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1. Nevus
(also, see card 2) Network Patchy network Peripheral Peripheral Peripheral Globular Globular Reticular
Homogenous Homogenous
network & central network & central network & Cobblestone Peripheral
blue brown
hypopigmentation hyperpigmentation central globules globules

Designed by Ralph P. Braun & Ashfaq A. Marghoob.

DF: network DF: network with ring-like IDN: comma/curved vessels, brown
with central globules, shiny white halo, brown pigmentation, globules
white blotch streaks & pink hue

3. BCC
Arborizing / Spoke wheel like Ulceration
Leaf like areas Blue gray ovoid nests Multiple blue gray Shiny white blotches &
branched vessels structures dots / globules strands

4. SCC
Glomerular / White circles Brown circles Rosettes Brown dots Yellow scale Strawberry Hairpin vessels with
coiled vessels radially arranged pattern whitish halo

5. Seb K
Fissures/sulci Fingerprint like Moth eaten Sharp demarcation Gyri / ridges and Hairpin vessels with
Milia like cysts Comedo like openings sulci / fissures
structures border whitish halo

Step 2: Look for

6. Other melanoma patterns &
Angioma: Red lacunae Angiokeratoma: Sebaceous hyperplasia: CCA: Vessels in serpiginous structures
Red / blue / black lacunae Crown vessels / string of pearls arrangement
(Card 2&3)
Nevus patterns that require context
(melanoma should be in the differential)
Designed by Ralph P. Braun & Ashfaq A. Marghoob.
Two component pattern Structureless tan / pink pattern Multi component pattern Tiered globular pattern Starburst pattern
Kissing nevus Nevi in skin type 1 Symmetric Spitz / Reed Spitz / Reed

Melanoma pattern:
1. Do not manifest any of the benign nevus patterns depicted on card 1
2. Usually display a multicomponent disorganized pattern with at least one melanoma specific structure
depicted on (Card 3)
3. Can be structureless or featureless or blue-black in color (non-specific or feature-poor)
4. On sun-damaged skin they often appear as large lentiginous lesions with the patterns shown below

Melanoma on sun damaged skin

Structureless: Structureless: patchy peripheral pigmented Tan structureless areas Angulated line
Multi component Structureless brown
Blue black nodule Pink / tan macule islands or hyperpigmented foci with granularity pattern
Melanoma specific structures

Atypical streaks Atypical dots Tan structureless areas Prominent skin markings
Atypical network Angulated lines Negative network
and globules
Regression structures

multiple small Atypical Raised blue white structureless Granularity / Regression scarlike Flat blue white Shiny white structures
hyperpigmented areas blotches area Blue white veil peppering depigmentation and peppering structureless area

Atypical vascular patterns

Polymorphous vessels Milky red areas /

Comma / curved vessels Dotted vessels Serpentine vessels Corkscrew vessels
milky red globules

Designed by Ralph P. Braun & Ashfaq A. Marghoob

Palms and soles Melanoma specific pattern: special locations

Parallel ridge pattern Atypical fibrillar pattern Diffuse pigmentation with Milky red areas Multi-component pattern

Designed by Ralph P. Braun & Ashfaq A. Marghoob

multiple shades of brown

Pigmented follicular Annular granular pattern Rhomboidal structures Dark blotches and obliterated hair follicles
Melanin inclusions

No Yes
Grey band Brown band:

melanocytic activation

Hemorrhage Fungus Brown regular: Brown irregular:

Pseudomonas melanoma