Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location

BACKGROUND

Correctly diagnosing basal cell carcinoma (BCC) clinical type is crucial for the therapeutic management. A systematic description of the variability of all reported BCC dermoscopic features according to clinical type and anatomic location is lacking.

OBJECTIVES

To describe the dermoscopic variability of BCC according to clinical type and anatomic location and to test the hypothesis of a clinical/dermoscopic continuum across superficial BCCs (sBCCs) with increasing palpability.

METHODS

Clinical/dermoscopic images of nodular BCCs (nBCCs) and sBCCs with different degrees of palpability were retrospectively evaluated for the presence of dermoscopic criteria including degree of pigmentation, BCC-associated patterns, diverse vascular patterns, melanocytic patterns and polarized light patterns.

RESULTS

We examined 501 histopathologically proven BCCs (66.9% sBCCs; 33.1% nBCCs), mainly located on trunk (46.7%; mostly sBCCs) and face (30.5%; mostly nBCCs). Short fine telangiectasias, leaf-like areas, spoke-wheel areas, small erosions and concentric structures were significantly associated with sBCC, whereas arborizing telangiectasias, blue-white veil-like structures, white shiny areas and rainbow pattern with nBCCs. Short fine telangiectasia, spoke-wheel areas and small erosions were independently associated with trunk location, whereas arborizing telangiectasias with facial location. Scalp BCCs had significantly more pigmentation and melanocytic criteria than BCCs located elsewhere. Multiple clinical/dermoscopic parameters displayed a significant linear trend across increasingly palpable sBCCs.

CONCLUSIONS

Particular dermoscopic criteria are independently associated with clinical type and anatomic location of BCC. Heavily pigmented, scalp BCCs are the most challenging to diagnose. A clinical/dermoscopic continuum across increasingly palpable sBCCs was detected and could be potentially important for the non-surgical management of the disease.

Vascular patterns in basal cell carcinoma

BACKGROUND

Dermoscopy has been proved to increase the diagnostic accuracy of basal cell carcinoma (BCC).

OBJECTIVE

To characterize the type and frequency of vascular patterns in superficial and nodular BCCs.

METHODS

We retrospectively analysed the dermoscopic images of 504 histopathologically proven BCCs.

RESULTS

The most common vascular pattern was represented by arborizing vessels (306/504; 60.7%), which were significantly more frequent in nodular BCCs (nBCCs) compared with superficial BCCs (sBCCs), and in pigmented sBCCs vs. non-pigmented sBCCs (P<0.0001). Short fine telangectasias (SFTs) were found in 33.1% (167/504) of cases and were significantly more frequent in sBCCs compared with nBCCs (P<0.0001). Hairpin vessels were detected in 52/504 (10.3%) BCCs. Minor vascular patterns included glomerular vessels (41/504; 8.1%), dotted (21/504; 4.2%), comma vessels (5/504; 1.0%) and polymorphous pattern (9/504; 1.8%).

CONCLUSIONS

Arborizing vessels are prototypic of nBCCs, whereas SFTs are characteristics of sBCCs. Differential diagnosis with squamous cell carcinoma or melanoma is mandatory when a polymorphous pattern is detected.

Pigmented reticular structures in basal cell carcinoma and collision tumours

BACKGROUND

The dermatoscopic diagnosis of basal cell carcinoma (BCC) is based on well-known specific criteria. Despite the fact that a pigment network is considered a negative feature for the diagnosis of BCC, its detection in a BCC context has been reported in 2.8% of cases.

OBJECTIVES

To determine whether pigment networks or network-like structures might represent a pitfall for the correct diagnosis of BCC.

METHODS

Dermatoscopic images of 412 histopathologically proven BCCs were analysed retrospectively.

RESULTS

Pigment network or network-like structures were detected in 14 of 412 (3.4%) BCCs. Nine of 14 BCCs presented a typical pigment network, due to the association of a BCC lesion with a naevus, solar lentigo or actinic keratosis; two BCCs located on the face showed a pseudonetwork, and three of 14 lesions displayed a network-like structure characterized by light-brown irregularly meshed short linear structures, histopathologically related to a hyperpigmentation of the basal layer of the epidermis.

CONCLUSIONS

The presence of a pigment network in the context of a BCC is uncommon, and it usually reflects the association of BCC with a solar lentigo, naevus or a specific location of the lesion on photodamaged skin.

The additive value of second opinion teleconsulting in the management of patients with challenging inflammatory, neoplastic skin diseases: a best practice model in dermatology?

BACKGROUND

Telemedicine is the practice of healthcare using interactive processes of communication to facilitate healthcare delivery, including diagnosis, consultation and treatment, as well as education and transfer of medical data. The aim of teledermatology, just as telemedicine, is to promote best practice procedures and to improve the consistency and competence of health care.

AIM

To investigate the diagnostic additive value of second opinion teleconsulting in patients with challenging dermatoses, among dermatologists working in two different dermatology departments.

SETTING

Thirty-three cases of patients with challenging inflammatory and neoplastic skin diseases at the University of L'Aquila Department of Dermatology were sent for teleconsultation to the Department of Dermatology, Medical University of Graz, Austria.

METHODS

All cases were selected in the outpatient service in L'Aquila. After face-to-face consultation with a local colleague had been completed, images were sent using a store-and-forward (SAF)-based system (http://www.telederm.org) to Graz. Histopathological examination together with follow-up of the patient represents the diagnostic gold standard for this study.

RESULTS

Telediagnosis was correct in 26 of 33 (78.8%) cases. Sixteen of 33 cases (48.5%) had already been diagnosed face-to-face by at least one of the two dermatologists in L'Aquila. In 10 of 33 cases (30.3%), the correct diagnosis was made in teleconsultation only.

CONCLUSIONS

Second opinion teleconsulting may represent an additive value in the diagnosis of numerous challenging inflammatory and neoplastic skin diseases. It may be particularly useful as a best practice model for smaller departments in order to discuss and/or to confirm diagnoses and also for the management of patients with unusual difficult dermatoses.

Dermoscopy of facial nonpigmented actinic keratosis

BACKGROUND

The accuracy of clinical diagnosis of nonpigmented, facial actinic keratosis (AK) is often suboptimal, even for experienced clinicians.

OBJECTIVES

To investigate the dermoscopic features of nonpigmented AK located on the head/neck that may assist the clinical diagnosis.

METHODS

Forty-one nonpigmented AKs on facial sites were examined by dermoscopy for any consistent underlying features. Lesions were gathered from skin cancer centres in Australia, Austria, Italy and the U.S.A. All cases were diagnosed histopathologically.

RESULTS

Four essential dermoscopic features were observed in facial AK: (i) erythema, revealing a marked pink-to-red 'pseudonetwork' surrounding the hair follicles (95%); (ii) white-to-yellow surface scale (85%); (iii) fine, linear-wavy vessels surrounding the hair follicles (81%); and (vi) hair follicle openings filled with yellowish keratotic plugs (66%) and/or surrounded by a white halo (100%). These features combined, in 95% of cases, to produce a peculiar 'strawberry' appearance.

CONCLUSIONS

A dermoscopic model of 'strawberry' pattern is presented, which may prove helpful in the in vivo diagnosis of nonpigmented, facial AK. A limitation of this study is the lack of testing of the specificity of the described dermoscopic criteria in differentiating nonpigmented AKs from other nonpigmented skin lesions at this site.