                                        Less common findings: Structureless, brown (40%); Structureless, white + branched vessels (20%);
                                                                                                                                                        Structureless zone, white (central or uniform) +/- structureless zone, brown/ lines, brown, curved,
                                                                                                                                                        parallel, thin (20%); Structureless zone, white (central) +/- lines, brown, curved, parallel, thin (20%);
                                                                                                                                                        Dots, gray, blue or black (20%)
                                                           Steatocytoma multiplex                1                  1[0]                                Common findings: -
                                                                                                                                                        Less common findings: -
                                                           Mycosis fungoides (MF)
                                                             Classic MF                          1                  4[0]                                Common findings: -
                                                                                                                                                        Less common findings: -
                                                             Hypopigmented MF                    1                  4[0]                                Common findings: -
                                                                                                                                                        Less common findings: -
                                                             Folliculotropic MF                  1                  1[0]                                Common findings: -
                                                                                                                                                        Less common findings: -
                                                             Verrucous MF                        1                  2[0]                                Common findings: -
                                                                                                                                                        Less common findings: -

                                                          *Dermoscopic findings for which a standardized terminology was available; these are divided into common (prevalence ≥ 50%) and less common (prevalence < 50%)

                                                          **Total prevalence is calculated only considering studies for which prevalence data of dermoscopic findings was available




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
Figure 2. Examples of dermoscopic clues of melanocytic neoplasms/keratinocytic tumors in dark-skinned patients: Brown lines (parallel,
thin) in the furrows in acral melanocytic nevus (A); Structureless blue and black areas in blue nevus (B); Structureless blue and black areas
along with brown lines (parallel, thick) on the ridges in acrolentiginous melanoma (C); White, black and blue structureless areas along with
ulceration/erosions in nodular basal cell carcinoma (D); Numerous radial lines connected to a common base (spoke wheel-like areas) (arrow)
and a diffuse white structureless area in superficial basal cell carcinoma (E); Central hyperkeratosis and hemorrhagic areas over a diffuse
white structureless area surrounded by a brown halo in keratoacanthoma (F); Multiple brown and black dots and clods in seborrheic kerato-
sis (G); Multiple brown dots (white arrow) and few dotted vessels (black arrow) along with diffuse white-brown hyperkeratosis in Bowen’s
disease (H); Linear, irregular vessels over a diffuse white structureless area in squamous cell carcinoma (I).




blue and grey color were observed more common in Fitz-                  structureless areas with multiple shades of brown, blue,
patrick skin type VI patients, while skin type V individuals            black, and pink colors [13].
mainly showed dark brown reticular pattern [9].                             Other common findings (more than two-thirds of cases)
    Moving to special sites, Madankumar et al found parallel            included parallel ridge pattern, diffuse plantar lentigines,
furrow pattern to be the most common presentation of acral              and parallel ridge pattern of surrounding skin [13]. Fibrillar
melanocytic nevi in a case-series on 369 lesions [12]. On the           pattern of surrounding skin, peripheral hypopigmentation,
other hand, pigmented pseudonetwork was reported as the                 ulceration, and atypical fibrillar pattern were less frequent
pattern of facial melanocytic nevi in a case-series by De Giorgi        features [13]. No specification about melanoma thickness
et al, yet no specification on the number of included lesions was       was reported for all the above-mentioned instances [13].
mentioned [11]. The same study reported blue homogeneous                    Finally, irregular      streaks, irregular     globules, and
pattern as a constant finding in four instances of blue nevi [11].      blue-whitish veil were detected in a case of invasive ALM
                                                                        (Breslow’s thickness: 1.2 mm) by De Giorgi et al [11].
Melanoma
All the data retrieved from the literature concerned acral len-         Keratinocytic Tumors
tiginous melanoma (ALM). Most of the information comes                  Basal Cell Carcinoma
from the study (case-series) by Manci et al involving a to-             The main study on dermoscopy of basal cell carcinoma
tal of eight dermoscopic instances, that constantly showed              (BCC) is a retrospective observational analysis (case-series)



Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S                                                                                    9
Figure 3. Examples of dermoscopic clues of adnexal tumors in dark-skinned patients: Central black follicular plug surrounded by a blue
structureless zone in dilated pore of Winer (A); Brown-blue structureless area in eccrine hidrocystoma (B); Multiple brown-black follicular
plugs in nevus comedonicus (C); Yellow-brown and white structureless areas (in some point featuring lines, curved and thick – “cerebriform
pattern”) along with white-yellow clods (arrows) in sebaceous nevus (D); White structureless area in nodular hidradenoma (E); Yellow-white
structureless areas over a red-brown diffuse structureless area in pilomatrixoma (F).




Figure 4. Examples of dermoscopic clues of adnexal tumors in dark-skinned patients: Erosions and dotted vessels surrounded by white halo
in eccrine poroma (A); Dotted and looped vessels surrounded by white halo in eccrine poroma (B); Yellow structureless areas and linear
vessels in sebaceous adenoma (C); Yellow clods and yellow-brown structureless area in sebaceous hyperplasia (D); White structureless areas
in trichoblastoma (E); White structureless area along with a white clod in trichoepithelioma (F).



by Behera et al on 60 lesions (32 nodular, 27 superficial              (40.6%), whereas maple leaf-like area (92.5%), red-white
and 1 infiltrative subtype) [14]. The most common features             homogenous area (66.6%), multiple small erosions (59.2%),
of nodular BCC were ulceration (84.3%) and blue-white                  short fine telangiectasia (59.2%), spoke wheel-like areas
veil (81.2%), followed by brown to blue-gray ovoid nests               (55.5%) turned out to be the main findings of superficial




10                                                                              Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
Figure 5. Examples of dermoscopic clues of vascular tumors in dark-skinned patients: Brown structureless area with white dots in facial
angiofibroma (A); Red-purple clods separated by white lines in angiokeratoma (B); Red clods with reticular white lines and peripheral brown
reticular lines in cherry angioma (C); Red clods separated by brown lines in infantile hemangioma (D); Yellow and red-brown clods sepa-
rated by white or brown lines in lymphangioma circumscriptum (E); Red structureless areas along with white structureless areas in pyogenic
granuloma (F).




BCC [14]. Notably, the prevalence of all the aforementioned            Keratoacanthoma
features was found to be statistically significant for the cor-        The only available data on keratoacanthoma comes from
responding subtype (nodular vs superficial) [14]; arborizing           a case-series including three lesions that displayed keratin-­
vessels were also indicative of nodular BCC, though they               related structures, including white scales/crusts, yellow/
were seen only in 37.5% of cases [14].                                 orange crusts and central white areas, along with radially ar-
    Besides the detection of shiny white blotches/strands and          ranged hairpin vessels, linear-irregular vessels, hemorrhages,
pigmented structures (mainly leaf-like areas, blue-gray ovoid          and brown areas [15]. Of note, no specific data on their
nests, and multiple blue-gray dots/globules) in half lesions           prevalence of such findings was provided [15].
(9/18), Manci et al also commonly observed loss of normal
background pigmentation/network (72.2%), milky red area                Seborrheic Keratosis
(66.7%), and accentuated normal background pigmentation/               Dermoscopy of seborrheic keratosis has been investigated
network surrounding the lesion (55.6%) [13]. Importantly,              in two descriptive studies (case-series) involving a total of
no specification about the histological subtype was provided           30 instances (15 for each analysis) [11,15]. Reported find-
in this dermosopic analysis [13].                                      ings included “moth eaten” borders, comedo-like openings,
    Additional dermoscopic findings retrieved from the two             milia-like cysts, “fat fingers”, cerebriform pattern, “finger
above-mentioned studies [13,14] and other analyses (one                print” pattern, surface white scaling, and “parchment-like”
case-series on 30 patients [15] and one single case-report             thick crust [11,15]. Of note, prevalence of each of the afore-
[16]) included negative pigment network, concentric struc-             mentioned findings was not specified; vessels were absent in
tures, brown to blue to blue-gray aggregates, coarse pepper-           all cases [11,15].
ing, peripheral striations, follicular plugging, peri-follicular           Moving to dermatosis papulosa nigra (a variant of seb-
white rings, brown to black blotch, adherent fabric fibers,            orrheic keratosis commonly seen in dark phototypes), an
milia-like cyst, comedo-like opening, in-focus dots, central or        observational study (case-series) on 100 patients by Bhat
peripheral hypopigmentation, atypical vessel running across            et al found cerebriform pattern to be the main feature
the lesion, hemorrhages, hairpin vessels, linear-irregular ves-        (59% of cases), followed by comedo-like openings (27% of
sels, chrysalis-like structures, multiple aggregated yellow/           cases), while milia-like cysts were observed only in 8% of
white, and scales/crusts.                                              instances [17].




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S                                                                                11
Figure 6. Examples of dermoscopic clues of connective tissue tumors, cystic neoplasms and others in dark-skinned patients: Brown structure-
less area with perpendicular white lines in dermatofibroma (A); White as well as brown structureless areas in dermatofibrosarcoma protu-
berans (B); Brown structureless areas and white structureless areas and lines in fibrokeratoma (C); White structureless areas in neurofibroma
(D); Blue-grey structureless area in epidermal cyst (E); White structureless areas/clods in milia (F); Yellow structureless area in sebaceous cyst
(steatocytoma multiplex) (G); Brown thick reticular lines in patch-stage mycosis fungoides (H) (adapted from Dermoscopy in General Der-
matology for Skin of Color, Errichetti E, Lallas A, eds. CRC Press 2021); White structureless area with a few brown lines in hypopigmented
mycosis fungoides (I).




Squamous Cell Carcinoma in Situ (Bowen’s Disease)                          Squamous Cell Carcinoma
The main study on dermoscopy of Bowen’s disease is a                       Most of data on dermoscopic findings of squamous cell
case-series including eight lesions (seven pigmented and                   carcinoma (SCC) comes from a case-series by Manci
one non-pigmented) by Behera et al, who found brown to                     et al on seven instances, including three pigmented and four
blue-gray dots/globules (in a peripheral clustered or linear               non-­pigmented lesions [13]. In detail, adherent scales with
arrangement) to be the main finding (7 lesions), followed by               pigment and peripheral hypopigmentation with loss of pig-
scales (6 lesions) and light to dark brown keratotic structure-            mented network in surrounding skin were constant findings
less areas (5 lesions) [18]. Such structures were also detected            of pigmented SCC, while non-pigmented mainly showed
in other three single reports [15,19,20].                                  adherent white scale (100%) along with white circles and
     Additional findings included clustered (and less com-                 ulceration (both 75%) [13].
monly peripheral) glomerular vessels, brown to blue-gray                       Further features for pigmented SCC included milky-red
peppering (fine and coarse), blue‑grey radial lines, ulcerations/          areas and white circles, while dotted vessels, serpentine ves-
erosions, blood spots/crusts, hairpin vessels, ring-like pat-              sels, shiny white strands, peripheral hypopigmentation with
tern, ill-defined gray outer border, well-defined thin brown               loss of pigmented network seen in surrounding skin, and pe-
outer border, interconnecting white lines, and grey-white/                 ripheral islands of hyperpigmentation turned out to be addi-
red-white areas [18].                                                      tional findings of non-pigmented SCC [13].



12                                                                                  Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
   In a descriptive analysis (case-series) including four         six patients [21]. Yellow/yellow-brown homogenous area and
SCCs, Ankad et al observed white and red structureless ar-        single to multiple puncta were seen in all instances, whereas fine
eas, along with ulcerations, blood spots and polymorphic          brown to blue-grey peppering, crown vessels, linear-branching
vascular pattern (i.e., dotted, linear-irregular, arborizing,     vessels were additional findings [21]. Besides yellow globules
atypical, unspecific and hairpin vessels); no specification       and crown vessels, pale white septae and patulous follicles
about subtype (pigmented vs non-pigmented) and prevalence         were also found in another series of two instances [15].
of dermoscopic findings was available [15].
                                                                  Syringoma
Adnexal Cutaneous Neoplasms                                       Most of data on dermoscopy of syringomas comes from the
Apocrine Hidrocystoma                                             analysis (case-series) by Behera et al including 119 lesions
A total of 10 lesions have been assessed by two case-series       (1 chondroid syringoma, 24 non-pigmented syringomas, 64
[15, 21]. Grey homogenous area was found to be a constant         pigmented syringomas, 10 milium-like syringomas, and 20
finding by Behera et al in a series of 8 lesions, whereas pe-     eruptive syringomas) from 16 patients [21]. The main finding
ripheral erythema, light brown peppering and arborising           shared by all the subtypes (apart from chondroid syringoma)
vessels were observed less commonly [21].                         was the presence of milia-like cysts [21]. Other common gen-
   On the other hand, Ankad et al by analyzing two le-            eral features included yellow/yellow-brown homogeneous area
sions reported yellowish-brown homogeneous area covering          and pigment network [21]. Such findings are in line whit what
whole lesion, linear irregular vessels running across the le-     observed by Ankad et al in five instances of syringoma [15].
sion, and white globules, yet specific data on their prevalence
                                                                  Trichoepithelioma
were not specified [15].
                                                                  One study assessing dermoscopy of ten trichoepitheliomas
Dilated Pore of Winer                                             (six solitary and four familial) from nine patients is avail-
Two instances of dilated pore of Winer have been retrieved,       able [21]. Skin-colored to white homogenous area with
with central black keratotic plug and bluish white homoge-        milia-like cysts was a constant finding in both solitary and
nous areas being described in both the cases [21].                familial lesions; additionally, fine brown peppering was also
                                                                  detected in all familial instances [21]. Further features in-
Eccrine Hidrocystoma                                              cluded focal white homogenous area and linear, arborizing
Data on dermoscopy of eccrine hidrocystoma comes from             and crown vessels [21].
the observational study (case-series) by Behera et al, who as-
sessed six lesions from a single patient and constantly found     Other Adnexal Cutaneous Neoplasms
a skin-colored homogenous area [21].                              This group includes adnexal cutaneous tumors retrieved in
                                                                  the review analysis whose dermoscopic data is based on sin-
Nevus Sebaceous
                                                                  gle reports/small series, i.e., eccrine syringofibroadenoma,
Seven instances of nevus sebaceous (without secondary tu-         nevus comedonicus, nodular hidradenoma, pilomatrixoma,
mors) were evaluated by dermoscopy, with the main features        reactive eccrine syringofibroadenoma, sebaceous adenoma,
being papillary to knob-like pattern with a yellow to grey        and trichoblastoma [21]. Reported dermoscopic findings are
background and yellow to yellow-white homogenous area/            showed in Table 1/Supplemental Table.
ovoid nest (both observed in three lesions) [21]. Additional
findings included linear irregular crypts, cerebriform pattern,   Vascular Tumors
milia-like cysts, hairpin vessels, and linear vessels [21].       Angiofibroma
Poroma                                                            A total of nine instances from three analyses (two case se-
Four cases reporting dermoscopic findings of poroma have          ries and a single report) were assessed by dermoscopy
been retrieved from the literature. In detail, diffuse white      [15,21,22]. The most common feature reported by all the
structureless area and branched vessels with a round ending       studies included white/yellow-white dots [15,21,22]; other
were seen in all lesions, while further features included focal   frequent findings were, brown/reddish-brown background,
yellow to yellow-brown structureless area, linear or hairpin      unfocused vessels, and brown dots [22].
vessels, polymorphous vascular pattern, and brown to blue-
                                                                  Angiokeratoma
grey blotch [21].
                                                                  Only one instance of angiokeratoma reporting dermoscopic
Sebaceous Hyperplasia                                             findings is available, with description of pink to purplish la-
The main dermoscopic study on sebaceous hyperplasia is an         goons, whitish ground glass film, and thick septa separating
observational analysis (case-series) including 26 lesions from    each lacuna [15].




Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S                                                                         13
Cherry Angioma                                                    (no prevalence data was available): homogeneous brown-
Knowledge on dermoscopy of cherry angioma comes from              ish-white and rosy-white area, white structureless areas (tree
the descriptive analysis (case-series) by Ankad et al including   branches-like arrangement), and dotted/linear vessels [15].
10 instances [15]. In all cases, red to purplish lagoons were
                                                                  Neurofibroma
seen, while milky-white veil was prominent in older lesions
                                                                  Dermoscopic findings based on the analysis of four instances
and a rim pigment network was noted in two lesions [15].
                                                                  included in a study by Ankad et al were pink-red homoge-
Infantile Hemangioma                                              neous areas, peripheral pigment network and fissures, and
Only one case of infantile hemangioma has been investi-           scar-like white areas with star burst appearance, yet they
gated from a dermoscopic point of view, with red lacunae          prevalence was not specified [15].
and white septa being reported [23].
                                                                  Cystic Neoplasms and Others
Lymphangioma Circumscriptum                                       Epidermal Cyst, Milia and Trichilemmal Cyst
Information on dermoscopy of lymphangioma circumscrip-            Two case-series investigated dermoscopy of such lesions for
tum comes from a series of three cases, that showed pale          a total of three milia, 11 epidermal cysts, and five trichilem-
yellow/pale pink lacunae (with some of them filled with           mal cysts [15,21]. In detail, white to yellow homogeneous
purplish globules) and white septa; no prevalence data was        area was the main finding for all of them; linear (milia) or
provided [15].                                                    branching (epidermal and trichilemmal cysts) vessels were
                                                                  also reported [15,21]. Additionally, brownish peripheral
Pyogenic Granuloma
                                                                  rim was found in milia and trichilemmal cysts, while central
A total of 39 lesions were analyzed by dermoscopy in the          pore/punctum was described in epidermal cyst [15,21].
only available study (case-series). In this analysis, reddish
homogeneous areas, white collarette, white rail line and          Steatocytoma Multiplex
vascular structures were observed, yet specific data on their     A single description of this entity was retrieved, with yellow
prevalence were not provided [15].                                homogeneous area covering the entire lesion, linear vessels,
                                                                  and peripheral brown rim being reported [15].
Connective Tissue Tumors
Dermatofibroma                                                    Mycosis Fungoides
The main study on dermoscopy of dermatofibroma is the             Only one observational study (case-series) on dermoscopy
analysis (case-series) by Kelati et al including a total of 100   of mycosis fungoides (MF) was available. In this analysis,
lesions from 95 patients (mainly phototype IV) [24]. Accord-      Nakamura et al assessed 33 images from 11 patients (four
ing to this study, the most common dermoscopic features           classic MF, four hypopigmented MF, one folliculotropic MF,
(more than two-thirds of cases) included pigmented net-           and two verrucous MF), yet no data on prevalence of dermo-
work (mainly located at the periphery) and white patches          scopic findings was provided [28].
(“central scar-like” or “eccentric multiple”) [24]. Moreover,        Classic MF was reported to show striking pigmentary
central homogeneous pigmentation was also frequently re-          change, thick black lines, white rosettes, and geometric
ported (36% of cases) [24], in line with a small case-series      white lines, while hypopigmented MF was characterized by
by Giddens et al [25]. Many other additional findings have        the loss of natural pigment network [28]. On the other hand,
been described and are displayed in the Supplemental Table        follicular plugging along with hyperpigmented to violaceous
[11, 15, 24, 25].                                                 perifollicular halos and yellow-gray amorphous structures
                                                                  coupled with yellow-gray ridges/comedo-like openings
Dermatofibrosarcoma Protuberans                                   within hyperkeratotic areas were observed in folliculotropic
Two case-reports described dermoscopy of dermatofibrosar-         and verrucous MF, respectively [28].
coma protuberans [26,27]. In detail, both instances showed
atypical/interrupted network [26,27]; additionally, hyper/        Conclusions
hypo-pigmented structureless areas, shiny white streaks and
unfocused linear-irregular vessels were noted in the first case   This review emphasizes that many skin neoplasias have
[26] and a pinkish background in the second case [27].            been investigated from a dermoscopic point of view in
                                                                  dark-skinned patients with description of potentially useful
Fibrokeratoma                                                     diagnostic features, though most of available data comes
The only analysis on dermoscopy of fibrokeratoma in-              from inhomogeneous/unstructured studies either includ-
cluded five cases, with the following findings being reported     ing small samples (especially case reports/series) or lacking



14                                                                        Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S
comparative analyses, thereby results have to be confirmed               12. Madankumar R, Gumaste PV, Martires K, et al. Acral melano-
through studies with a more robust statistical design. More-                 cytic lesions in the United States: Prevalence, awareness, and
                                                                             dermoscopic patterns in skin-of-color and non-Hispanic white
over, available information for some tumors concerns only
                                                                             patients. J Am Acad Dermatol. 2016;74:724-30.
some tones of “dark skin” spectrum (especially phototype
                                                                         13. Manci R, Dauscher M, Marchetti MA et al. Features of skin can-
IV). Nevertheless, the possible correspondence between                       cer in black individuals: a single-institution retrospective cohort
histopathological changes of cutaneous tumors and dermo-                     study. Dermatol Pract Concept. 2022;12:e2022075.
scopic findings even in skin of color makes oncological der-             14. Behera B, Kumari R, Thappa DM, Gochhait D, Srinivas BH,
moscopy a potential useful aid in dark phototypes too [8].                   Ayyanar P. Dermoscopic features of basal cell carcinoma in skin
                                                                             of color: A retrospective cross-sectional study from Puducherry,
Future comprehensive studies using a homogeneous/stan-
                                                                             South India. Indian J Dermatol Venereol Leprol. 2023;89:
dardized approach will help in this regard.
                                                                             254-260.
                                                                         15. Ankad BS, Sakhare PS, Prabhu MH. Dermoscopy of non-­

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