Figure 4 - uploaded by Mirjana Popadić
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Nodulocystic basal cell carcinoma with typical clinical (a), dermoscopic (b) and histological (c) presentation (haematoxylin and eosin ×40). Dermoscopic view: blue-grey ovoid nests (circle), arborising and large calibre vessels (squares). (d) Figure 4b with markings
Source publication
Background:
The role of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma (BCC) is not fully elucidated.
Aims:
To determine the accuracy of dermoscopy in diagnosing different BCC subtypes.
Methods:
The dermoscopic features of 102 histopathologically verified BCCs were studied retrospectively. The tumours were...
Context in source publication
Context 1
... BCC (46 lesions) were the most common histologic type in our study comprising 27 (58.7%) purely nodular and 19 (41.3%, Fig 4) mixed variants (including 11 N-S BCCs). Of the 46 histopathologically nodular BCCs, 5 (10.9%) were clinically categorised as superficial (Fig 5a) and 3 (6.5%) ...
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Citations
... Although the majority of dermatoscopy studies have been performed on Caucasians, most studies do not provide clear information on the race of the included population. Two studies clarified that the included population consisted exclusively of Caucasian individuals [5,6]. In this population, Squamous cell carcinoma (SCC) and keratoacanthoma were the least studied in SoC patients. ...
Introduction:
Individuals with melanin-rich skin account for the majority of the world's population. However, literature data regarding dermatoscopic characteristics of skin cancer in skin of color (SoC) are scarce. The dermatoscopic characteristics of cutaneous tumors might differ among skin types due to heterogeneity in composition and pigmentation.
Objectives:
To summarize literature data on the dermatoscopic findings of skin neoplasms, according to the skin color and race.
Methods:
The literature search was performed using PubMed database up to December 30, 2022 and was conducted with the use of terms referring to dermatoscopy, race (Caucasians, Hispanics, Asians, and Black/African) and skin cancer types (BCC, SCC, keratoacanthoma, Bowen's disease and melanoma).
Results:
In total, 30 race-specific records were included. 9 SoC records for BCCs (2 BCC studies in Hispanics, 1 BCC study in Black individuals and 6 BCC studies in Asians ), 9 SoC records for SCCs ( 1 SCC study in Hispanics, 1 SCC study in Black individuals and 7 SCCs in Asian population) and 8 SoC records for melanoma (2 melanoma studies in Hispanics, 1 melanoma study in Blacks and 5 melanoma studies in Asians) were compared with 4 records that involved only Caucasian population, according to their participant section as well as with studies on dermatoscopy characteristics without focusing on race origins and phototype of the patient. In Hispanics and in both fair and dark-skinned Asians, BCCs were more often pigmented or at least with pigmented structures on dermoscopy. Squamous cell carcinoma (SCC) and keratoacanthoma were the least studied in SoC patients. Bowen's disease in SoC patients can be pigmented in a higher frequency compared to Caucasians, with glomerular vessels and a squamous surface being the most common dermatoscopic findings. The most frequent pattern of melanomas in SoC individuals were the parallel ridge pattern in palmoplantar region.
Conclusion:
Based on a review of studies including Caucasians, Hispanics, Asians and Blacks /Africans, SoC patients present with more frequent and unique dermatoscopy features of skin cancers.
... In detail, Verduzco-Martine et al., in a previous study, suggested that the combined presence of ulceration and arborizing vessels was highly suggestive of high-risk BCCs, attributing to these features a highly predictive value [11]. This observation was further supported by the results of two other studies by Popadić et al. and Sgouros et al. that found ulceration to represent the strongest predictive factor of BCCs with a high risk of recurrence (increasing it up to 8-fold) [12,13]. Another feature that has been previously suggested to predict histopathologically aggressive BCC is the so-called MAY globules. ...
Background: The group of histopathologically aggressive BCC subtypes includes morpheaform, micronodular, infiltrative and metatypical BCC. Since these tumors are at increased risk of recurring, micrographically controlled surgery is considered the best therapeutic option. Although dermoscopy significantly improves the clinical recognition of BCC, scarce evidence exists on their dermoscopic criteria. Aim: To investigate the dermoscopic characteristics of histopathologically aggressive BCC subtypes. Materials and Methods: Dermoscopic images of morpheaform, micronodular, infiltrative and metatypical BCC were analyzed for the presence of predefined variables. Descriptive and analytical statistics were performed. Results: Most histopathologically aggressive BCCs were located on the head and neck. Infiltrative was the most common subtype. All subtypes, except micronodular BCC, rarely displayed dermoscopic pigmentation. The most frequent dermoscopic features of infiltrative BCC were arborizing vessels (67.1%), shiny white structures (48.6%) and ulceration (52.9%). The features prevailing in morpheaform BCC were arborizing vessels (68.4%), ulceration (n = 12, 63.2%) and white porcelain areas (47.4%). Micronodular BCC was typified by milky red structureless areas (53.8%), arborizing vessels (53.8%), short fine telangiectasias (50%), ulceration (46.2%) and blue structures (57.7%). The most common findings in metatypical BCC were arborizing vessels (77.8%), shiny white structures (66.7%), ulceration (62.9%) and keratin mass (29.6%). Limitations: Study population of only white skin and relatively small sample size in some groups. Conclusions: Our study provided data on the clinical, dermoscopic and epidemiological characteristics of histopathologically aggressive BCCs.
... There are no clear indicators for the tendency of recurrence in BCC exhibiting a combination of types from different risk groups; however, it is best to determine the risk according to the most aggressive component [37]. More aggressive variants are usually found deeper in the tissue, making it difficult to perform adequate dermatoscopy [38]. ...
Basal cell carcinoma (BCC) is one of the most common malignant tumors in human medicine and the most common skin malignancy, with the largest number of lesions found on exposed parts of the skin, on the face, head, and neck. The average age of the patients is 60 years, with an increasing incidence in younger ages and an increased incidence in males. The incidence of BCC is increasing and doubles every 25 years. Annually, there are approximately 1,000,000 newly diagnosed cases worldwide. The frequency of malignant skin tumors depends on the influence of external factors such as UV radiation and other biological properties of the skin with a higher incidence in fair-skinned people (Fitzpatrick type I and type II skin types). BCC is a slow growing malignant tumor that arises from the basal layer of the epidermis, the outer layer of hair follicles, or the sebaceous glands. BCC can be locally invasive and, if neglected, can infiltrate surrounding structures (muscles and cartilage) and vital structures, which can ultimately lead to death. The clinical presentation is very diverse and dependent on the histological subtype. Prevention is the most important and effective approach towards reducing the burden of BCC. The best treatment for BCC is surgical excision with confirmation and verification of surgical margins. The therapeutic goal is oncologic radical resection of the tumor, followed by reconstruction of the affected area for structure and optimal aesthetic result.
... 23 These findings were corroborated in another study from Serbia, which found that short fine telangiectasias improved the diagnostic accuracy of superficial BCC, whereas arborizing vessels were suggestive of an aggressive histological subtype. 25 In our study, arborizing vessels were also a common finding in the micronodular variant of BCC, but we additionally found a significant association of micronodular BCC with regular dotted vessels and blue-white veil. Dotted vessels have an association with melanocytic lesions in general; however, they have been noted in earlier studies in all types of BCC, particularly in aggressive variants involving the leg. ...
Background:
Literature on dermoscopic patterns of basal cell carcinoma (BCC) in Indian is limited.
Objective:
To describe the dermoscopic pattern and dermoscopic-histopathological correlation in a large cohort of BCC patients from India.
Materials and methods:
This retrospective study was conducted under the aegis of academy of dermoscopy (India). Clinical details were collected, and two lead authors independently analyzed the dermoscopic images of BCC for a predefined set of characteristics. The histopathological slides/ blocks were reviewed, and dermoscopic-histological correlation attempted.
Results:
A total of 143 subjects having BCC with skin phototype IV-VI were included. The mean largest diameter was 3.1±3.68 cm and there was a significant but weak association between duration of the lesion and the largest dimension (ρ= 0.33, p<0.01) of BCC. Nearly half of the cases were diagnosed to have pigmented BCC and the most common histological subtype was nodular BCC (37.9%). Dermoscopically, blue-gray dots and arborizing vessels were the most common features (60.0%). Pigmentary changes were found in majority, and included blue-white veil, blue-gray ovoid nests and maple leaf-like areas. A third of our patients had short linear telangiectasia, polymorphic vessels and regular dotted vessels and another third exhibited dermoscopic rainbow effect. Arborizing vessels were significantly more common with micronodular (78.9%) and nodular variants (74.1%, p=0.05), whereas regular dotted vessels (68.4%, p=0.04), blue-white veil (84.2%, p=0.02) were significantly associated with micronodular variant.
Conclusion:
Blue-white veil and regular dotted vessels on dermoscopy are soft pointers towards micronodular BCC in skin of colour and can help in prioritizing treatment.
