Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(2):e2022065 1

Supine Dermoscopy for Improved Visualisation  
of Lower Limb Lesions

Kelvin Truong1,2, Melissa Peera1,2, Raquel Ruiz Araujo1,2, Pablo Fernandez-Penas1,2

1 Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia 

2 Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

Citation: Truong K, Peera M, Ruiz Araujo R, Fernandez-Penas P. Supine dermoscopy for improved visualisation of lower limb lesions. 
Dermatol Pract Concept. 2022;12(2):e2022065. DOI: https://doi.org/10.5826/dpc.1202a65

Accepted: August 19, 2021; Published: April 2022

Copyright: ©2022 Truong et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication

Corresponding author: Kelvin Truong, Department of Dermatology, D5A, Westmead Hospital, PO BOX 533, Westmead NSW 2145, 
Australia. E-mail: kelvin.truong@sydney.edu.au

Case Presentation

Dermoscopic evaluation of suspicious lesions in the context 

of venous insufficiency, such as varicose veins, venous stasis, 

and lipodermatosclerosis, remains a diagnostic challenge. 

The background erythema created by non-lesional vascula-

ture often obscures the assessment of true lesional structures.

Teaching Point

Dermoscopy helps assess for atypical vascular morphol-

ogy such as predominantly central vessels, polymorphous 

vessels, and milky red-pink areas, which is critical in dif-

ferentiating malignant from benign pigmented skin lesions, 

especially in the context of amelanotic and hypomelanotic 

melanoma [1,2]. 

To better delineate skin lesion vasculature from back-

ground vascular noise, consider laying patients supine to 

reduce venous congestion (Figure 1). This is particularly im-

portant in gravity-dependent areas such as the lower limbs. 

Furthermore, use non-contact polarized dermatoscopes or 

immersion fluids of a high viscosity with contact dermato-

scopes, to minimize blanching of vessels and thereby max-

imizing visualization of vascular architecture in cutaneous 

lesions [1]. 

References

1. Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricalà C, 

 Argenziano G. How to diagnose nonpigmented skin tumors: a re-

view of vascular structures seen with dermoscopy: part I. Melano-

cytic skin tumors. J Am Acad Dermatol. 2010;63(3):361–374; quiz 

375-366. DOI: 10.1016/j.jaad.2009.11.698. PMID: 20708469.

2. Menzies SW, Kreusch J, Byth K, et al. Dermoscopic Eval-

uation of Amelanotic and Hypomelanotic Melanoma. Ar-

chives of Dermatology. 2008;144(9):1120–1127. DOI: 

10.1001/ archderm.144.9.1120. PMID: 18794455.



2 Image Letter | Dermatol Pract Concept. 2022;12(2):e2022065

Figure 1. (A,C,E) Dermoscopy of cutaneous lesions of the lower leg with patients standing up. Minimal pressure was applied. Note the 

 prominent background blood vessels which may obscure proper examination of the skin lesion of interest. (B,D,F) Dermoscopy of the same 

lower leg skin lesions with patients laying supine. Minimal pressure was applied. Reduced background blood vessels allow for clearer visu-

alization of the lesion. Dermoscopic pictures taken with Medicam 1000, FotoFinder Systems.