Strategies for Recognizing Benign Patterns in Dermoscopy, with Orit Markowitz, MD

Dermoscopy is a non-invasive skin examination technique that has changed the assessment of pigmented lesions among dermatologists and physician associates (PAs), but pattern recognition alone may not always suffice for diagnoses.

Orit Markowitz, MD, presented a talk at the 2025 SDPA Annual Summer Dermatology Conference in Washington, DC, titled ‘Dermoscopy Track: Recognizing Benign Patterns in Dermoscopy: Tools for Clinical Confidence.’ Markowitz, an assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai, spoke about the talk’s main points with HCPLive, highlighting her own unique "color wheel" approach and its use when diagnosing benign conditions.

“The color wheel approach is an approach that just sort of thinks about benign versus malignant,” Markowitz said. “Dermoscopy is a very detailed specialty, and because it's so detailed and literally microscopic, we tend to go into a lot of details before, and sometimes almost get into the weeds, about what's benign and what needs to be biopsied and what doesn't need to be biopsied. So when I was tasked with trying to create a textbook with an approach that I use, it's the polar opposite of getting into the weeds. I like to kind of decide, do I need to cut this human being, though nowadays we have non-invasive imaging, so we don't necessarily need to cut. But do I need to take the extra step in diagnosing, or is this benign?”

Markowitz noted that she utilizes the color wheel to identify patterns to determine whether a lesion is malignant or benign, taking not just what we see dermascopically, but also clinically. She was then asked about how PAs and clinicians can incorporate a color identification strategy into daily practice to improve early detection of malignant lesions across a range of skin tones.

“When we're able to decide whether something is benign or not, we're already 10 steps ahead,” Markowitz explained. “...The other precedent for the color wheel approach was really melanotic melanomas. This is a topic that people are often a little bit anxious about, as they should be, because they're difficult to diagnose lesions, even on dermoscopy, and even on non-invasive devices like confocal. So I tried to boil it down to, what color is it clinically? What color is it dermoscopically? Then get into the weeds of the very subtle details. What this enables us to do is actually catch these lesions very early.”

Markowitz highlighted that, given that certain malignancies, such as a melonotic can progress quite rapidly. Therefore, the ability to diagnose early is essential among healthcare providers if it can be accomplished.

“There are certain just really basic patterns as well, or colors, that enable us to know [something] is malignant,” Markowitz said. “[Even if] it's 2 millimeters in diameter, we can see if it's malignant.”

For any additional information on the color wheel system and Markowitz’s interview, view her full discussion segment posted above. To find out more about related topics, check out our latest conference coverage.

The quotes used in this summary were edited for clarity.