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Dermatopathology: Practical & Conceptual October - December 2008
>
3. New Insights: Dermatoscopy of unpigmented lesions of the skin: A new classification of vessel morphology based on pattern analysis
Harald Kittler, M.D.
Elisabeth Riedl, M.D.
Cliff Rosendahl, MBBS
Alan Cameron, MBBS
Background
Morphology of vessels
Patterns and arrangements
Diagnosis of unpigmented skin lesions with specificity by vascular patterns
Summary
References
SEE ALSO
-
dermatoscopy
-
pattern analysis
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Morphology of vessels
In accordance with our prior classification of structures pigmented by melanin, vessels are best described by simple geometric terms that are defined in a lucid fashion. [
3
] Consequently, we apply the terms dots, clods, and lines also to vessel morphology. Dots are tiny round spots not extending in any direction (no length and no breath), clods are well-circumscribed, solid objects larger than dots that may take any shape (length and breath), and lines are two-dimensional continuous geometric figures extending in one direction (only length but no breath). Vessels appearing as lines (linear vessels) may take different forms: Linear vessels without a bend are
straight.
Linear vessels with only one bend are
looped
if the bend is sharp (180°) and results in a reversal of direction (U-turn) and
curved
if the bend is gentle. Linear vessels with more than one bend are termed
serpentine
if the bends are arranged in a snakelike fashion,
helical
if the bends are twisted along a central axis, and
coiled
if the bends are convoluted compactly (
Fig. 1
). The additional attributes
thin
and
thick
and
short
and
long
may be applied to all types of linear vessels. The attribute
thick
should only be applied if the thickness of the vessels exceeds the diameter of normal nail fold capillaries by far. The attribute long may be used for straight,
serpentine
or
helical
vessels if they cross a significant part of the lesion.
View Figure
Fig. 1
Vascular patterns: Vessels as dots (A), clods (B), and linear vessels (C to H). Different types of linear vessels: Straight (C); looped (D), curved (E); serpentine (F), helical (G), and coiled (H).
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