Dermatology: Practical and Conceptual Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 1 Dermoscopy of Cutaneous Neoplasms in Skin of Color – A Systematic review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force Nkechi Anne Enechukwu1, Biswanath Behera2, Delaney D Ding3, Aimilios Lallas4, Payal Chauhan5, Soumil Khare6, Martyna Sławińska7, Bengu Nisa Akay8, Balachandra S Ankad9, Yasmeen J Bhat10, Abhijeet Kumar Jha11, Feroze Kaliyadan12, Awatef Kelati13, Shekhar Neema14, Nisha V Parmar15, Jennifer Stein16, Richard P Usatine17, Keshavamurthy Vinay18, Adebola Olufunmilayo Ogunbiyi19, Enzo Errichetti20 1 Nnamdi Azikiwe University/Nnamdi Azikiwe Teaching Hospital Nnewi, Anambra State, Nigeria 2 Department of Dermatology and Venereology, AIIMS, Bhubaneswar, India 3 University of Florida College of Medicine, Gainesville, FL, USA 4 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece 5 Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India 6 Department of Dermatology, Venereology and Leprosy, AIIMS, Raipur, India 7 Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland 8 Department of Dermatology, School of Medicine, Ankara University, Ankara, Turkey 9 Department of Dermatology, Venereology and Leprosy, SN Medical College, Bagalkot, Karnataka, India 10 Department of Dermatology, Venereology and Leprology, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India 11 Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India 12 Department of Dermatology, Sree Narayana Institute of Medical Sciences, Ernakulum, India 13 Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco 14 Department of Dermatology, Venereology and Leprology, Armed Force Medical College, Pune, Maharashtra, India 15 Department of Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates 16 The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA 17 Department of Dermatology and Cutaneous Surgery, Department of Family and Community Medicine, University of Texas Health San Antonio, San Antonio, TX, USA 18 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India 19 College of Medicine, University of Ibadan, Oyo State, Nigeria 20 Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy Key words: dermoscopy, dermatoscopy, epiluminescence, tumors, neoplasia, skin of color, dark skin, black skin, ethnic skin, dark phototype, african skin, systematic review Citation: Enechukwu NA, Behera B, Ding DD, et al. Dermoscopy of Cutaneous Neoplasms in Skin of Color – a systematic review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force. Dermatol Pract Concept. 2023;13(4)S1:e2023308S. DOI: https://doi.org/10.5826/dpc.1304S1a308S Accepted: September 26, 2023; Published: October 2023 Copyright: ©2023 Enechukwu 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. 2 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Emmanouil Karampinis MD,MSc, Phd, Second Dermatology Department, School of Health Sciences, Aristotle University of Thessaloniki, Greece. Naxos Island, Cyclades, tel: 6980420401 Email: emankarampinis@gmail.com Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light photo- types. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assess- ment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of “dark skin” spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization. ABSTRACT Introduction Cutaneous neoplasms are among the most relevant diseases in dermatologist’s clinical practice as they may cause signif- icant issues, ranging from aesthetic/functional problems to fatal outcomes, hence a timely diagnosis is of utmost impor- tance [1,2]. In this regard, over the last decades, dermoscopy has been showed to be helpful in assisting the early recog- nition of both benign and malignant skin tumors, mainly in fair-skinned patients [1,2]. However, although some cutane- ous neoplasms are less frequent in skin of color (Fitzpatrick’s phototypes IV-VI) as the result of photoprotection provided by the higher melanin content, there is growing evidence that skin tumors may benefit from dermoscopic assessment even for darker phototypes [3]. This is of relevant interest as clin- ical diagnosis of such lesions may be particularly challenging in dark-skinned patients due to the lack of some clues, such as lesion shade or surface changes (e.g., pigmentation and telangiectasias) [3,4]. This review by the International Dermoscopy Society (IDS) Task Force on “Imaging in Skin of Color” systemat- ically evaluated for the first time literature data on dermos- copy of both benign and malignant cutaneous neoplasms in skin of color, also attempting to correlate reported dermo- scopic terminology with a standardized methodology. Materials and Methods This systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines. A search of the pa- pers published up to 30th June 2022 was carried out through the PubMed electronic database with the use of the following search terms: “dermoscopy” OR “epiluminescence” OR “der- matoscopy” AND “skin of color” OR “dark skin” OR “black skin” OR “ethnic skin” OR “dark phototype” OR “african skin” OR “indian skin”. Titles and abstracts were screened by two independent reviewers to identify articles reporting dermoscopic findings of both benign and malignant skin tu- mors; papers on mucosal and nail neoplasms were not con- sidered and non-English articles, reviews, personal opinions/ editorials and duplicates were excluded. A manual search was also carried out by assessing the reference sections of all significant studies or reviews on the topic. Articles considered not relevant and those not mention- ing dermoscopic structures according to specific tumor were excluded after full-text reading. Only articles specifically dealing with Fitzpatrick’s phototypes IV-VI were included. If information on the skin phototype was not provided, de- cision on inclusion was made based on a title/abstract/full text showing that the manuscript concerned “dark skin” or “skin of color” and for single cases also according to the at- tached figures. We also included papers from African, Indian subcontinent, and Caribbean countries as most of patients from these areas belong to IV-VI skin phototypes. Of note, studies grouping light and dark phototypes with no specific subanalyses were ruled out. All of the retrieved studies were classified based on stan- dard definitions for diagnostic accuracy studies [5,6] and their level of evidence was assigned according to The Oxford Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 3 2011 Levels of Evidence [7]. Dermoscopic findings, histo- pathological background (if available), dermoscopic setting (polarized vs non-polarized/magnification degree), skin type of the patient (if specified), and number of cases were as- sessed and summarized. Additionally, standardized termi- nology based on the IDS dermoscopic criteria for cutaneous neoplasms validated for skin of color was specified for each dermoscopic finding reported in the literature [8]. Results The initial PubMed search yielded 1287 publications which were screened for relevance to the subject of review, while 10 studies were added after additional reference screening. A total of 29 items were admitted for full-text reading af- ter title and abstract screening and excluding duplicates. Of these, nine papers were ruled out according to the exclusion criteria, with final selection of 20 articles for the review pro- cess. Figure 1 shows the flow chart summarizing the study selection procedure. The full-text review included six single case-reports, 12 case-series, and two case-control studies, thus a proportion of 10% of the studies showed a level of evidence of IV, while the rest of the studies displayed a level of evidence of V. Fourty-six different tumors were evaluated (also considering relevant subtypes with clinical/dermoscopic peculiarities), including four melanocytic neoplasms, eight keratinocyte tumors, 15 adnexal cutaneous neoplasms, seven vascu- lar tumors, four connective tissue tumors, and eight cystic neoplasms/others; a total of 1724 instances were retrieved. Table 1 displays the number of studies and total number of included patients for each condition. Dermoscopic setting (polarised vs non-polarised) was reported in 8/20 records (3 polarized; 3 non-polarized; 2 both), magnification in 7/20 records (6: x10 magnification; 1: x20 magnification), and dermoscopic-pathological cor- relation in 4/20 records. Supplemental Table summarizes all such data, along with analytical description of each of the study evaluated in the review (number of patients, type of study and level of evidence), dermoscopic features, skin type of the patient, and corresponding terminology according to the IDS dermoscopic criteria for cutaneous neoplasms vali- dated for skin of color. Table 1 also shows the general prev- alence (calculated from all data reported in the literature) of dermoscopic findings of included tumors for which a stan- dardized terminology was available. Relevant findings for each neoplasia are reported as follows; for practical purpose, we have grouped them according to the cellular/tissue origin. Figures 2-6 show dermoscopic clues of such conditions. Melanocytic Neoplasms Melanocytic Nevi Dermoscopy of melanocytic nevi has been reported to vary based on the histological subtype, localization, and skin tone (in the spectrum of Fitzpatrick’s phototypes IV-VI) [9-13]. According to a case-control study by Lallas et at involving 300 patients (excluding facial and acral lesions), the main morphological patterns of common acquired melanocytic nevi included reticular, globular and structureless, whereas the most frequent pigment arrangements turned out to be uniform and “central hyperpigmentation” [9]. Such find- ings are consistent with data coming from other studies (a case-control study [10] and a case-series [11]) including a total of 455 lesions. Of note, structureless pattern and black, Figure 1. PRISMA flowchart displaying the selection process for study inclusion in the systematic review. 4 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S Ta b le 1 . T ot al n um be r of s tu di es , p at ie nt s an d pr ev al en ce o f st an da rd iz ed d er m os co pi c fin di ng s of c ut an eo us t um or s in s ki n of c ol or . Tu m or To ta l n u m b er o f st u d ie s To ta l n u m b er o f in st an ce s [i n st an ce s w it h d er m o sc o p y p re va le n ce  d at a] D er m o sc o p ic fi n d in g s* ( to ta l p re va le n ce )* * M el an oc yt ic n eo pl as m s M el an oc yt ic n ev i A cr al m el an oc yt ic n ev i 1 39 6 [3 96 ] C om m on fi nd in gs : - L es s co m m on fi nd in gs : L in es , p ar al le l, th in , i n th e fu rr ow s (4 3% ); L in es , p ar al le l, th in , i n th e fu rr ow s an d cr os si ng t he r id ge s (1 3% ); L in es , p ar al le l, sh or t, cr os si ng r id ge s (7 % ); S tr uc tu re le ss ( 10 % ); L in es , p ar al le l, th ic k, o n th e ri dg es ( 1% ) B lu e ne vu s 1 4 [4 ] C om m on fi nd in gs : St ru ct ur el es s, b lu e (1 00 % ) L es s co m m on fi nd in gs : M el an oc yt ic n ev i (n ot  c on si de ri ng s pe ci fic s it es or h is to lo gi ca l t yp es ) 3 75 5 [7 55 ] C om m on fi nd in gs : C ol or : b ro w n (7 6% ) L es s co m m on fi nd in gs : L in es , r et ic ul ar ( 48 % ); B la ck c ol or ( 20 % ); S tr uc tu re le ss ( 16 % ); L in es , re ti cu la r (1 0% ); C lo ds , s m al l, ro un d or o va l ( 7% ); L in es , r et ic ul ar /s tr uc tu re le ss ( 7% ); G re y co lo r (7 % ); B lu e- gr ay c ol or ( 7% ); B lu e co lo r (6 % ); C lo ds , s m al l, ro un d or o va l + li ne s, r et ic ul ar ( 3% ); L in es , r et ic ul ar + s tr uc tu re le ss ( 3% ); C lo ds , s m al l, ro un d or o va l/l in es , r et ic ul ar ( 3% ); C lo ds , s m al l, ro un d or o va l + s tr uc tu re le ss ( 1% ); L in es r et ic ul ar /c lo ds , sm al l, ro un d or o va l ( 1% ); P se ud op od s, ci rc um fe re nt ia l o r lin es , r ad ia l, ci rc um fe re nt ia l ( 0. 6% ); R ed c ol or ( 0. 4% ); W hi te c ol or ( 0. 3% ) M el an om a (a cr ol en ti gi no us , ex cl ud in g na ils ) 2 9 [9 ] C om m on fi nd in gs : L in es , p ar al le l, th ic k, o n th e ri dg es ( 10 0% ); S tr uc tu re le ss , b ro w n, b lu e, b la ck (8 9% ); L in es , p ar al le l, sh or t, cr os si ng r id ge s (5 1% ) L es s co m m on fi nd in gs : E ro si on /u lc er at io n (2 2% ); S tr uc tu re le ss z on e, b lu e (1 1% ); I rr eg ul ar c lo ds , sm al l ( 11 % ); L in es , r ad ia l ( al w ay s at p er ip he ry ) (1 1% ) K er at in oc yt ic t um or s B as al c el l c ar ci no m a (B C C ) 4 10 9 [1 09 ] C om m on fi nd in gs : D ot s, g ra y, b lu e or b la ck ( 62 % ) L es s co m m on fi nd in gs : E ro si on /u lc er at io n (4 6% ); L in es , r ad ia l, co nn ec te d to a c om m on b as e (4 3% ); B lu e- w hi te v ei l ( 29 % ); L in es , r et ic ul ar , h yp op ig m en te d, a ro un d br ow n cl od s (2 8% ); S tr uc tu re le ss zo ne , r ed -w hi te ( 22 % ); L in es , r ad ia l, co nv er gi ng t o a ce nt ra l d ot o r cl od ( 19 % ); C lo ds , b lu e to br ow n, la rg e, c lu st er ed ( 18 % ); D ot s or c lo ds , w hi te , c lu st er ed o r di ss em in at ed ( 17 % ); S tr uc tu re le ss zo ne , b ro w n or b la ck ( 11 % ); C lo ds , b ro w n, y el lo w , o r or an ge ( ra re ly b la ck ) (1 1% ); B ra nc he d ve ss el s (1 1% ); C lo ds , b ro w n- bl ue , s m al l ( 10 % ); L in es , r et ic ul ar a nd t hi ck ( pe ri le si on al ) (9 % ); C lo ds , bl ue , l ar ge , c lu st er ed ( 8% ); D ot s, b lu e an d cl od s, b lu e, s m al l ( 8% ); C lo ds , w hi te , s hi ny ( 8% ); C ir cl es , co nc en tr ic ( 7% ); L in es , r ad ia l ( al w ay s at p er ip he ry ) (6 % ); S tr uc tu re le ss z on e, w hi te , c en tr al ( 5% ); L oo pe d ve ss el s (3 % ); F ol lic ul ar p lu gs ( 2% ); S er pe nt in e ve ss el s (2 % ); D ot , n on -s pe ci fie d co lo r (2 % ); St ru ct ur el es s zo ne , b lu e (2 % ); S tr uc tu re le ss z on e, w hi te (0 .9 % ); D ot s, b ro w n (0 .9 % ); L in es , w hi te , pe rp en di cu la rl y (0 .9 % ) K er at oa ca nt ho m a 1 3[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 5 Se bo rr he ic k er at os is (S K ) C la ss ic S K 2 30 [0 ] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - D er m at os is p ap ul os a ni gr a 1 10 0 [1 00 ] C om m on fi nd in gs : L in es , c ur ve d an d th ic k (5 9% ) L es s co m m on fi nd in gs : C lo ds , b ro w n, y el lo w , o r or an ge ( ra re ly b la ck ) (2 7% ); D ot s or c lo ds , w hi te , c lu st er ed o r di ss em in at ed ( 8% ) Sq ua m ou s ce ll ca rc in om a in si tu ( B ow en ’s d is ea se ) 4 11 [1 1] C om m on fi nd in gs : D ot s, g ra y, b lu e (i n a pe ri ph er al c lu st er ed o r lin ea r ar ra ng em en t) ( 64 % ) L es s co m m on fi nd in gs : D ot s, b ro w n, g ra y, b lu e (3 6% ); C lo ds , b ro w n (3 6% ) St ru ct ur el es s zo ne , g re y- w hi te (3 6% ); C oi le d ve ss el s, c lu st er ed ( 27 % ); E ro si on s/ ul ce ra ti on s (1 8% ); L in es , r ad ia l ( al w ay s at p er ip he ry ) (1 8% ); C oi le d ve ss el s (p er ip he ra l) ( 9% ); L in es , b lu e- gr ey ( ra di al ) (9 % ); L oo pe d ve ss el s (9 % ); L in es , w hi te ( 9% ); V es se ls ( 9% ); S tr uc tu re le ss , b ro w n, a nd b lu e- gr ey (9 % ); C oi le d ve ss el s (9 % ); C lo ds ( 9% ); S tr uc tu re le ss , g ra y- bl ac k (9 % ) Sq ua m ou s ce ll ca rc in om a (S C C ) P ig m en te d 1 3[ 3] C om m on fi nd in gs : - L es s co m m on fi nd in gs : C ir cl es , w hi te (3 3% ) N on -p ig m en te d 1 4[ 4] C om m on fi nd in gs : C ir cl es , w hi te ( 75 % ); E ro si on s, u lc er at io ns ( 75 % ); D ot s, v es se ls ( 50 % ) L es s co m m on fi nd in gs : L in ea r, ir re gu la r (2 5% ); C lo ds , w hi te , s hi ny ( 25 % ) N ot s pe ci fie d 1 4[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - A dn ex al c ut an eo us n eo pl as m s A po cr in e hi dr oc ys to m a 2 10 [8 ] C om m on fi nd in gs : S tr uc tu re le ss , g ra y (1 00 % ) L es s co m m on fi nd in gs : D ot s, b ro w n (1 3% ); B ra nc he d ve ss el s (1 3% ) D ila te d po re o f W in er 1 2[ 2] C om m on fi nd in gs : F ol lic ul ar p lu g (1 00 % ); S tr uc tu re le ss z on e, b lu e (1 00 % ) L es s co m m on fi nd in gs : - E cc ri ne h id ro cy st om a 1 6[ 6] C om m on fi nd in gs : S tr uc tu re le ss a re a, b ro w n (1 00 % ) L es s co m m on fi nd in gs : - E cc ri ne s yr in go fib ro ad en om a 1 1[ 1] C om m on fi nd in gs : C lo ds , b ro w n or s ki n co lo re d, la rg e an d po ly go na l ( 10 0% ); S tr uc tu re le ss z on e, gr ay , w hi te , o r ye llo w ( 10 0% ); D ot s, w hi te ( 10 0% ) L es s co m m on fi nd in gs : - N ev us c om ed on ic us 1 1[ 1] C om m on fi nd in gs : C lo ds , b ro w n, y el lo w , o r or an ge ( ra re ly b la ck ) (1 00 % ); F ol lic ul ar p lu gs ( 10 0% ) L es s co m m on fi nd in gs : - N ev us s eb ac eo us 1 7[ 7] C om m on fi nd in gs : - L es s co m m on fi nd in gs : S tr uc tu re le ss , y el lo w -g ra y (4 3% ); S tr uc tu re le ss , y el lo w , y el lo w - w hi te ( 43 % ); C lo ds , l ar ge ( 43 % ); L in es , c ur ve d an d th ic k, in c om bi na ti on w it h cl od s (2 9% ); D ot s or c lo ds , w hi te , c lu st er ed o r di ss em in at ed ( 14 % ); L in es , c ur ve d an d th ic k (1 4% ); L oo pe d ve ss el s (1 4% ); L in ea r  ve ss el s  (1 4% ) T ab le 1 c on ti nu es 6 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S Tu m or To ta l n u m b er o f st u d ie s To ta l n u m b er o f in st an ce s [i n st an ce s w it h d er m o sc o p y p re va le n ce  d at a] D er m o sc o p ic fi n d in g s* ( to ta l p re va le n ce )* * N od ul ar h id ra de no m a 1 1[ 1] C om m on fi nd in gs : S tr uc tu re le ss , w hi te -g ra y (1 00 % ); E ro si on s/ ul ce ra ti on s (1 00 % ); D ot s, g ra y or bl ue ( 10 0% ); P ol ym or ph ou s ve ss el s (1 00 % ) L es s co m m on fi nd in gs : - P ilo m at ri xo m a 1 1[ 1] C om m on fi nd in gs : S tr uc tu re le ss , b ro w n/ ye llo w ( 10 0% ); L in es , r et ic ul ar ( 10 0% ) L es s co m m on fi nd in gs : - Po ro m a 1 4[ 4] C om m on fi nd in gs : B ra nc he d ve ss el s (1 00 ); S tr uc tu re le ss a re a, w hi te (1 00 % ); S tr uc tu re le ss , y el lo w / ye llo w -b ro w n (5 0% ); L in ea r ve ss el s (5 0% ); L oo pe d ve ss el s (5 0% ); P ol ym or ph ou s ve ss el s (5 0% ) L es s co m m on fi nd in gs : St ru ct ur el es s zo ne , b ro w n or b lu e- gr ay ( 25 % ) R ea ct iv e ec cr in e sy ri ng ofi br oa de no m a 1 2[ 2] C om m on fi nd in gs : S tr uc tu re le ss , g ra y/ gr ay -w hi te ( 10 0% ); C lo ds , l ar ge a nd p ol yg on al ( 10 0% ) L es s co m m on fi nd in gs : - Se ba ce ou s ad en om a 1 1[ 1] C om m on fi nd in gs : St ru ct ur el es s, y el lo w /y el lo w -b ro w n (1 00 % ); C lo ds , s m al l, ro un d or o va l (b lu e- gr ey ) (1 00 % ); D ot s, b ro w n (1 00 % ); L in ea r ve ss el s (1 00 % ) L es s co m m on fi nd in gs : - Se ba ce ou s hy pe rp la si a 2 28 [2 6] C om m on fi nd in gs : S tr uc tu re le ss y el lo w /y el lo w -b ro w n (1 00 % ) L es s co m m on fi nd in gs : L in ea r ve ss el s, r ad ia l ( 46 % ); D ot s, g ra y or b lu e (3 1% ); B ra nc he d ve ss el s (4 % ) T ri ch ob la st om a 1 1[ 1] C om m on fi nd in gs : St ru ct ur el es s, b ro w n (1 00 % ) D ot s or c lo ds , w hi te ( 10 0% ); S tr uc tu re le ss , w hi te (1 00 % ) L es s co m m on fi nd in gs : - T ri ch oe pi th el io m a (f am ili al ) 1 4[ 4] C om m on fi nd in gs : S tr uc tu re le ss z on e, b ro w n + do ts o r cl od s, w hi te , c lu st er ed o r di ss em in at ed (1 00 % ); D ot s, b ro w n (1 00 % ); L in ea r ve ss el s (7 5% ); S tr uc tu re le ss z on e, w hi te ( 50 % ); B ra nc he d ve ss el s (5 0% ) L es s co m m on fi nd in gs : L in ea r ve ss el s, r ad ia l ( 25 % ) T ri ch oe pi th el io m a (s ol it ar y) 1 6[ 6] C om m on fi nd in gs : S tr uc tu re le ss , b ro w n/ w hi te ( 10 0% ); D ot s or c lo ds , w hi te , c lu st er ed o r di ss em in at ed ( 10 0% ) Le ss c om m on fi nd in gs : D ot s, br ow n (3 3% ); Li ne ar v es se ls (1 7% )) V as cu la r tu m or s A ng io fib ro m a Fa ci al 3 9[ 5] C om m on fi nd in gs : D ot s, y el lo w /w hi te ( 10 0% ); S tr uc tu re le ss , b ro w n, r ed -b ro w n (8 0% ); D ot s, b ro w n (8 0% ) L es s co m m on fi nd in gs : - Pe ni le 1 4[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - Ta b le 1 . T ot al n um be r of s tu di es , p at ie nt s an d pr ev al en ce o f st an da rd iz ed d er m os co pi c fin di ng s of c ut an eo us t um or s in s ki n of c ol or . ( co nt in ue d) Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 7 A ng io ke ra to m a 1 1[ 1] C om m on fi nd in gs : C lo ds , r ed -p ur pl e (1 00 % ); L in es , w hi te ( 10 0% ) L es s co m m on fi nd in gs : - C he rr y an gi om a 1 10 [1 0] C om m on fi nd in gs : C lo ds , r ed o r pu rp le ( 10 0% ) L es s co m m on fi nd in gs : L in es , r et ic ul ar ( pe ri ph er al ), br ow n (2 0% ) In fa nt ile h em an gi om a 1 1[ 1] C om m on fi nd in gs : C lo ds , r ed o r pu rp le ( 10 0% ); L in es , w hi te ( 10 0% ) L es s co m m on fi nd in gs : L ym ph an gi om a ci rc um sc ri pt um 1 3[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - P yo ge ni c gr an ul om a 1 39 [0 ] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - C on ne ct iv e ti ss ue t um or s D er m at ofi br om a 4 11 2[ 11 2] C om m on fi nd in gs : L in es , r et ic ul ar ( 71 % ); S tr uc tu re le ss z on e, w hi te ( 63 % ) L es s co m m on fi nd in gs : L in es : p er ip he ra l ( 41 % ); S tr uc tu re le ss z on e, w hi te : c en tr al ( 36 % ); St ru ct ur el es s zo ne , b ro w n (3 2% ); V es se ls ( 27 % ); S tr uc tu re le ss z on e, w hi te : m ul ti fo ca l ( 27 % ); St ru ct ur el es s zo ne , b ro w n: c en tr al ( 24 % ); V es se ls : c ur ve d (2 1% ); V es se ls : d ot s (2 1% ); C lo ds , s m al l, ro un d or o va l ( 16 % ); L in es , w hi te , p er pe nd ic ul ar ly ( 16 % ); L in es : m ul ti fo ca l ( 16 % ); L in es : u ni fo rm (1 4% ); V es se ls : l in ea r (1 2% ); E ro si on s/ ul ce ra ti on s (5 % ); L in es , r ad ia l ( 5% ); S tr uc tu re le ss z on e, br ow n: p er ip he ra l ( 5% ); L in es , r et ic ul ar a nd t hi n (p er ip he ra l) ( 5% ); S tr uc tu re le ss z on e, b ro w n (c en tr al ) (3 % ); S tr uc tu re le ss z on e, b ro w n: e cc en tr ic ( 3% ); C lo ds , b ro w n, y el lo w , o ra ng e (r ar el y bl ac k) ( 3% ); L in es , r et ic ul ar , h yp op ig m en te d, a ro un d br ow n cl od s (3 % ); D ot s or c lo ds , w hi te , cl us te re d or d is se m in at ed ( 2% ); L in es , r et ic ul ar a nd t hi ck o r re ti cu la r lin es th at v ar y in c ol or ( 1% ); St ru ct ur el es s zo ne , b lu e- w hi te ( ce nt ra l) ( 1% ); L in es , r et ic ul ar a nd th in ( 1% ); S tr uc tu re le ss z on e, w hi te ( ce nt ra l) ( 1% ) D er m at ofi br os ar co m a pr ot ub er an s 2 2[ 1] C om m on fi nd in gs : L in es , r et ic ul ar a nd th ic k or r et ic ul ar li ne s th at v ar y in c ol or ( 10 0% ); L in es , w hi te , p er pe nd ic ul ar ly ( 10 0% ); S er pe nt in e ve ss el s (1 00 % ) L es s co m m on fi nd in gs : - Fi br ok er at om a 1 5[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - N eu ro fib ro m a 1 4[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - T ab le 1 c on ti nu es 8 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S Tu m or To ta l n u m b er o f st u d ie s To ta l n u m b er o f in st an ce s [i n st an ce s w it h d er m o sc o p y p re va le n ce  d at a] D er m o sc o p ic fi n d in g s* ( to ta l p re va le n ce )* * C ys ti c ne op la sm s an d ot he rs E pi de rm al c ys t 2 11 [4 ] C om m on fi nd in gs : - L es s co m m on fi nd in gs : S tr uc tu re le ss , y el lo w ( 25 % ); S tr uc tu re le ss , g ra y (2 5% ); S tr uc tu re le ss z on e, br ow n (2 5% ) M ili a 1 3[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - T ri ch ile m m al c ys t 1 5[ 5] C om m on fi nd in gs : - L es s co m m on fi nd in gs : S tr uc tu re le ss , b ro w n (4 0% ); S tr uc tu re le ss , w hi te + b ra nc he d ve ss el s (2 0% ); St ru ct ur el es s zo ne , w hi te ( ce nt ra l o r un if or m ) +/ - st ru ct ur el es s zo ne , b ro w n/ li ne s, b ro w n, c ur ve d, pa ra lle l, th in ( 20 % ); S tr uc tu re le ss z on e, w hi te ( ce nt ra l) + /- li ne s, b ro w n, c ur ve d, p ar al le l, th in ( 20 % ); D ot s, g ra y, b lu e or b la ck ( 20 % ) St ea to cy to m a m ul ti pl ex 1 1[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - M yc os is f un go id es ( M F) C la ss ic M F 1 4[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - H yp op ig m en te d M F 1 4[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - Fo lli cu lo tr op ic M F 1 1[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - V er ru co us M F 1 2[ 0] C om m on fi nd in gs : - L es s co m m on fi nd in gs : - *D er m os co pi c fi nd in gs f or w hi ch a s ta nd ar di ze d te rm in ol og y w as a va ila bl e; t he se a re d iv id ed in to c om m on ( pr ev al en ce ≥ 5 0% ) an d le ss c om m on ( pr ev al en ce < 5 0% ) ** To ta l p re va le nc e is c al cu la te d on ly c on si de ri ng s tu di es f or w hi ch p re va le nc e da ta o f de rm os co pi c fi nd in gs w as a va ila bl e Ta b le 1 . T ot al n um be r of s tu di es , p at ie nt s an d pr ev al en ce o f st an da rd iz ed d er m os co pi c fin di ng s of c ut an eo us t um or s in s ki n of c ol or . ( co nt in ue d) Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 9 structureless areas with multiple shades of brown, blue, black, and pink colors [13]. Other common findings (more than two-thirds of cases) included parallel ridge pattern, diffuse plantar lentigines, and parallel ridge pattern of surrounding skin [13]. Fibrillar pattern of surrounding skin, peripheral hypopigmentation, ulceration, and atypical fibrillar pattern were less frequent features [13]. No specification about melanoma thickness was reported for all the above-mentioned instances [13]. Finally, irregular streaks, irregular globules, and blue-whitish veil were detected in a case of invasive ALM (Breslow’s thickness: 1.2 mm) by De Giorgi et al [11]. Keratinocytic Tumors Basal Cell Carcinoma The main study on dermoscopy of basal cell carcinoma (BCC) is a retrospective observational analysis (case-series) blue and grey color were observed more common in Fitz- patrick skin type VI patients, while skin type V individuals mainly showed dark brown reticular pattern [9]. Moving to special sites, Madankumar et al found parallel furrow pattern to be the most common presentation of acral melanocytic nevi in a case-series on 369 lesions [12]. On the other hand, pigmented pseudonetwork was reported as the pattern of facial melanocytic nevi in a case-series by De Giorgi et al, yet no specification on the number of included lesions was mentioned [11]. The same study reported blue homogeneous pattern as a constant finding in four instances of blue nevi [11]. Melanoma All the data retrieved from the literature concerned acral len- tiginous melanoma (ALM). Most of the information comes from the study (case-series) by Manci et al involving a to- tal of eight dermoscopic instances, that constantly showed Figure 2. Examples of dermoscopic clues of melanocytic neoplasms/keratinocytic tumors in dark-skinned patients: Brown lines (parallel, thin) in the furrows in acral melanocytic nevus (A); Structureless blue and black areas in blue nevus (B); Structureless blue and black areas along with brown lines (parallel, thick) on the ridges in acrolentiginous melanoma (C); White, black and blue structureless areas along with ulceration/erosions in nodular basal cell carcinoma (D); Numerous radial lines connected to a common base (spoke wheel-like areas) (arrow) and a diffuse white structureless area in superficial basal cell carcinoma (E); Central hyperkeratosis and hemorrhagic areas over a diffuse white structureless area surrounded by a brown halo in keratoacanthoma (F); Multiple brown and black dots and clods in seborrheic kerato- sis (G); Multiple brown dots (white arrow) and few dotted vessels (black arrow) along with diffuse white-brown hyperkeratosis in Bowen’s disease (H); Linear, irregular vessels over a diffuse white structureless area in squamous cell carcinoma (I). 10 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S (40.6%), whereas maple leaf-like area (92.5%), red-white homogenous area (66.6%), multiple small erosions (59.2%), short fine telangiectasia (59.2%), spoke wheel-like areas (55.5%) turned out to be the main findings of superficial by Behera et al on 60 lesions (32 nodular, 27 superficial and 1 infiltrative subtype) [14]. The most common features of nodular BCC were ulceration (84.3%) and blue-white veil (81.2%), followed by brown to blue-gray ovoid nests Figure 3. Examples of dermoscopic clues of adnexal tumors in dark-skinned patients: Central black follicular plug surrounded by a blue structureless zone in dilated pore of Winer (A); Brown-blue structureless area in eccrine hidrocystoma (B); Multiple brown-black follicular plugs in nevus comedonicus (C); Yellow-brown and white structureless areas (in some point featuring lines, curved and thick – “cerebriform pattern”) along with white-yellow clods (arrows) in sebaceous nevus (D); White structureless area in nodular hidradenoma (E); Yellow-white structureless areas over a red-brown diffuse structureless area in pilomatrixoma (F). Figure 4. Examples of dermoscopic clues of adnexal tumors in dark-skinned patients: Erosions and dotted vessels surrounded by white halo in eccrine poroma (A); Dotted and looped vessels surrounded by white halo in eccrine poroma (B); Yellow structureless areas and linear vessels in sebaceous adenoma (C); Yellow clods and yellow-brown structureless area in sebaceous hyperplasia (D); White structureless areas in trichoblastoma (E); White structureless area along with a white clod in trichoepithelioma (F). Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 11 Keratoacanthoma The only available data on keratoacanthoma comes from a case-series including three lesions that displayed keratin- related structures, including white scales/crusts, yellow/ orange crusts and central white areas, along with radially ar- ranged hairpin vessels, linear-irregular vessels, hemorrhages, and brown areas [15]. Of note, no specific data on their prevalence of such findings was provided [15]. Seborrheic Keratosis Dermoscopy of seborrheic keratosis has been investigated in two descriptive studies (case-series) involving a total of 30 instances (15 for each analysis) [11,15]. Reported find- ings included “moth eaten” borders, comedo-like openings, milia-like cysts, “fat fingers”, cerebriform pattern, “finger print” pattern, surface white scaling, and “parchment-like” thick crust [11,15]. Of note, prevalence of each of the afore- mentioned findings was not specified; vessels were absent in all cases [11,15]. Moving to dermatosis papulosa nigra (a variant of seb- orrheic keratosis commonly seen in dark phototypes), an observational study (case-series) on 100 patients by Bhat et al found cerebriform pattern to be the main feature (59% of cases), followed by comedo-like openings (27% of cases), while milia-like cysts were observed only in 8% of instances [17]. BCC [14]. Notably, the prevalence of all the aforementioned features was found to be statistically significant for the cor- responding subtype (nodular vs superficial) [14]; arborizing vessels were also indicative of nodular BCC, though they were seen only in 37.5% of cases [14]. Besides the detection of shiny white blotches/strands and pigmented structures (mainly leaf-like areas, blue-gray ovoid nests, and multiple blue-gray dots/globules) in half lesions (9/18), Manci et al also commonly observed loss of normal background pigmentation/network (72.2%), milky red area (66.7%), and accentuated normal background pigmentation/ network surrounding the lesion (55.6%) [13]. Importantly, no specification about the histological subtype was provided in this dermosopic analysis [13]. Additional dermoscopic findings retrieved from the two above-mentioned studies [13,14] and other analyses (one case-series on 30 patients [15] and one single case-report [16]) included negative pigment network, concentric struc- tures, brown to blue to blue-gray aggregates, coarse pepper- ing, peripheral striations, follicular plugging, peri-follicular white rings, brown to black blotch, adherent fabric fibers, milia-like cyst, comedo-like opening, in-focus dots, central or peripheral hypopigmentation, atypical vessel running across the lesion, hemorrhages, hairpin vessels, linear-irregular ves- sels, chrysalis-like structures, multiple aggregated yellow/ white, and scales/crusts. Figure 5. Examples of dermoscopic clues of vascular tumors in dark-skinned patients: Brown structureless area with white dots in facial angiofibroma (A); Red-purple clods separated by white lines in angiokeratoma (B); Red clods with reticular white lines and peripheral brown reticular lines in cherry angioma (C); Red clods separated by brown lines in infantile hemangioma (D); Yellow and red-brown clods sepa- rated by white or brown lines in lymphangioma circumscriptum (E); Red structureless areas along with white structureless areas in pyogenic granuloma (F). 12 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S Squamous Cell Carcinoma Most of data on dermoscopic findings of squamous cell carcinoma (SCC) comes from a case-series by Manci et al on seven instances, including three pigmented and four non- pigmented lesions [13]. In detail, adherent scales with pigment and peripheral hypopigmentation with loss of pig- mented network in surrounding skin were constant findings of pigmented SCC, while non-pigmented mainly showed adherent white scale (100%) along with white circles and ulceration (both 75%) [13]. Further features for pigmented SCC included milky-red areas and white circles, while dotted vessels, serpentine ves- sels, shiny white strands, peripheral hypopigmentation with loss of pigmented network seen in surrounding skin, and pe- ripheral islands of hyperpigmentation turned out to be addi- tional findings of non-pigmented SCC [13]. Squamous Cell Carcinoma in Situ (Bowen’s Disease) The main study on dermoscopy of Bowen’s disease is a case-series including eight lesions (seven pigmented and one non-pigmented) by Behera et al, who found brown to blue-gray dots/globules (in a peripheral clustered or linear arrangement) to be the main finding (7 lesions), followed by scales (6 lesions) and light to dark brown keratotic structure- less areas (5 lesions) [18]. Such structures were also detected in other three single reports [15,19,20]. Additional findings included clustered (and less com- monly peripheral) glomerular vessels, brown to blue-gray peppering (fine and coarse), blue-grey radial lines, ulcerations/ erosions, blood spots/crusts, hairpin vessels, ring-like pat- tern, ill-defined gray outer border, well-defined thin brown outer border, interconnecting white lines, and grey-white/ red-white areas [18]. Figure 6. Examples of dermoscopic clues of connective tissue tumors, cystic neoplasms and others in dark-skinned patients: Brown structure- less area with perpendicular white lines in dermatofibroma (A); White as well as brown structureless areas in dermatofibrosarcoma protu- berans (B); Brown structureless areas and white structureless areas and lines in fibrokeratoma (C); White structureless areas in neurofibroma (D); Blue-grey structureless area in epidermal cyst (E); White structureless areas/clods in milia (F); Yellow structureless area in sebaceous cyst (steatocytoma multiplex) (G); Brown thick reticular lines in patch-stage mycosis fungoides (H) (adapted from Dermoscopy in General Der- matology for Skin of Color, Errichetti E, Lallas A, eds. CRC Press 2021); White structureless area with a few brown lines in hypopigmented mycosis fungoides (I). Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 13 six patients [21]. Yellow/yellow-brown homogenous area and single to multiple puncta were seen in all instances, whereas fine brown to blue-grey peppering, crown vessels, linear-branching vessels were additional findings [21]. Besides yellow globules and crown vessels, pale white septae and patulous follicles were also found in another series of two instances [15]. Syringoma Most of data on dermoscopy of syringomas comes from the analysis (case-series) by Behera et al including 119 lesions (1 chondroid syringoma, 24 non-pigmented syringomas, 64 pigmented syringomas, 10 milium-like syringomas, and 20 eruptive syringomas) from 16 patients [21]. The main finding shared by all the subtypes (apart from chondroid syringoma) was the presence of milia-like cysts [21]. Other common gen- eral features included yellow/yellow-brown homogeneous area and pigment network [21]. Such findings are in line whit what observed by Ankad et al in five instances of syringoma [15]. Trichoepithelioma One study assessing dermoscopy of ten trichoepitheliomas (six solitary and four familial) from nine patients is avail- able  [21]. Skin-colored to white homogenous area with milia-like cysts was a constant finding in both solitary and familial lesions; additionally, fine brown peppering was also detected in all familial instances [21]. Further features in- cluded focal white homogenous area and linear, arborizing and crown vessels [21]. Other Adnexal Cutaneous Neoplasms This group includes adnexal cutaneous tumors retrieved in the review analysis whose dermoscopic data is based on sin- gle reports/small series, i.e., eccrine syringofibroadenoma, nevus comedonicus, nodular hidradenoma, pilomatrixoma, reactive eccrine syringofibroadenoma, sebaceous adenoma, and trichoblastoma [21]. Reported dermoscopic findings are showed in Table 1/Supplemental Table. Vascular Tumors Angiofibroma A total of nine instances from three analyses (two case se- ries and a single report) were assessed by dermoscopy [15,21,22]. The most common feature reported by all the studies included white/yellow-white dots [15,21,22]; other frequent findings were, brown/reddish-brown background, unfocused vessels, and brown dots [22]. Angiokeratoma Only one instance of angiokeratoma reporting dermoscopic findings is available, with description of pink to purplish la- goons, whitish ground glass film, and thick septa separating each lacuna [15]. In a descriptive analysis (case-series) including four SCCs, Ankad et al observed white and red structureless ar- eas, along with ulcerations, blood spots and polymorphic vascular pattern (i.e., dotted, linear-irregular, arborizing, atypical, unspecific and hairpin vessels); no specification about subtype (pigmented vs non-pigmented) and prevalence of dermoscopic findings was available [15]. Adnexal Cutaneous Neoplasms Apocrine Hidrocystoma A total of 10 lesions have been assessed by two case-series [15, 21]. Grey homogenous area was found to be a constant finding by Behera et al in a series of 8 lesions, whereas pe- ripheral erythema, light brown peppering and arborising vessels were observed less commonly [21]. On the other hand, Ankad et al by analyzing two le- sions reported yellowish-brown homogeneous area covering whole lesion, linear irregular vessels running across the le- sion, and white globules, yet specific data on their prevalence were not specified [15]. Dilated Pore of Winer Two instances of dilated pore of Winer have been retrieved, with central black keratotic plug and bluish white homoge- nous areas being described in both the cases [21]. Eccrine Hidrocystoma Data on dermoscopy of eccrine hidrocystoma comes from the observational study (case-series) by Behera et al, who as- sessed six lesions from a single patient and constantly found a skin-colored homogenous area [21]. Nevus Sebaceous Seven instances of nevus sebaceous (without secondary tu- mors) were evaluated by dermoscopy, with the main features being papillary to knob-like pattern with a yellow to grey background and yellow to yellow-white homogenous area/ ovoid nest (both observed in three lesions) [21]. Additional findings included linear irregular crypts, cerebriform pattern, milia-like cysts, hairpin vessels, and linear vessels [21]. Poroma Four cases reporting dermoscopic findings of poroma have been retrieved from the literature. In detail, diffuse white structureless area and branched vessels with a round ending were seen in all lesions, while further features included focal yellow to yellow-brown structureless area, linear or hairpin vessels, polymorphous vascular pattern, and brown to blue- grey blotch [21]. Sebaceous Hyperplasia The main dermoscopic study on sebaceous hyperplasia is an observational analysis (case-series) including 26 lesions from 14 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S (no prevalence data was available): homogeneous brown- ish-white and rosy-white area, white structureless areas (tree branches-like arrangement), and dotted/linear vessels [15]. Neurofibroma Dermoscopic findings based on the analysis of four instances included in a study by Ankad et al were pink-red homoge- neous areas, peripheral pigment network and fissures, and scar-like white areas with star burst appearance, yet they prevalence was not specified [15]. Cystic Neoplasms and Others Epidermal Cyst, Milia and Trichilemmal Cyst Two case-series investigated dermoscopy of such lesions for a total of three milia, 11 epidermal cysts, and five trichilem- mal cysts [15,21]. In detail, white to yellow homogeneous area was the main finding for all of them; linear (milia) or branching (epidermal and trichilemmal cysts) vessels were also reported [15,21]. Additionally, brownish peripheral rim was found in milia and trichilemmal cysts, while central pore/punctum was described in epidermal cyst [15,21]. Steatocytoma Multiplex A single description of this entity was retrieved, with yellow homogeneous area covering the entire lesion, linear vessels, and peripheral brown rim being reported [15]. Mycosis Fungoides Only one observational study (case-series) on dermoscopy of mycosis fungoides (MF) was available. In this analysis, Nakamura et al assessed 33 images from 11 patients (four classic MF, four hypopigmented MF, one folliculotropic MF, and two verrucous MF), yet no data on prevalence of dermo- scopic findings was provided [28]. Classic MF was reported to show striking pigmentary change, thick black lines, white rosettes, and geometric white lines, while hypopigmented MF was characterized by the loss of natural pigment network [28]. On the other hand, follicular plugging along with hyperpigmented to violaceous perifollicular halos and yellow-gray amorphous structures coupled with yellow-gray ridges/comedo-like openings within hyperkeratotic areas were observed in folliculotropic and verrucous MF, respectively [28]. Conclusions This review emphasizes that many skin neoplasias have been investigated from a dermoscopic point of view in dark-skinned patients with description of potentially useful diagnostic features, though most of available data comes from inhomogeneous/unstructured studies either includ- ing small samples (especially case reports/series) or lacking Cherry Angioma Knowledge on dermoscopy of cherry angioma comes from the descriptive analysis (case-series) by Ankad et al including 10 instances [15]. In all cases, red to purplish lagoons were seen, while milky-white veil was prominent in older lesions and a rim pigment network was noted in two lesions [15]. Infantile Hemangioma Only one case of infantile hemangioma has been investi- gated from a dermoscopic point of view, with red lacunae and white septa being reported [23]. Lymphangioma Circumscriptum Information on dermoscopy of lymphangioma circumscrip- tum comes from a series of three cases, that showed pale yellow/pale pink lacunae (with some of them filled with purplish globules) and white septa; no prevalence data was provided [15]. Pyogenic Granuloma A total of 39 lesions were analyzed by dermoscopy in the only available study (case-series). In this analysis, reddish homogeneous areas, white collarette, white rail line and vascular structures were observed, yet specific data on their prevalence were not provided [15]. Connective Tissue Tumors Dermatofibroma The main study on dermoscopy of dermatofibroma is the analysis (case-series) by Kelati et al including a total of 100 lesions from 95 patients (mainly phototype IV) [24]. Accord- ing to this study, the most common dermoscopic features (more than two-thirds of cases) included pigmented net- work (mainly located at the periphery) and white patches (“central scar-like” or “eccentric multiple”) [24]. Moreover, central homogeneous pigmentation was also frequently re- ported (36% of cases) [24], in line with a small case-series by Giddens et al [25]. Many other additional findings have been described and are displayed in the Supplemental Table [11, 15, 24, 25]. Dermatofibrosarcoma Protuberans Two case-reports described dermoscopy of dermatofibrosar- coma protuberans [26,27]. In detail, both instances showed atypical/interrupted network [26,27]; additionally, hyper/ hypo-pigmented structureless areas, shiny white streaks and unfocused linear-irregular vessels were noted in the first case [26] and a pinkish background in the second case [27]. Fibrokeratoma The only analysis on dermoscopy of fibrokeratoma in- cluded five cases, with the following findings being reported Review | Dermatol Pract Concept. 2023;13(4)S1:e2023308S 15 12. Madankumar R, Gumaste PV, Martires K, et al. Acral melano- cytic lesions in the United States: Prevalence, awareness, and dermoscopic patterns in skin-of-color and non-Hispanic white patients. J Am Acad Dermatol. 2016;74:724-30. 13. Manci R, Dauscher M, Marchetti MA et al. Features of skin can- cer in black individuals: a single-institution retrospective cohort study. Dermatol Pract Concept. 2022;12:e2022075. 14. Behera B, Kumari R, Thappa DM, Gochhait D, Srinivas BH, Ayyanar P. Dermoscopic features of basal cell carcinoma in skin of color: A retrospective cross-sectional study from Puducherry, South India. Indian J Dermatol Venereol Leprol. 2023;89: 254-260. 15. Ankad BS, Sakhare PS, Prabhu MH. Dermoscopy of non- melanocytic and pink tumors in brown skin: A descriptive study. 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Dermoscopic features of benign cuta- neous adnexal tumours in dark skin: A retrospective study from South India. Australas J Dermatol. 2021;62:e249-e255. 22. Jindal R, Sethi S, Chauhan P. Dermoscopy of Facial Angiofibro- mas in Four Patients of Skin of Color with Tuberous Sclerosis Complex: A Case-Series. Dermatol Pract Concept. 2021;11: e2021036. 23. Kusari A, Reiley H, Seiverling E. A lesion on the abdomen in an infant. Pediatr Dermatol. 2021;38:117-118. 24. Kelati A, Aqil N, Baybay H, Gallouj S, Mernissi FZ. Beyond classic dermoscopic patterns of dermatofibromas: a prospective research study. J Med Case Rep. 2017;11:266. 25. Giddens T, Seiverling E, Marghoob A, Usatine R. Absence of cen- tral white patch in dermatofibromas presenting in darker skin. JAAD Case Rep. 2022;21:63-65. 26. Piccolo V, Russo T, Staibano S, et al. Dermoscopy of dermato- fibrosarcoma protuberans on black skin. J Am Acad Dermatol. 2016;74:e119-20. 27. Escobar GF, Ribeiro CK, Leite LL, Barone CR, Cartell A. 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