Characterizing UV-Induced Fluorescence Dermatoscopy (UVFD) of Warts and Molluscum Contagiosum and Its Utility for Expert and Novice Dermatoscopists

Characterizing UV-Induced Fluorescence Dermatoscopy (UVFD) of Warts and Molluscum Contagiosum and Its Utility for Expert and Novice Dermatoscopists | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Characterizing UV-Induced Fluorescence Dermatoscopy (UVFD) of Warts and Molluscum Contagiosum and Its Utility for Expert and Novice Dermatoscopists Sebastián González-Valdés, Sergio Bustos, Magdalena Vial, Marie-Chantal Caussade, and 14 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7218176/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Dermatoscopy is a non-invasive technique that allows visualization of skin structures not visible to the naked eye. Ultraviolet-induced fluorescence dermatoscopy (UVFD), an emerging dermatoscopy mode, has proven utility in guiding the diagnosis of skin conditions by identifying unique patterns. Objectives: The primary aim was to describe the dermatoscopic findings of warts and molluscum contagiosum (MC) using UVFD. The secondary objective was to determine the perceived diagnostic confidence of this technique across different levels of experience. Methods: We conducted a descriptive and observational study at a Tertiary Care Center. Thirty warts and fifty-five MCs were included. UVFD structures were evaluated. Diagnostic confidence (scored from 1 to 6) under UVFD was assessed for both conditions and tested across different levels of dermatoscopy expertise using an online-survey. Results: Under UVFD, 96.7% of the warts had bluish-white fluorescence (κ=0.651, substantial agreement), while 43.6% of MC were hyporeflective (κ=0.515, moderate agreement) and 100% had yellowish or bluish fluorescent rounded/oval structures (κ=1.0, almost perfect agreement). There was a statistically significant increase in the mean diagnostic confidence score when using UVFD compared to polarized light for the assessment of warts (5.52±0.45 vs. 4.89±0.75; p=0.005) and MC (5.41±0.43 vs. 5.05±0.42; p=0.012) in the ‘non-expert group’. In the ‘expert group’ this difference in confidence was not significant. Conclusions: This study highlights the potential of UVFD as a complementary tool to traditional dermatoscopy for the identification of warts and MC. UVFD might be especially relevant among less experienced dermatoscopists. Dermatoscopy ultraviolet radiation ultraviolet-induced fluorescence dermatoscopy viral wart molluscum contagiosum diagnosis Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Dermatoscopy is a non-invasive technique that allows for magnified visualization of the skin and its structures, which are not visible to the naked human eye [ 15 , 16 ]. This technique is widely used in dermatology to evaluate both neoplastic and non-neoplastic dermatoses [ 16 ]. Dermatoscopic devices have evolved throughout history, incorporating features such as polarized light and video dermatoscopes, and more recently, ultraviolet (UV) A light, which allows for the visualization of specific clues that are not visible with conventional dermatoscopy modes (i.e. polarized and non-polarized dermatoscopy) [ 25 ]. The human eye can only see a limited range within the electromagnetic spectrum, known as visible light, with a wavelength ranging from 400 to 720 nm. UV light has a shorter wavelength (< 400 nm), but when interacting with specific chromophores in the skin, UV light can induce fluorescent clues in the visible light spectrum, a phenomenon known as the Stokes shift [ 18 , 22 ]. In this way, characteristic patterns of different skin conditions, both neoplastic and non-neoplastic, have been identified under ultraviolet-induced fluorescence dermatoscopy (UVFD) with multiple emerging uses [ 1 , 19 – 25 ]. The dermatoscopy of infectious diseases (‘entodermoscopy’ or ‘infectoscopy’) can be used as a diagnostic support tool in common infections such as common warts and molluscum contagiosum (MC) [ 4 ]. Warts are a frequent infection caused by the human papillomavirus (HPV) [ 27 ]. Under the dermatoscope, common warts present with papillae containing red and black hemorrhagic spots, surrounded by a whitish halo, as well as multiple whitish, and finger-like projections with elongated and dilated vessels in exophytic lesions [ 12 , 17 , 28 ]. MC presents as firm pink or skin-colored papules with a shiny and umbilicated surface, typically affecting exposed areas of the skin [ 14 ]. Dermatoscopically, they display a central pore with white-yellowish, polylobulated, amorphous structures surrounded by linear serpentine and serpentine branching vessels with peripheral/radial distribution [ 12 , 17 , 27 ]. Although the diagnosis of warts and MC is straightforward in the majority of clinical scenarios, in some instances they might mimic other benign or malignant conditions both clinically and dermatoscopically. UVFD findings of warts and MC have been poorly characterized. In this study, we explore the UVFD clues of warts and MCs. Our secondary objective was to determine and compare the perceived diagnostic confidence of polarized dermatoscopy and UVFD in the evaluation of warts and MC across different levels of dermatoscopy expertise. MATERIALS AND METHODS This single-center, prospective, cross-sectional, descriptive and observational study was performed at a University Hospital in Santiago, Chile and was approved by the Internal Review Board of Pontificia Universidad Católica de Chile (#211213001). All patients and/or their legal guardians signed informed consent. Participants We included consecutive patients of all ages with lesions naïve to the treatment and clinically-compatible with warts or MC that were seen in our Department from January 1st, 2024 to June 30th, 2024. Poor image quality was an exclusion criterion. Diagnoses were made by a senior dermatologist based on clinical examination, or were pathology-confirmed. Dermatoscopic evaluation A total of 30 warts and 55 MC lesions were photographed under contact polarized dermatoscopy and UVFD. We used 70% isopropyl alcohol as a contact medium. A commercially available hybrid dermatoscope (DermLite DL5, San Juan Capistrano, CA USA) attached to a smartphone was used to collect the images. Briefly, UVFD uses 365-nm UV-light emitting diode with 10-mW/cm2, evoking UV-fluorescence. Subsequently, all images were paired (polarized + UVFD), and were described by two independent investigators (S.G-V., C.M.). In cases of disagreement, a second meeting was held to reach a consensus. We recorded the following contact polarized dermatoscopy criteria (presence/absence) in warts: papillomatous surface, ‘frogspawn’ appearance (hemorrhagic spots surrounded by a whitish halo), finger-like projections (long narrow projections that extend from the skin), whitish background, linear vessels, linear looped/hairpin vessels, dotted vessels, and hemorrhagic spots [ 2 , 12 , 17 , 28 ]. For MC, we recorded: polarizing-independent yellowish-white clods, linear serpentine/serpentine branching vessels with peripheral/radial distribution, dotted vessels, and rosettes (polarizing specific four bright white dots or clods arranged together as a square) [ 3 , 7 , 10 – 12 , 17 , 27 ]. For UVFD findings, we recorded the following criteria (presence/absence) based on the authors’ experience and on Pietkiewicz et al [ 22 ]. For warts: bluish-white fluorescence; for MC: yellowish or bluish fluorescent rounded/oval structures, and hyporeflective appearance of the main body [ 22 ]. Evaluation of diagnostic confidence To evaluate diagnostic confidence, we conducted two surveys that included 10 pairs of images for each lesion type (warts and MC). Each pair consisted of images of the same lesion captured using polarized light and UVFD, resulting in a total of 40 images (i.e., 10 warts under polarized light, 10 warts under UVFD, 10 MCs under polarized light, and 10 MCs under UVFD). Initially, we sent a pilot survey to 5 dermatoscopy-trained dermatologists members of the International Dermoscopy Society with more than ten years of experience (United States, Italy, Israel and Greece; the ‘expert group’). They were shown 40 individual images of warts and MCs under polarized light and UVFD, all randomized. Then, we distributed a second survey to a ‘non-expert group’ members consisting of 14 Chilean general dermatologists, 1 Brazilian dermatologist, and 6 Chilean dermatology residents. They were shown individual images of warts and MCs, first under polarized light and then the same lesion under UVFD. Both surveys included the same 40 images. All evaluators had basic experience with UVFD and were pre-trained with a single demonstrative set of cases of wart and MC (not included in the image pairs). The participants chose between two options (‘warts’ or ‘MC’) and scored their diagnostic confidence on a scale from 1 (minimum confidence) to 6 (maximum confidence). Statistical analysis Continuous variables were described using the mean and standard deviation, while qualitative or categorical variables were described using frequency and percentage. For interobserver agreement we calculated a Cohen's kappa coefficient [ 13 ]. For the description of diagnostic confidence, the mean and standard deviation were used, and for the calculation of statistical significance regarding the differences between the polarized dermatoscopy group and the UVFD group, the Wilcoxon signed-rank test was performed. A two-tailed p-value of < 0.05 was considered significant. Statistical analyses were performed using SPSS software version 26.0. RESULTS Dermatoscopic features A total of 30 warts (26 common warts and 4 flat warts) ( Figs. 1 and 2 ) and 55 MCs ( Fig. 3 ) were diagnosed based on clinical examination or histopathological confirmation (2 warts and 1 MC were histopathologically confirmed), and were imaged under both contact polarized dermatoscopy and UVFD. Under polarized dermatoscopy, warts presented with papillomatous surface (80.0%), hemorrhagic spots (73.3%), dotted vessels (60.0%), ‘frogspawn’ appearance (46.7%), linear vessels (40.0%), finger-like projections (20.0%), whitish background (13.3%), and linear looped/hairpin vessels (6.7%). Under UVFD, warts featured bluish-white fluorescence (96.7%) (κ = 0.651, substantial agreement) ( Table 1 ) . Under polarized dermatoscopy, MC displayed polarizing-independent yellowish-white clods (94.5%), linear serpentine/serpentine branching vessels with peripheral/radial distribution (85.5%), dotted vessels (29.1%), and rosettes (10.9%). UVFD imaging of MC demonstrated yellowish or bluish fluorescent rounded/oval structures (100%) (κ = 1.0, almost perfect agreement) and a hyporeflective appearance of the main body (43.6%) (κ = 0.515, moderate agreement) ( Table 2 ) . Table 1 Dermatoscopic description of warts. Modality Features Frequency Interobserver agreement Polarized dermatoscopy Papillomatous surface 80% (24/30) κ = 0.667 Hemorrhagic spots 73.3% (22/30) κ = 0.918 Dotted vessels 60% (18/30) κ = 0.667 ‘Frogspawn’ appearance 46.7% (14/30) κ = 0.577 Linear vessels 40% (12/30) κ = 0.254 Finger-like projections 20% (6/30) κ = 0.516 Whitish background 13.3% (4/30) κ = 1 Linear looped/hairpin vessels 6.7% (2/30) κ = 0.259 UVFD Bluish-white fluorescence 96.7% (29/30) κ = 0.651 Abbreviations: UVFD – ultraviolet-induced fluorescence dermatoscopy Table 2 Dermatoscopic features of molluscum contagiosum. Modality Features Frequency Interobserver agreement Polarized dermatoscopy Polarizing-independent yellowish-white clods 94.5% (52/55) n/a Linear serpentine/serpentine branching vessels with peripheral/radial distribution 85.5% (47/55) κ = 0.395 Dotted vessels 29.1% (16/55) κ = 0.243 Rosettes 10.9% (6/55) κ = 0.469 UVFD Yellowish or bluish fluorescent rounded/oval structures 100% (55/55) κ = 1 Hyporeflective appearance of the main body 43.6% (24/55) κ = 0.515 Abbreviations: n/a – not applicable, UVFD – ultraviolet-induced fluorescence dermatoscopy Diagnostic confidence In the first survey conducted on 5 dermatoscopy experts, mean diagnostic confidence score for the warts group and for the MC group did not differ significantly (4.98 ± 0.86 for polarized, and 4.9 ± 0.92 for UVFD mode; p = 0.45; and 4.98 ± 0.86 for polarized and 4.36 ± 0.91 for UVFD mode; p = 0.085). In a second survey among non-experts, mean diagnostic confidence score was significantly higher for UVFD than polarized mode both for wart group (5.51 ± 0.45 vs. 4.89 ± 0.75; p = 0.005) and MC group (5.41 ± 0.43 vs. 5.05 ± 0.42; p = 0.012) ( Table 3 ) . A total of 88.5% (24/26) of the respondents (both in the ‘expert’ and ‘non-expert’ group) considered UVFD useful for the diagnosis of warts and MCs. Table 3 Diagnostic confidence for diagnosis in expert and non-expert groups. Group Polarized dermatoscopy (mean score ± SD) UVFD (mean score ± SD) p-value Experts Warts 4.98 ± 0.86 4.9 ± 0.92 p = 0.45 MC 4.98 ± 0.86 4.36 ± 0.91 p = 0.085 Non-experts Warts 4.89 ± 0.75 5.51 ± 0.45 p = 0.005 MC 5.05 ± 0.42 5.41 ± 0.43 p = 0.012 Abbreviations: MC – Molluscum contagiosum , SD – standard deviation, UVFD – ultraviolet-induced fluorescence dermatoscopy DISCUSSION In this descriptive and observational study, which included 30 warts and 55 MCs, we found that UVFD revealed distinct patterns and additional clues that complement conventional polarized dermatoscopy. The fluorescence patterns observed under UVFD varied between warts and MCs. Warts displayed bluish-white fluorescence in the hyperkeratotic areas. MCs displayed yellowish or bluish fluorescent rounded/oval structures and a hyporeflective appearance of the main body under UVFD. Both warts and MCs patterns demonstrated good interobserver agreement. Furthermore, the survey results indicate that UVFD significantly enhances diagnostic confidence among non-experts, while the diagnostic confidence among expert dermatologists was similar and not inferior to polarized dermatoscopy. A previous study by Pietkiewicz et al., described 6 warts and 8 MCs evaluated under UVFD. The 6 warts evaluated exhibited perivascular bright halos or fluorescence on the tips of the papillae [ 25 ], which was also seen in our cohort (97%, n = 29) and was referred to as a bluish-white fluorescence. In contrast to our cohort, all the MC lesions showed a hyporeflective main body, with only some exhibited a yellowish fluorescence and no bluish fluorescence was described [ 25 ]. This could be due to differences in the anatomical location of the lesions, the smartphone devices used to capture the images or racial/ethnic differences. Despite no histopathological correlation was performed, we hypothesize that the hyperkeratosis of the papillomatous projections typically seen in warts were likely responsible for the excited bright blue fluorescence. We also hypothesize that the intracytoplasmic viral elements and abnormal keratinization of the MC bodies were likely responsible for the yellowish and bluish fluorescent rounded/oval structures, while the rich blood supply, inflammatory infiltrate, and fibroedematous changes with cytoplasmic vacuolization could be responsible for the hyporeflective appearance of the main body seen in MCs [ 8 , 25 ]. The results of this study are relevant given the frequency of both warts and MCs and how simple is the application of pocket dermatoscopes with UVFD mode. Since the use of UVFD is probably going to be adopted by dermatologists worldwide, it is relevant to describe and recognize the UVFD patterns of diverse lesions and conditions under this emerging dermoscopy mode, such as warts and MC. There is a growing body of data on the description of new signs under UVFD for dermatologic diseases where its role is being documented [ 1 , 18 – 25 ]. While we continue to investigate the role of UVFD, we believe that its use might potentially lead to a reduced number of biopsies, especially in cases lacking classic findings. This is especially relevant in the pediatric population, where a biopsy might require general anesthesia that produces stress and anxiety in both children, parents, and physicians, in an already overloaded health system. Finally, since it has been shown that there is a gradient for dermatoscopy accuracy between experts and non-experts [ 5 ], any tool that improves the accuracy of non-experts is valuable. Since most of these pathologies are seen by primary care physicians, who are having more access to the dermatoscope [ 6 , 9 , 26 ], UVFD might prove useful in these general clinic scenarios. Limitations The limitations of this study include the relatively small sample size, particularly for warts, which may affect the generalizability of the findings. No controls were included. Viral warts may present with different manifestations depending on the affected site and serotype. However, we did not assess these differences based on anatomical location (e.g., genital/flexural vs. non-genital/non-flexural lesions and based on serotype), as our study included patients from general daily practice rather than from a sexually transmitted infections clinic. Although histopathological analysis of the observed lesions was not performed routinely, only lesions with characteristic clinical and dermatoscopic features were included. In the daily dermatological practice, warts and MC are not routinely biopsied. Should we have included only biopsied warts and MCs, we would have skewed our sample to only the atypical and challenging lesions. Three of the included lesions were biopsied due to clinician’s concern and all of them were confirmed to be warts or MC. Additionally, since no histopathological correlation was performed between H&E and UVFD findings, we can only speculate on the correlation of UVFD findings. While UVFD showed promising results, the interpretation of fluorescence patterns relied on subjective assessments by observers, introducing the potential for interobserver variability; however, moderate-to-substantial kappa values were found in our study. Additionally, the inclusion of only a limited number of dermatologists and residents in the surveys may not fully capture the range of diagnostic experience encountered in clinical practice. Furthermore, the study did not evaluate the cost-effectiveness or practicality of incorporating UVFD into routine dermatological care, and it might not be available in all clinical settings, both important factors for broader implementation. However, dermatoscopes including UVFD mode are currently commercially-available and we expect a significant price drop as they become more popular. CONCLUSIONS This study highlights the emerging role of UVFD as a complementary tool to conventional dermatoscopy and shows a novel potential use. Under UVFD, warts exhibited bluish-white fluorescence, while MC showed a hyporeflective main body with rounded or oval structures displaying yellowish or bluish fluorescence, providing additional distinctive features that facilitate lesion identification. Moreover, most participants (88.5%) perceived UVFD as a useful and cheap bedside diagnostic tool, underscoring its potential integration into routine clinical practice. These findings suggest that UVFD enhances diagnostic accuracy, especially among less experienced clinicians, and warrants further exploration in other dermatoses and its impact on clinical decision-making. Declarations Author contribution statement: All authors listed in the manuscript have produced (i) substantial contributions to conception and/or design, or data acquisition, or analysis and interpretation; (ii) drafting or critically revising the article for important intellectual content; (iii) final approval of the version to be published, and therefore, quality as authors. Funding information: None Conflicts of interest: None declared Ethical Approval: Reviewed and approved by Pontificia Universidad Católica de Chile IRB; approval #211213001 Ethics statement: The patients in this manuscript have given written informed consent to the publication of their case details Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request References Al-Nasiri M, Navarrete-Dechent C, Korecka K, Salwowska N, Goldust M, Pietkiewicz P (2023) Ultraviolet-induced fluorescence dermatoscopy of trichobacteriosis axillaris reveals peripilar yellow-green luminescent concretions. Dermatology Practical Concept 13(2):e2023169 Al Rudaisat MA, Cheng H Dermoscopy features of cutaneous warts. Int J Gen Med 2021 Dec 16:9903–9912 Alorainy M, Buchanan K, Nussinow T, Rabinowitz JB, Cyr P, Seiverling EV (2024) A systematic review of diagnoses with rosettes under dermoscopy. Dermatology Practical Concept 14(2):e2024125 Chatterjee M, Neema S (2021) Dermatoscopy of infections and infestations. Indian Dermatology Online J 12(1):14–23 Chen JY, Fernandez K, Fadadu RP, Reddy R, Kim MO, Tan J et al (2024) Skin Cancer Diagnosis by Lesion, Physician, and Examination Type: A Systematic Review and Meta-Analysis. JAMA Dermatology. Nov 13 Fee JA, McGrady FP, Hart ND (2022) Dermoscopy use in primary care: a qualitative study with general practitioners. BMC Prim Care 23(1):47 Ianhez M, Cestari SD, Enokihara MY, Seize MB (2011) Dermoscopic patterns of molluscum contagiosum: a study of 211 lesions confirmed by histopathology. An Bras Dermatol 86:74–79 Ishikawa MK, Arps DP, Chow C, Hocker TL, Fullen DR (2015) Histopathological features of molluscum contagiosum other than molluscum bodies. Histopathology 67(6):836–842 Jones OT, Jurascheck LC, Utukuri M, Pannebakker MM, Emery J, Walter FM (2019) Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology. J Eur Acad Dermatol Venereol 33(9):1706–1712 Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R et al (2016) Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. Journal of the American Academy of Dermatology. ;74(6):1093 – 106 Ku SH, Cho EB, Park EJ, Kim KH, Kim KJ (2015) Dermoscopic features of molluscum contagiosum based on white structures and their correlation with histopathological findings. Clin Exp Dermatol 40(2):208–210 Lallas A, Zalaudek I, Argenziano G, Longo C, Moscarella E, Di Lernia V et al (2013) Dermoscopy in general dermatology. Dermatol Clin 31(4):679–694 Landis JR, Koch GG (1977 Mar) The measurement of observer agreement for categorical data. Biometrics 1:159–174 Meza-Romero R, Navarrete-Dechent C, Downey C (2019) Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, Cosmetic and Investigational Dermatology. 30:373–381 Micali G, Lacarrubba F, Dermatoscopy (2018) Instrumental Update. Dermatol Clin 36(4):345–348 Micali G, Verzì AE, Lacarrubba F (2018) Alternative uses of dermoscopy in daily clinical practice: an update. J Am Acad Dermatol 79(6):1117–1132 Micali G, Verzì AE, Quattrocchi E, Ng CY, Lacarrubba F (2018) Dermatoscopy of common lesions in pediatric dermatology. Dermatol Clin 36(4):463–472 Mojeski JA, Almashali M, Jowdy P, Fitzgerald ME, Brady KL, Zeitouni NC et al (2020) Ultraviolet imaging in dermatology. Photodiagn Photodyn Ther 30:101743 Navarrete-Dechent C, Pietkiewicz P, Astronave G, Marghoob NG, Dusza SW, Lorenzoni J et al (2024) The role of ultraviolet-induced fluorescence dermatoscopy for the detection of multiple aggregated yellow-white globules in basal cell carcinoma. J Am Acad Dermatol 91(6):1250–1252 Navarrete-Dechent C, Pietkiewicz P, Dusza SW, Andreani S, Nehal KS, Rossi AM et al (2023) Ultraviolet-induced fluorescent dermoscopy for biopsy site identification prior to dermatologic surgery: A retrospective study. J Am Acad Dermatol 89(4):841–843 Pietkiewicz P, Navarrete-Dechent C (2023) Scabies mite is bright green under UV dermatoscopy. Dermatology Practical Concept 13(2):e2023135 Pietkiewicz P, Navarrete-Dechent C, Goldust M, Korecka K, Todorovska V, Errichetti E (2023) Differentiating fordyce spots from their common simulators using ultraviolet-induced fluorescence dermatoscopy—retrospective study. Diagnostics 13(5):985 Pietkiewicz P, Navarrete-Dechent C, Mayisoğlu H, Jolly G, Kutlu Ö, Errichetti E (2023) Pink-red fluorescence observed in ultraviolet-induced fluorescence dermoscopy of psoriatic plaques. Dermatology Practical Concept 13(3):e2023243 Pietkiewicz P, Navarrete-Dechent C, Salwowska N, Cantisani C, Goldust M, Errichetti E (2023) Ultraviolet-induced fluorescence dermatoscopy reveals fluorescent clues in pitted keratolysis. Dermatology Practical Concept 13(3):e2023242 Pietkiewicz P, Navarrete-Dechent C, Togawa Y, Szlązak P, Salwowska N, Marghoob AA et al (2024) Applications of ultraviolet and sub-ultraviolet dermatoscopy in neoplastic and non-neoplastic dermatoses: A Systematic Review. Dermatology Therapy 14(2):361–390 Sawyers EA, Wigle DT, Marghoob AA, Blum A (2020) Dermoscopy training effect on diagnostic accuracy of skin lesions in Canadian family medicine physicians using the triage amalgamated dermoscopic algorithm. Dermatology Practical Concept 10(2):e2020035 Verzì AE, Lacarrubba F, Dinotta F, Micali G (2018) Dermatoscopy of parasitic and infectious disorders. Dermatol Clin 36(4):349–358 Yoong C, Di Stefani A, Hofmann-Wellenhof R, Campbell T, Soyer HP (2009) Unusual clinical and dermoscopic presentation of a wart. Australas J Dermatol. ;50(3) Additional Declarations No competing interests reported. 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16:46:12","extension":"png","order_by":43,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34693,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure1d.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/74b1669556de623626f6d788.png"},{"id":93067020,"identity":"33229e5b-b902-4021-b2f7-f46ea38d3f82","added_by":"auto","created_at":"2025-10-08 16:54:14","extension":"png","order_by":44,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19148,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure1f.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/c73b5e41c6e3f9447e21698d.png"},{"id":93065970,"identity":"da0131ba-a046-4c97-9a37-e8f127f4b81e","added_by":"auto","created_at":"2025-10-08 16:46:13","extension":"png","order_by":45,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40650,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure2a.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/bf7242a2e79e793380b5a64b.png"},{"id":93065992,"identity":"448d576c-916b-4896-a38b-a43001ea7a85","added_by":"auto","created_at":"2025-10-08 16:46:13","extension":"png","order_by":46,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":32172,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure2b.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/9aaef153fa924d38df214f6a.png"},{"id":93065983,"identity":"6cbc6cd4-d9ef-4b59-bfc2-57d6b25cbd54","added_by":"auto","created_at":"2025-10-08 16:46:13","extension":"png","order_by":47,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21589,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure2c.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/29d3c4b476250f302597c442.png"},{"id":93067022,"identity":"15f0df03-393b-47cc-b7f7-fd5b653e31ce","added_by":"auto","created_at":"2025-10-08 16:54:14","extension":"png","order_by":48,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16755,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure2d.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/732ee483f3c664a21fd6930f.png"},{"id":93065979,"identity":"b79ca895-bf21-43ab-92e9-d28556b55b5b","added_by":"auto","created_at":"2025-10-08 16:46:13","extension":"png","order_by":49,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19603,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure3a.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/9e42792765d3ffd663be01bc.png"},{"id":93066007,"identity":"8a1f9b2e-e7ab-4c28-bbff-a1b7054001c4","added_by":"auto","created_at":"2025-10-08 16:46:14","extension":"png","order_by":50,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17060,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure3b.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/387d198c67045df12bb401f1.png"},{"id":93067009,"identity":"702db90b-ab11-4b7e-b621-6bf52097024d","added_by":"auto","created_at":"2025-10-08 16:54:12","extension":"png","order_by":51,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21655,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure3c.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/4dbeb25be0f47cd4f7963824.png"},{"id":93067406,"identity":"363b33a9-b4ac-4bc0-8cf0-231b3a41d2de","added_by":"auto","created_at":"2025-10-08 17:02:13","extension":"png","order_by":52,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33834,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure3d.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/7e05271982902aafd68a9782.png"},{"id":93067019,"identity":"97df25c8-ea39-4596-b910-720171dc061a","added_by":"auto","created_at":"2025-10-08 16:54:13","extension":"png","order_by":53,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21876,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure3f.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/f712a2bfdd8c87f7a9263e94.png"},{"id":93065981,"identity":"4d6be758-3a9d-4044-bb7d-9fc231631944","added_by":"auto","created_at":"2025-10-08 16:46:13","extension":"png","order_by":54,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":129214,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/23f48f5f989a00f1001734e9.png"},{"id":93065969,"identity":"0862f815-ba80-4e3a-9bcd-dae22b11f1c6","added_by":"auto","created_at":"2025-10-08 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16:46:14","extension":"png","order_by":57,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":129214,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/51ed0796a44a223cfec23f0e.png"},{"id":93067018,"identity":"a43c5d54-183b-46fc-b6dd-70ae1928a3d4","added_by":"auto","created_at":"2025-10-08 16:54:13","extension":"png","order_by":58,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75216,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/40a2cd31fb3d0db72c2159d5.png"},{"id":93065990,"identity":"455a5f96-49f1-41a0-85c7-c45dd1b3b9f7","added_by":"auto","created_at":"2025-10-08 16:46:13","extension":"png","order_by":59,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90162,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/8c1c26e9eb4c263fc3fee8ab.png"},{"id":93066005,"identity":"77820f8c-75f7-4a27-a8e5-d8514eb46988","added_by":"auto","created_at":"2025-10-08 16:46:14","extension":"xml","order_by":60,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":96302,"visible":true,"origin":"","legend":"","description":"","filename":"aee7350617ac4ff4a882f381516a08ff1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/71420a2e6c682bbed95b494b.xml"},{"id":93067023,"identity":"8814a7dd-adef-41db-a74e-ce7610b5b77c","added_by":"auto","created_at":"2025-10-08 16:54:14","extension":"html","order_by":61,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110475,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/22a70e8c1d7324eebd85c299.html"},{"id":93065942,"identity":"c5f7dc5d-8b3d-457a-94cd-f6f0b383a64d","added_by":"auto","created_at":"2025-10-08 16:46:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":956084,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCommon warts. a-c. \u003c/strong\u003ePolarized light dermatoscopy showing hyperkeratotic lesions, with papillomatous surface and hemorrhagic spots (blue arrows), consistent with common warts (original magnification 10X).\u003cstrong\u003e d-f. \u003c/strong\u003eUltraviolet-induced fluorescence dermatoscopy showing bluish-white fluorescence (black arrows), particularly highlighting the papillomatous areas in common warts (original magnification 10X).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/1d431d13dda487cf10d0cd84.png"},{"id":93065936,"identity":"9aff0d14-e722-4da9-a6d5-a3d301b888e3","added_by":"auto","created_at":"2025-10-08 16:46:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":678542,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlat warts. a-b. \u003c/strong\u003ePolarized light dermatoscopy showing homogeneous white lesions with hyperkeratotic surfaces (blue arrows), consistent with flat warts (original magnification 10X). \u003cstrong\u003ec-d. \u003c/strong\u003eUltraviolet-induced fluorescence dermatoscopy showing homogeneous bluish-white fluorescence (black arrows) in flat warts, contrasting with the surrounding skin (original magnification 10X).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/f64a36adf183ac431db71431.png"},{"id":93065929,"identity":"70b8ef53-3974-4764-9f10-1d8094df78af","added_by":"auto","created_at":"2025-10-08 16:46:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":860726,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMolluscum contagiosum. a-c. \u003c/strong\u003ePolarized dermatoscopy reveals pink papules with central yellowish-white clods (blue arrows) and linear serpentine/serpentine branching vessels with peripheral/radial distribution (red arrows), consistent with molluscum contagiosum (original magnification 10X). \u003cstrong\u003ed-f.\u003c/strong\u003eUltraviolet-induced fluorescence dermatoscopy exhibits yellowish or bluish fluorescent rounded/oval structures (black arrows) and a hyporeflective appearance of the main body (original magnification 10X).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/bfb676150bbbfce78400461d.png"},{"id":93067407,"identity":"c47292f8-cf99-42ed-889e-eac071c25c1a","added_by":"auto","created_at":"2025-10-08 17:02:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4286096,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7218176/v1/e952d9fa-4b6f-4bd3-810d-5ce65e8ad091.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Characterizing UV-Induced Fluorescence Dermatoscopy (UVFD) of Warts and Molluscum Contagiosum and Its Utility for Expert and Novice Dermatoscopists","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDermatoscopy is a non-invasive technique that allows for magnified visualization of the skin and its structures, which are not visible to the naked human eye [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This technique is widely used in dermatology to evaluate both neoplastic and non-neoplastic dermatoses [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Dermatoscopic devices have evolved throughout history, incorporating features such as polarized light and video dermatoscopes, and more recently, ultraviolet (UV) A light, which allows for the visualization of specific clues that are not visible with conventional dermatoscopy modes (i.e. polarized and non-polarized dermatoscopy) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The human eye can only see a limited range within the electromagnetic spectrum, known as visible light, with a wavelength ranging from 400 to 720 nm. UV light has a shorter wavelength (\u0026lt;\u0026thinsp;400 nm), but when interacting with specific chromophores in the skin, UV light can induce fluorescent clues in the visible light spectrum, a phenomenon known as the Stokes shift [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In this way, characteristic patterns of different skin conditions, both neoplastic and non-neoplastic, have been identified under ultraviolet-induced fluorescence dermatoscopy (UVFD) with multiple emerging uses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe dermatoscopy of infectious diseases (\u0026lsquo;entodermoscopy\u0026rsquo; or \u0026lsquo;infectoscopy\u0026rsquo;) can be used as a diagnostic support tool in common infections such as common warts and molluscum contagiosum (MC) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Warts are a frequent infection caused by the human papillomavirus (HPV) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Under the dermatoscope, common warts present with papillae containing red and black hemorrhagic spots, surrounded by a whitish halo, as well as multiple whitish, and finger-like projections with elongated and dilated vessels in exophytic lesions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. MC presents as firm pink or skin-colored papules with a shiny and umbilicated surface, typically affecting exposed areas of the skin [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Dermatoscopically, they display a central pore with white-yellowish, polylobulated, amorphous structures surrounded by linear serpentine and serpentine branching vessels with peripheral/radial distribution [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Although the diagnosis of warts and MC is straightforward in the majority of clinical scenarios, in some instances they might mimic other benign or malignant conditions both clinically and dermatoscopically. UVFD findings of warts and MC have been poorly characterized.\u003c/p\u003e\u003cp\u003eIn this study, we explore the UVFD clues of warts and MCs. Our secondary objective was to determine and compare the perceived diagnostic confidence of polarized dermatoscopy and UVFD in the evaluation of warts and MC across different levels of dermatoscopy expertise.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis single-center, prospective, cross-sectional, descriptive and observational study was performed at a University Hospital in Santiago, Chile and was approved by the Internal Review Board of Pontificia Universidad Cat\u0026oacute;lica de Chile (#211213001). All patients and/or their legal guardians signed informed consent.\u003c/p\u003e\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe included consecutive patients of all ages with lesions na\u0026iuml;ve to the treatment and clinically-compatible with warts or MC that were seen in our Department from January 1st, 2024 to June 30th, 2024. Poor image quality was an exclusion criterion. Diagnoses were made by a senior dermatologist based on clinical examination, or were pathology-confirmed.\u003c/p\u003e\u003cp\u003e\u003cem\u003eDermatoscopic evaluation\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA total of 30 warts and 55 MC lesions were photographed under contact polarized dermatoscopy and UVFD. We used 70% isopropyl alcohol as a contact medium. A commercially available hybrid dermatoscope (DermLite DL5, San Juan Capistrano, CA USA) attached to a smartphone was used to collect the images. Briefly, UVFD uses 365-nm UV-light emitting diode with 10-mW/cm2, evoking UV-fluorescence. Subsequently, all images were paired (polarized\u0026thinsp;+\u0026thinsp;UVFD), and were described by two independent investigators (S.G-V., C.M.). In cases of disagreement, a second meeting was held to reach a consensus. We recorded the following contact polarized dermatoscopy criteria (presence/absence) in warts: papillomatous surface, \u0026lsquo;frogspawn\u0026rsquo; appearance (hemorrhagic spots surrounded by a whitish halo), finger-like projections (long narrow projections that extend from the skin), whitish background, linear vessels, linear looped/hairpin vessels, dotted vessels, and hemorrhagic spots [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. For MC, we recorded: polarizing-independent yellowish-white clods, linear serpentine/serpentine branching vessels with peripheral/radial distribution, dotted vessels, and rosettes (polarizing specific four bright white dots or clods arranged together as a square) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For UVFD findings, we recorded the following criteria (presence/absence) based on the authors\u0026rsquo; experience and on Pietkiewicz et al [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. For warts: bluish-white fluorescence; for MC: yellowish or bluish fluorescent rounded/oval structures, and hyporeflective appearance of the main body [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eEvaluation of diagnostic confidence\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTo evaluate diagnostic confidence, we conducted two surveys that included 10 pairs of images for each lesion type (warts and MC). Each pair consisted of images of the same lesion captured using polarized light and UVFD, resulting in a total of 40 images (i.e., 10 warts under polarized light, 10 warts under UVFD, 10 MCs under polarized light, and 10 MCs under UVFD). Initially, we sent a pilot survey to 5 dermatoscopy-trained dermatologists members of the International Dermoscopy Society with more than ten years of experience (United States, Italy, Israel and Greece; the \u0026lsquo;expert group\u0026rsquo;). They were shown 40 individual images of warts and MCs under polarized light and UVFD, all randomized. Then, we distributed a second survey to a \u0026lsquo;non-expert group\u0026rsquo; members consisting of 14 Chilean general dermatologists, 1 Brazilian dermatologist, and 6 Chilean dermatology residents. They were shown individual images of warts and MCs, first under polarized light and then the same lesion under UVFD. Both surveys included the same 40 images. All evaluators had basic experience with UVFD and were pre-trained with a single demonstrative set of cases of wart and MC (not included in the image pairs). The participants chose between two options (\u0026lsquo;warts\u0026rsquo; or \u0026lsquo;MC\u0026rsquo;) and scored their diagnostic confidence on a scale from 1 (minimum confidence) to 6 (maximum confidence).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were described using the mean and standard deviation, while qualitative or categorical variables were described using frequency and percentage. For interobserver agreement we calculated a Cohen's kappa coefficient [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For the description of diagnostic confidence, the mean and standard deviation were used, and for the calculation of statistical significance regarding the differences between the polarized dermatoscopy group and the UVFD group, the Wilcoxon signed-rank test was performed. A two-tailed p-value of \u0026lt;\u0026thinsp;0.05 was considered significant. Statistical analyses were performed using SPSS software version 26.0.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cem\u003eDermatoscopic features\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 30 warts (26 common warts and 4 flat warts) \u003cstrong\u003e(\u003c/strong\u003eFigs. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e and 55 MCs \u003cstrong\u003e(\u003c/strong\u003eFig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e were diagnosed based on clinical examination or histopathological confirmation (2 warts and 1 MC were histopathologically confirmed), and were imaged under both contact polarized dermatoscopy and UVFD. Under polarized dermatoscopy, warts presented with papillomatous surface (80.0%), hemorrhagic spots (73.3%), dotted vessels (60.0%), \u0026lsquo;frogspawn\u0026rsquo; appearance (46.7%), linear vessels (40.0%), finger-like projections (20.0%), whitish background (13.3%), and linear looped/hairpin vessels (6.7%). Under UVFD, warts featured bluish-white fluorescence (96.7%) (\u0026kappa;\u0026thinsp;=\u0026thinsp;0.651, substantial agreement) \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e. Under polarized dermatoscopy, MC displayed polarizing-independent yellowish-white clods (94.5%), linear serpentine/serpentine branching vessels with peripheral/radial distribution (85.5%), dotted vessels (29.1%), and rosettes (10.9%). UVFD imaging of MC demonstrated yellowish or bluish fluorescent rounded/oval structures (100%) (\u0026kappa;\u0026thinsp;=\u0026thinsp;1.0, almost perfect agreement) and a hyporeflective appearance of the main body (43.6%) (\u0026kappa;\u0026thinsp;=\u0026thinsp;0.515, moderate agreement) \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e.\u003c/p\u003e\n\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDermatoscopic description of warts.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFeatures\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInterobserver agreement\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003ePolarized dermatoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePapillomatous surface\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80% (24/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemorrhagic spots\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.3% (22/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.918\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDotted vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60% (18/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lsquo;Frogspawn\u0026rsquo; appearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.7% (14/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinear vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40% (12/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFinger-like projections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20% (6/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhitish background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.3% (4/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinear looped/hairpin vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7% (2/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUVFD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBluish-white fluorescence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.7% (29/30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.651\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003eUVFD \u0026ndash; ultraviolet-induced fluorescence dermatoscopy\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDermatoscopic features of molluscum contagiosum.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFeatures\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInterobserver agreement\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003ePolarized dermatoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolarizing-independent yellowish-white clods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.5% (52/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinear serpentine/serpentine branching vessels with peripheral/radial distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.5% (47/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDotted vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.1% (16/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRosettes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9% (6/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eUVFD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYellowish or bluish fluorescent rounded/oval structures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100% (55/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHyporeflective appearance of the main body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.6% (24/55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026kappa;\u0026thinsp;=\u0026thinsp;0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003en/a \u0026ndash; not applicable, UVFD \u0026ndash; ultraviolet-induced fluorescence dermatoscopy\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDiagnostic confidence\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the first survey conducted on 5 dermatoscopy experts, mean diagnostic confidence score for the warts group and for the MC group did not differ significantly (4.98\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.86 for polarized, and 4.9\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.92 for UVFD mode; p\u0026thinsp;=\u0026thinsp;0.45; and 4.98\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.86 for polarized and 4.36\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.91 for UVFD mode; p\u0026thinsp;=\u0026thinsp;0.085). In a second survey among non-experts, mean diagnostic confidence score was significantly higher for UVFD than polarized mode both for wart group (5.51\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.45 vs. 4.89\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.75; p\u0026thinsp;=\u0026thinsp;0.005) and MC group (5.41\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.43 vs. 5.05\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0.42; p\u0026thinsp;=\u0026thinsp;0.012) \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e. A total of 88.5% (24/26) of the respondents (both in the \u0026lsquo;expert\u0026rsquo; and \u0026lsquo;non-expert\u0026rsquo; group) considered UVFD useful for the diagnosis of warts and MCs.\u003c/p\u003e\n\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDiagnostic confidence for diagnosis in expert and non-expert groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePolarized dermatoscopy\u003c/p\u003e\n \u003cp\u003e(mean score\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUVFD\u003c/p\u003e\n \u003cp\u003e(mean score\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eExperts\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWarts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-experts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWarts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003eMC \u0026ndash; Molluscum contagiosum\u003cem\u003e,\u0026nbsp;\u003c/em\u003eSD \u0026ndash; standard deviation, UVFD \u0026ndash; ultraviolet-induced fluorescence dermatoscopy\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this descriptive and observational study, which included 30 warts and 55 MCs, we found that UVFD revealed distinct patterns and additional clues that complement conventional polarized dermatoscopy. The fluorescence patterns observed under UVFD varied between warts and MCs. Warts displayed bluish-white fluorescence in the hyperkeratotic areas. MCs displayed yellowish or bluish fluorescent rounded/oval structures and a hyporeflective appearance of the main body under UVFD. Both warts and MCs patterns demonstrated good interobserver agreement. Furthermore, the survey results indicate that UVFD significantly enhances diagnostic confidence among non-experts, while the diagnostic confidence among expert dermatologists was similar and not inferior to polarized dermatoscopy.\u003c/p\u003e\u003cp\u003eA previous study by Pietkiewicz et al., described 6 warts and 8 MCs evaluated under UVFD. The 6 warts evaluated exhibited perivascular bright halos or fluorescence on the tips of the papillae [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], which was also seen in our cohort (97%, n\u0026thinsp;=\u0026thinsp;29) and was referred to as a bluish-white fluorescence. In contrast to our cohort, all the MC lesions showed a hyporeflective main body, with only some exhibited a yellowish fluorescence and no bluish fluorescence was described [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This could be due to differences in the anatomical location of the lesions, the smartphone devices used to capture the images or racial/ethnic differences. Despite no histopathological correlation was performed, we hypothesize that the hyperkeratosis of the papillomatous projections typically seen in warts were likely responsible for the excited bright blue fluorescence. We also hypothesize that the intracytoplasmic viral elements and abnormal keratinization of the MC bodies were likely responsible for the yellowish and bluish fluorescent rounded/oval structures, while the rich blood supply, inflammatory infiltrate, and fibroedematous changes with cytoplasmic vacuolization could be responsible for the hyporeflective appearance of the main body seen in MCs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results of this study are relevant given the frequency of both warts and MCs and how simple is the application of pocket dermatoscopes with UVFD mode. Since the use of UVFD is probably going to be adopted by dermatologists worldwide, it is relevant to describe and recognize the UVFD patterns of diverse lesions and conditions under this emerging dermoscopy mode, such as warts and MC. There is a growing body of data on the description of new signs under UVFD for dermatologic diseases where its role is being documented [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. While we continue to investigate the role of UVFD, we believe that its use might potentially lead to a reduced number of biopsies, especially in cases lacking classic findings. This is especially relevant in the pediatric population, where a biopsy might require general anesthesia that produces stress and anxiety in both children, parents, and physicians, in an already overloaded health system. Finally, since it has been shown that there is a gradient for dermatoscopy accuracy between experts and non-experts [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], any tool that improves the accuracy of non-experts is valuable. Since most of these pathologies are seen by primary care physicians, who are having more access to the dermatoscope [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], UVFD might prove useful in these general clinic scenarios.\u003c/p\u003e\u003cp\u003e\u003cem\u003eLimitations\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe limitations of this study include the relatively small sample size, particularly for warts, which may affect the generalizability of the findings. No controls were included. Viral warts may present with different manifestations depending on the affected site and serotype. However, we did not assess these differences based on anatomical location (e.g., genital/flexural vs. non-genital/non-flexural lesions and based on serotype), as our study included patients from general daily practice rather than from a sexually transmitted infections clinic. Although histopathological analysis of the observed lesions was not performed routinely, only lesions with characteristic clinical and dermatoscopic features were included. In the daily dermatological practice, warts and MC are not routinely biopsied. Should we have included only biopsied warts and MCs, we would have skewed our sample to only the atypical and challenging lesions. Three of the included lesions were biopsied due to clinician\u0026rsquo;s concern and all of them were confirmed to be warts or MC. Additionally, since no histopathological correlation was performed between H\u0026amp;E and UVFD findings, we can only speculate on the correlation of UVFD findings. While UVFD showed promising results, the interpretation of fluorescence patterns relied on subjective assessments by observers, introducing the potential for interobserver variability; however, moderate-to-substantial kappa values were found in our study. Additionally, the inclusion of only a limited number of dermatologists and residents in the surveys may not fully capture the range of diagnostic experience encountered in clinical practice. Furthermore, the study did not evaluate the cost-effectiveness or practicality of incorporating UVFD into routine dermatological care, and it might not be available in all clinical settings, both important factors for broader implementation. However, dermatoscopes including UVFD mode are currently commercially-available and we expect a significant price drop as they become more popular.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study highlights the emerging role of UVFD as a complementary tool to conventional dermatoscopy and shows a novel potential use. Under UVFD, warts exhibited bluish-white fluorescence, while MC showed a hyporeflective main body with rounded or oval structures displaying yellowish or bluish fluorescence, providing additional distinctive features that facilitate lesion identification. Moreover, most participants (88.5%) perceived UVFD as a useful and cheap bedside diagnostic tool, underscoring its potential integration into routine clinical practice. These findings suggest that UVFD enhances diagnostic accuracy, especially among less experienced clinicians, and warrants further exploration in other dermatoses and its impact on clinical decision-making.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors listed in the manuscript have produced (i) substantial contributions to conception and/or design, or data acquisition, or analysis and interpretation; (ii) drafting or critically revising the article for important intellectual content; (iii) final approval of the version to be published, and therefore, quality as authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u0026nbsp;\u003c/strong\u003eNone declared\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eReviewed and approved by Pontificia Universidad Católica de Chile IRB; approval #211213001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement:\u003c/strong\u003e The patients in this manuscript have given written informed consent to the publication of their case details\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl-Nasiri M, Navarrete-Dechent C, Korecka K, Salwowska N, Goldust M, Pietkiewicz P (2023) Ultraviolet-induced fluorescence dermatoscopy of trichobacteriosis axillaris reveals peripilar yellow-green luminescent concretions. Dermatology Practical Concept 13(2):e2023169\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl Rudaisat MA, Cheng H Dermoscopy features of cutaneous warts. Int J Gen Med 2021 Dec 16:9903\u0026ndash;9912\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlorainy M, Buchanan K, Nussinow T, Rabinowitz JB, Cyr P, Seiverling EV (2024) A systematic review of diagnoses with rosettes under dermoscopy. Dermatology Practical Concept 14(2):e2024125\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChatterjee M, Neema S (2021) Dermatoscopy of infections and infestations. Indian Dermatology Online J 12(1):14\u0026ndash;23\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen JY, Fernandez K, Fadadu RP, Reddy R, Kim MO, Tan J et al (2024) Skin Cancer Diagnosis by Lesion, Physician, and Examination Type: A Systematic Review and Meta-Analysis. JAMA Dermatology. Nov 13\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFee JA, McGrady FP, Hart ND (2022) Dermoscopy use in primary care: a qualitative study with general practitioners. BMC Prim Care 23(1):47\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIanhez M, Cestari SD, Enokihara MY, Seize MB (2011) Dermoscopic patterns of molluscum contagiosum: a study of 211 lesions confirmed by histopathology. An Bras Dermatol 86:74\u0026ndash;79\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIshikawa MK, Arps DP, Chow C, Hocker TL, Fullen DR (2015) Histopathological features of molluscum contagiosum other than molluscum bodies. Histopathology 67(6):836\u0026ndash;842\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJones OT, Jurascheck LC, Utukuri M, Pannebakker MM, Emery J, Walter FM (2019) Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology. J Eur Acad Dermatol Venereol 33(9):1706\u0026ndash;1712\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R et al (2016) Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. Journal of the American Academy of Dermatology. ;74(6):1093\u0026thinsp;\u0026ndash;\u0026thinsp;106\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKu SH, Cho EB, Park EJ, Kim KH, Kim KJ (2015) Dermoscopic features of molluscum contagiosum based on white structures and their correlation with histopathological findings. Clin Exp Dermatol 40(2):208\u0026ndash;210\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLallas A, Zalaudek I, Argenziano G, Longo C, Moscarella E, Di Lernia V et al (2013) Dermoscopy in general dermatology. Dermatol Clin 31(4):679\u0026ndash;694\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLandis JR, Koch GG (1977 Mar) The measurement of observer agreement for categorical data. Biometrics 1:159\u0026ndash;174\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeza-Romero R, Navarrete-Dechent C, Downey C (2019) Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, Cosmetic and Investigational Dermatology. 30:373\u0026ndash;381\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMicali G, Lacarrubba F, Dermatoscopy (2018) Instrumental Update. Dermatol Clin 36(4):345\u0026ndash;348\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMicali G, Verz\u0026igrave; AE, Lacarrubba F (2018) Alternative uses of dermoscopy in daily clinical practice: an update. J Am Acad Dermatol 79(6):1117\u0026ndash;1132\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMicali G, Verz\u0026igrave; AE, Quattrocchi E, Ng CY, Lacarrubba F (2018) Dermatoscopy of common lesions in pediatric dermatology. Dermatol Clin 36(4):463\u0026ndash;472\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMojeski JA, Almashali M, Jowdy P, Fitzgerald ME, Brady KL, Zeitouni NC et al (2020) Ultraviolet imaging in dermatology. Photodiagn Photodyn Ther 30:101743\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavarrete-Dechent C, Pietkiewicz P, Astronave G, Marghoob NG, Dusza SW, Lorenzoni J et al (2024) The role of ultraviolet-induced fluorescence dermatoscopy for the detection of multiple aggregated yellow-white globules in basal cell carcinoma. J Am Acad Dermatol 91(6):1250\u0026ndash;1252\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavarrete-Dechent C, Pietkiewicz P, Dusza SW, Andreani S, Nehal KS, Rossi AM et al (2023) Ultraviolet-induced fluorescent dermoscopy for biopsy site identification prior to dermatologic surgery: A retrospective study. J Am Acad Dermatol 89(4):841\u0026ndash;843\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePietkiewicz P, Navarrete-Dechent C (2023) Scabies mite is bright green under UV dermatoscopy. Dermatology Practical Concept 13(2):e2023135\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePietkiewicz P, Navarrete-Dechent C, Goldust M, Korecka K, Todorovska V, Errichetti E (2023) Differentiating fordyce spots from their common simulators using ultraviolet-induced fluorescence dermatoscopy\u0026mdash;retrospective study. Diagnostics 13(5):985\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePietkiewicz P, Navarrete-Dechent C, Mayisoğlu H, Jolly G, Kutlu \u0026Ouml;, Errichetti E (2023) Pink-red fluorescence observed in ultraviolet-induced fluorescence dermoscopy of psoriatic plaques. Dermatology Practical Concept 13(3):e2023243\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePietkiewicz P, Navarrete-Dechent C, Salwowska N, Cantisani C, Goldust M, Errichetti E (2023) Ultraviolet-induced fluorescence dermatoscopy reveals fluorescent clues in pitted keratolysis. Dermatology Practical Concept 13(3):e2023242\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePietkiewicz P, Navarrete-Dechent C, Togawa Y, Szlązak P, Salwowska N, Marghoob AA et al (2024) Applications of ultraviolet and sub-ultraviolet dermatoscopy in neoplastic and non-neoplastic dermatoses: A Systematic Review. Dermatology Therapy 14(2):361\u0026ndash;390\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSawyers EA, Wigle DT, Marghoob AA, Blum A (2020) Dermoscopy training effect on diagnostic accuracy of skin lesions in Canadian family medicine physicians using the triage amalgamated dermoscopic algorithm. Dermatology Practical Concept 10(2):e2020035\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVerz\u0026igrave; AE, Lacarrubba F, Dinotta F, Micali G (2018) Dermatoscopy of parasitic and infectious disorders. Dermatol Clin 36(4):349\u0026ndash;358\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoong C, Di Stefani A, Hofmann-Wellenhof R, Campbell T, Soyer HP (2009) Unusual clinical and dermoscopic presentation of a wart. Australas J Dermatol. ;50(3)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Dermatoscopy, ultraviolet radiation, ultraviolet-induced fluorescence dermatoscopy, viral wart, molluscum contagiosum, diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-7218176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7218176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDermatoscopy is a non-invasive technique that allows visualization of skin structures not visible to the naked eye. Ultraviolet-induced fluorescence dermatoscopy (UVFD), an emerging dermatoscopy mode, has proven utility in guiding the diagnosis of skin conditions by identifying unique patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThe primary aim was to describe the dermatoscopic findings of warts and molluscum contagiosum (MC) using UVFD. The secondary objective was to determine the perceived diagnostic confidence of this technique across different levels of experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a descriptive and observational study at a Tertiary Care Center. Thirty warts and fifty-five MCs were included. UVFD structures were evaluated. Diagnostic confidence (scored from 1 to 6) under UVFD was assessed for both conditions and tested across different levels of dermatoscopy expertise using an online-survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eUnder UVFD, 96.7% of the warts had bluish-white fluorescence (κ=0.651, substantial agreement), while 43.6% of MC were hyporeflective (κ=0.515, moderate agreement) and 100% had yellowish or bluish fluorescent rounded/oval structures (κ=1.0, almost perfect agreement). There was a statistically significant increase in the mean diagnostic confidence score when using UVFD compared to polarized light for the assessment of warts (5.52±0.45 vs. 4.89±0.75; p=0.005) and MC (5.41±0.43 vs. 5.05±0.42; p=0.012) in the ‘non-expert group’. In the ‘expert group’ this difference in confidence was not significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study highlights the potential of UVFD as a complementary tool to traditional dermatoscopy for the identification of warts and MC. UVFD might be especially relevant among less experienced dermatoscopists.\u003c/p\u003e","manuscriptTitle":"Characterizing UV-Induced Fluorescence Dermatoscopy (UVFD) of Warts and Molluscum Contagiosum and Its Utility for Expert and Novice Dermatoscopists","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 16:46:00","doi":"10.21203/rs.3.rs-7218176/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-17T19:16:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-14T15:36:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288637745094863373855446513055848899652","date":"2025-11-02T17:33:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260430058191103931927222100583300544103","date":"2025-10-29T01:59:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-25T05:24:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124828541672368206184620927376577347596","date":"2025-09-26T05:40:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T18:55:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T12:23:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-28T12:23:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2025-07-26T03:25:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"535fb194-fea4-429e-98cd-e6424a2611b1","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T18:39:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 16:46:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7218176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7218176","identity":"rs-7218176","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}