Section 07 of 08
Pitfalls and pulling it together
Common pitfalls
Assuming that any lesion with a white central area must be a dermatofibroma. White structures can appear in other lesion types including BCC (shiny white structures) and melanoma (regression, desmoplastic variant).
The central white patch of dermatofibroma is a structureless zone surrounded by a delicate peripheral network. If the white structure appears as short streaks, irregular scar-like areas, or lacks the surrounding network, it is not the dermatofibroma pattern.
Pulling it together
Dermatofibroma completes your TADA benign pattern library. You can now recognise all three lesion types that the algorithm uses as its first decision point: seborrhoeic keratosis (comedo-like openings, milia-like cysts, fissures and ridges), cherry angioma (red lacunae, pale septa, sharp demarcation), and dermatofibroma (central white patch, peripheral pigment network, dimple sign).
Each of these three patterns works the same way in clinical practice. When you see a lesion and the pattern is unequivocal — when the features are clearly present and you recognise them without hesitation — you can confidently identify the lesion and reassure the patient. But when the pattern is incomplete, atypical, or mixed with features that do not fit, the lesion moves into the uncertain category and warrants further evaluation.
That distinction — between confident recognition and uncertain assessment — is the foundation of the TADA algorithm, which you will explore in detail in Module 7.
You have now learned all three TADA benign patterns. Which statement best captures how they should be applied in practice?