Dermatoscopy has become a widely used technique for diagnosis of pigmented lesions of the skin. Beginners in dermatoscopy often are confused by the lack of precise, repeatable criteria and opaque terminology. Conventional descriptions of structures observed by dermatoscopy employ images that do not correspond to those in the brain of most viewers. The language established universally is jargon of a fraternity and is not suitable for communication in a scientific discipline. What follows now are examples of nomenclature in dermatoscopy that are misleading.

The images invoked by metaphoric terms and opaque expressions result inevitably in failure to conjure the very same construct in the brain of any two individuals.

Examples: "Leaf-like areas," "fingerprint-like structures," "fat fingers," "radial streaming," "moth-eaten border," "blue gray veil," and "honeycomb-like pattern." Those images impede repeatable diagnosis by dermatoscopy and prevent rational communication between dermatoscopists.

There is no consistency in the naming of dermatoscopic structures.

Examples: "Globules" are described as "brown, black or red spherical or ovoid structures with diameters usually greater than 0.1mm," yet "large blue-gray ovoid nests" are defined as "circumscribed, blue-gray, ovoid structures larger than globules." The first definition conveys the notion that all ovoid structures greater than 0.1 mm in diameter are globules and, therefore, ovoid nests must be globules, even though a globule ("a tiny globe or ball") and a nest ("a structure resembling a bird's nest") is round, not ovoid. "Cobblestone globules" are defined as "polyglonal globules," but according to the first definition, globules are not polygonal but are either spherical or ovoid.

Some of the metaphoric terms and expressions already are part of the lexicon of dermatology and pathology, but with a meaning very different from the one assigned to it by those who are responsible for the language of dermatoscopy.

Examples: In dermatoscopy, a "blue-white veil" is defined as "irregularly marginated, confluent blue pigmentation with overlying, white, ground-glass haze," but "ground glass" is an image in dermatopathology that refers specifically to the cytoplasm of histiocytes in reticulohistiocytic granuloma. Ground glass has also been used by pathologists for cells that contain hepatitis B surface antigen in sections of tissue of liver.

"Stars in the sky" is utilized by dermatoscopists for "milia-like cysts" characterized by "cystic structures resembling cysts which often shine brightly," but that image has been employed for decades by pathologists to describe macrophages filled with droplets of lipid ("white stars") scattered between cancer cells of Burkitt"s lymphoma ("blue sky") and for "tingible bodies" in germinal centers of a pseudolymphoma ("starry-sky appearance").

Some explanations for descriptions of structures seen through a dermatoscope are wrong.

Examples: The pigment network is said to be "web-like structure consisting of brown or black lines and hypopigmented holes which create a honeycomb-like pattern." In actuality, it consists of lines that cross one another and of the spaces between those lines. The spaces are not hypopigmented, i.e., of a color lighter than that of the normal skin, but rather they are pigmented lightly.

Many terms are introduced without any definition or with tautology as a substitute for a definition.

Examples: "Typical and atypical network" and "typical and atypical vessels" are not defined properly. "Branched streaks" are described as "network fragments that are broken up," but fragments, by definition, are broken up. The terms "lacunae" and "saccules" of hemangioma are not defined at all.

Despite these limitations, dermatoscopy has still become a very popular technique for diagnosis of pigmented lesions of the skin. One of the reasons for the applicability of it was the development of simple algorithms and "scoring systems" that confined themselves to a circumscribed number of criteria. The major disadvantages of these scoring systems, however, are that they (1) are restricted to melanocytic lesions, (2) do not cover certain anatomic sites, such as the face, genitalia, and glabrous skin, (3) are based on cookbook-like recipes that tend to make the practitioner robotic rather than reflective, and (4) are far from all-inclusive by virtue of the paucity of them. All of this makes for a method simplistic and adynamic.

We sought to create a system based on terms defined clearly, precisely, and lucidly, and one that could be used for every morphologic aspect of dermatoscopy. We aimed to forge a standardized language in order to enhance communication and to reduce errors. Last, we undertook to enable the system to be applicable to every pigmented lesion on every anatomic site of the skin.

To accomplish this endeavor, we advocate a three-step procedure. First, we define simple geometric elements and basic patterns created by them. Second, we integrate information gleaned from color. Third, we distinguish specific pigmented skin lesions by way of their stereotypical presentation that results from characteristic combinations of elements, patterns (including ones vascular), and colors. These repeatable combinations of elements, patterns, and colors are referred to as "clues." Each of the three steps is then integrated into an algorithm that directs the practitioner to a diagnosis with specificity.