Common Misinterpretations of Benign Dermoscopic Patterns, with Orit Markowitz, MD

In an interview with HCPLive at the 2025 SDPA Annual Summer Dermatology Conference in Washington, DC, Orit Markowitz, MD, spoke about some of the key points highlighted in her session titled ‘Dermoscopy Track: Recognizing Benign Patterns in Dermoscopy: Tools for Clinical Confidence.’

Markowitz, known for her work as an assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai and as Director of Pigmented Lesions and Skin Cancer at the Faculty Practice Mount Sinai Doctors’ Department of Dermatology. During this interview with HCPLive, Markowitz was asked about some of the most common benign dermoscopic patterns that clinicians and physician associates (PAs) can misinterpret.

“Clinicians, for example, might get very excited when they see something that clinically scares them,” Markowitz explained. “For example, a lot of times, seborrheic keratosis might have some tindling, which is the blue discoloration, and they're elevated and follow all the A, B, C, D, E, clinical criteria. Then you look dermoscopically, and you start worrying. But this is a benign lesion. Then, you really should use some of the category patterns. People will be worried about aggressive skin cancers, and if they see that it's an elevated lesion, then look dermoscopically and it's completely symmetric, even if it's like really dark and really bizarre looking clinically, you don't even need to think about a pattern. That's not an aggressive tumor, that's not a nodular melanoma.”

Markowitz highlighted that her ‘color wheel’ approach, highlighted in her session, allows clinicians and PAs to take a step back and consider what they are truly looking at. She was asked about what were some practical tips that clinicians and PAs can start applying right away to better recognize benign patterns in clinical practice.

“I like my textbook approach, and I'm told that it's very popular among trainees, globally, which is nice,” Markowitz said. “...But there are a lot of online resources, and nowadays it's so easy to take a picture. Way back when, and I don't want to say how many years ago, when I started utilizing dermoscopy in my early practice, I always went back and looked at the images. Whenever I would get a pathology result, especially one that I didn't anticipate and even now today, I'm still going back and asking, ‘What did that look like dermoscopically? What did that look like clinically?’ Build your image library from your own experiences. Obviously, there are many tools today. You can go on, like your dermoscopedia. You'll see my way of diagnosing. You'll see a variety of other ways. Pick the one that makes the most sense for you. In the end, it's going to be tailored to what your own image library has taught you.”

For any additional information on the color wheel approach emphasized by Markowitz, as well as other information on dermoscopy, view her full interview segment above. To learn more about topics like these in dermatology, view our latest conference coverage.

The quotes contained in this video summary were edited for clarity.