Classifying distinct basal cell carcinoma subtype by means of dermatoscopy and reflectance confocal microscopy

Longo, Caterina; Lallas, Aimilios; Kyrgidis, Athanassios; Rabinovitz, Harold; Moscarella, Elvira; Ciardo, Silvana; Zalaudek, Iris; Oliviero, Margaret; Losi, A.; González, Salvador; Guitera, Pascale; Piana, Simonetta; Argenziano, Giuseppe; Pellacani, Giovanni

doi:10.1016/j.jaad.2014.04.067

Cited by 150 publications

(169 citation statements)

References 41 publications

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“…The main RCM criteria for typical BCC diagnosis include the presence of tumor islands (nests of basaloid cells), peripheral palisading and peritumoral clefts[20, 21], and in the current study, these RCM features proved useful in identifying all the BCCs in this cohort of lesions with dermoscopic suspicion of melanoma. This finding has a significant impact for therapeutic patient management, as BCC patients can be offered differential diagnosis from MM, at the patients’ bedside, with a noninvasive procedure, saving the patient the concern of an uncertain MM diagnosis and eventually an unnecessary surgical excision, whilst enabling the physician to immediately commence correct treatment.…”

Section: Discussionmentioning

confidence: 80%

“…RCM is a noninvasive, in vivo imaging tool, which assists in timely differential diagnoses and optimizes therapeutic management[12], with reported pooled sensitivity and specificity of BCC detection of 91.7% (95% CI: 0.87–0.95) and 91.3% (95% CI: 0.94–0.96), respectively[37]. Further, RCM features of typical BCC have also been applied to, and have successfully defined, the BCC subtypes[20-22, 29]. However, to date, RCM features of atypical BCCs mimicking MM in dermoscopy are missing.…”

Section: Discussionmentioning

confidence: 99%

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Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy

et al. 2018

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Background: Atypical basal cell carcinoma (BCC), characterized by equivocal dermoscopic features typical of malignant melanoma (MM), can be difficult to diagnose. Reflectance confocal microscopy (RCM) enables in vivo imaging at nearly histological resolution. Objectives: To evaluate with RCM atypical melanocytic lesions identified in dermoscopy, according to common RCM criteria for the differential diagnosis of BCC, and to identify representative RCM parameters for superficial (sBCCs) and nonsuperficial (nsBCCs) basal cell carcinomas (BCCs). Methods: A retrospective analysis of consecutive patients evaluated with RCM, selecting excised lesions classified at dermoscopy with ≥1 score from the re visited 7-point checklist, mimicking melanoma, registered between 2010 and 2016. Cluster analysis identified BCC subclassifications. Results: Of 178 atypical lesions, 34 lesions were diagnosed as BCCs with RCM. Lesions were confirmed BCCs with histopathology. Dermoscopic features included atypical network (55.9%) and regression structures (35.5%) associated with sBCCs, and an atypical vascular pattern (58.8%) and irregular blotches (58.8%) with nsBCCs. Hierarchical cluster analysis identified 2 clusters: cluster 1 (100% sBCCs) was characterized by the presence of cords connected to the epidermis (90%, p < 0.001), tumor islands located in the epidermis (100%, p < 0.001), smaller vascular diameter (100%, p < 0.001) and solar elastosis (90%, p = 0.017), and cluster 2 (nsBCCs 85%) was defined by the dermic location of tumor islands (87.5%, p < 0.001) with branch-like structures (70.8%, p = 0.007) and surrounding collagen (83.3%, p = 0.012), peripheral palisading (83.3%, p = 0.012) and coiled vascular morphology (79.2%, p < 0.001) with a larger vascular diameter (50%, p < 0.001). Conclusions: RCM is able to diagnose BCCs mimicking melanoma at dermoscopy and seems able to identify sBCCs and nsBCCs.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy

et al. 2018

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“…Therefore, vascular changes have to be significant to be seen by dermoscopy. Reflectance confocal microscopy also allows the in vivo evaluation of vessels and suggests that the distinct vasculature of BCC as well as of AK and SCC in situ may well be visualized [51,52,53,54]. Reflectance confocal microscopy is however limited to the very superficial part of the papillary dermis, and it may be hypothesized that initial changes of the vascular pattern involved in neoplasia occur at deeper levels closer to the vascular plexus.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Optical Coherence Tomography in Dermatology

Ulrich¹,

et al. 2016

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Optical coherence tomography (OCT) represents a non-invasive imaging technology, which may be applied to the diagnosis of non-melanoma skin cancer and which has recently been shown to improve the diagnostic accuracy of basal cell carcinoma. Technical developments of OCT continue to expand the applicability of OCT for different neoplastic and inflammatory skin diseases. Of these, dynamic OCT (D-OCT) based on speckle variance OCT is of special interest as it allows the in vivo evaluation of blood vessels and their distribution within specific lesions, providing additional functional information and consequently greater density of data. In an effort to assess the potential of D-OCT for future scientific and clinical studies, we have therefore reviewed the literature and preliminary unpublished data on the visualization of the microvasculature using D-OCT. Information on D-OCT in skin cancers including melanoma, as well as in a variety of other skin diseases, is presented in an atlas. Possible diagnostic features are suggested, although these require additional validation.

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“…logic subtypes of BCC have been described; the most frequently encountered are superficial, nodular, infiltrative, and sclerodermiform [2]. The first therapeutic option for BCC remains surgery in the majority of cases, with the exception of the superficial form which has shown high response rates to nonsurgical approaches [3].…”

Section: Introductionmentioning

confidence: 99%

Dermoscopic Features of Basal Cell Carcinoma on the Lower Limbs: A Chameleon!

et al. 2017

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Background:Lower limbs represent an uncommon location for basal cell carcinoma (BCC) and only few reports have described dermoscopic features of BCC in this body site. Since BCCs of the lower limbs frequently display nonclassic BCC dermoscopic criteria, they can simulate other benign or malignant lesions. Objective: Our aim was to describe the dermoscopic features of BCC located on lower limbs and to define which criteria were more associated with their benignor malignant-looking appearance. Methods: We conducted a retrospective study enrolling consecutive patients with histologically confirmed BCCs of the lower limbs. Lesions were classified in 7 categories according to the clinical and dermoscopic global appearance. Clear BCC, squamous cell carcinoma (SCC) or Bowen disease-like, Kaposi disease-like, melanoma-like, and aspecific pattern were considered malignant-looking lesions; however, seborrheic keratosis-like and dermatofibroma-like were considered benign-looking. To define which dermoscopic criteria were independently associated with benign-or malignant-looking appearance, we conducted a multivariate logistic regression analysis. Results:A total of 81 BCCs were enrolled: 18 (22%) were benign-looking lesions (of which 11 were seborrheic keratosis-like and 7 dermatofibroma-like) and 63 (78%) were malignant-looking BCCs (of which 24 were clear-cut BCCs, 23 SCC-like, 2 Kaposi disease-like, 9 melanoma-like, and 5 had aspecific pattern). Multivariate regression analysis showed that erosions/ulceration and vessels were independently associated with malignant-looking appearance. The most represented vessels were glomerular and polymorphic, which are more frequently encountered in SCC, together with ulceration. Conclusion: BCC of the lower legs frequently simulates other benign or malignant lesions, with SCC being the main differential diagnosis.

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Classifying distinct basal cell carcinoma subtype by means of dermatoscopy and reflectance confocal microscopy

Cited by 150 publications

References 41 publications

Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy

Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy

Dynamic Optical Coherence Tomography in Dermatology

Dermoscopic Features of Basal Cell Carcinoma on the Lower Limbs: A Chameleon!

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