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Which criteria can be used to diagnose a melanocytic lesion?

A. Milia-like cysts and pigmented pseudofollicular openings

B. Arborizing vessels, ulceration, and pigmentation

C. A central white patch plus fine peripheral pigment network

D. Lacunae and black homogenous blotches

E. Pigment network, brown globules, homogeneous blue color, or parallel patterns

E. Criteria to diagnose a melanocytic lesion include any variation of pigment network (regular and/or irregular), multiple brown dots and/or globules, homogeneous blue color of a blue nevus, and parallel patterns seen on acral skin. The default category is the last way to diagnose a melanocytic lesion. Milia-like cysts and follicular openings can be seen in melanocytic lesions but are not primary criteria to make the diagnosis. Answers A, B, and C diagnose a basal cell carcinoma, dermatofibroma, and hemangioma.

Diagnosing a melanocytic lesion by default means that:

A. There are high-risk criteria at the periphery of the lesion that are hard to identify.

B. There are criteria for a seborrheic keratosis or basal cell carcinoma associated with pigment network and brown globules.

C. There is an absence of criteria to diagnose a melanocytic lesion, seborrheic keratosis, dermatofibroma, pyogenic granuloma, or ink spot lentigo; therefore, the lesion should be considered melanocytic.

D. There is an absence of criteria to diagnose a melanocytic lesion, seborrheic keratosis, basal cell carcinoma, dermatofibroma, or hemangioma; therefore, the lesion should be considered melanocytic.

E. None of the above.

D. Diagnosing a melanocytic lesion by default means that one does not see criteria for a melanocytic lesion, seborrheic keratosis, basal cell carcinoma, dermatofibroma, or hemangioma. Default is an absence of criteria. One has to memorize all the criteria from each specific potential diagnosis to be able to diagnose a melanocytic lesion by default. Dermoscopy cannot be mastered by osmosis. It is essential to study and practice the technique routinely in ones daily practice. Ink spot lentigo and pyogenic granuloma are not in this algorithm.

Which criteria can be used to diagnose a seborrheic keratosis?

A. Milky red areas, irregular streaks, and pigmented follicular openings

B. Streaks, irregular blotches, and regression

C. Furrows, ridges, sharp border demarcation, milia-like cysts, pseudofollicular openings, fat fingers, and hairpin vessels

D. Rhomboid structures and/or circle within a circle

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