Scope Alon, Benvenuto-Andrade Cristiane, Agero Anna Liza C, Marghoob Ashfaq A
Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
Dermatol Surg. 2006 Nov;32(11):1398-406. doi: 10.1111/j.1524-4725.2006.32312.x.
The first step of the two-step algorithm of dermoscopy aims at differentiating melanocytic from nonmelanocytic pigmented lesions, using a stepwise evaluation for the presence of specific dermoscopic criteria. The purpose of this article is to heighten awareness of clinicians to nonmelanocytic lesions that defy the two-step algorithm, thus simulating melanocytic lesions dermoscopically. Seborrheic keratosis, solar lentigo, dermatofibroma, and supernumerary accessory nipple may present with network-like structures. Seborrheic keratosis, dermatofibroma, subcorneal hemorrhage, basal cell carcinoma (BCC), and cutaneous metastases of breast and other cancers may contain pigmented globules. Peripheral streaks can also be seen in seborrheic keratosis and BCC. Homogenous bluish pigmentation, simulating a blue nevus, can also be seen in benign vascular lesions, Kaposi sarcoma, radiation tattoo, and BCC. This overlap of features between melanocytic and nonmelanocytic lesions suggests that integration of all dermoscopic features in the lesion, rather than a stepwise evaluation, may facilitate reaching the correct diagnosis in select cases as outlined in this article.
皮肤镜两步诊断法的第一步旨在通过逐步评估特定皮肤镜标准的存在情况，区分黑素细胞性与非黑素细胞性色素沉着病变。本文的目的是提高临床医生对那些不符合两步诊断法、在皮肤镜下类似黑素细胞性病变的非黑素细胞性病变的认识。脂溢性角化病、日光性雀斑样痣、皮肤纤维瘤和副乳头可能呈现网状结构。脂溢性角化病、皮肤纤维瘤、角膜下出血、基底细胞癌（BCC）以及乳腺癌和其他癌症的皮肤转移灶可能含有色素小球。脂溢性角化病和基底细胞癌中也可见周边条纹。良性血管病变、卡波西肉瘤、放射性纹身和基底细胞癌中也可出现类似蓝痣的均匀蓝色色素沉着。黑素细胞性和非黑素细胞性病变之间的这些特征重叠表明，如本文所述，综合病变的所有皮肤镜特征，而非进行逐步评估，可能有助于在某些病例中做出正确诊断。
