Dermoscopic Clues of Histopathologically Aggressive Basal Cell Carcinoma Subtypes

Abstract

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.

Basosquamous Carcinoma: Comprehensive Clinical and Histopathological Aspects, Novel Imaging Tools, and Therapeutic Approaches

“…Additionally, follicular criteria and milky red structureless regions were common dermoscopic clues, each noted in 40.7% of cases. The study also found that the percentage of BSC cases with keratin masses (29.6%) was higher than in other aggressive subtypes of Basal Cell Carcinoma (BCC) such as morpheaform, micronodular, infiltrative, and metatypical BCC [24].…”

“…In a recent study, Camela et al [24] revealed that arborizing telangiectasias (77.8%), shiny white structures (66.7%), and ulceration (62.9%) are the most frequently observed dermoscopic structures in BSC. Additionally, follicular criteria and milky red structureless regions were common dermoscopic clues, each noted in 40.7% of cases.…”

“…However, occasional misclassifications of BSC as Basal Cell Carcinoma (BCC) or Squamous Cell Carcinoma (SCC) have been reported, frequently due to nonrepresentative biopsies of deeply located tumors. In this context, noninvasive skin imaging plays a crucial role in both improving BSC recognition and optimizing subsequent followup strategies [22][23][24][25][26][27][28].…”

Recurrence or de novo? Intradermal Basal Cell Carcinoma of the Scrotum: A Report of Two Cases

“…Clinically, micronodular BCCs are often difficult to distinguish from superficial and nodular BCCs because they can present as erythematous macules or thin plaques. Dermoscopically, milky red structureless areas (53.8%), arborizing vessels and short fine telangiectasias (53.8% and 50%, respectively), ulceration (46.2%), and blue structure (57.7%) were commonly observed [ 24 ]. Owing to their multifocal nature, these lesions often have subclinical extension and, consequently, higher recurrence rates.…”

Immunohistochemical Analysis of Single-Stranded DNA Binding Protein 2 in Non-Melanoma Skin Cancers

“…All tissue slides used at diagnosis were reviewed to determine pathological characteristics, including histological subtypes of BCC, histological grade of SCC, level of invasion, and perineural invasion. Micronodular, infiltrating, sclerosing/morphoeic, and basosquamous patterns were classified as histopathologically aggressive BCC subtypes [20,21]. The histological grade of SCC was divided using a three-level grading system according to several morphologic features of differentiation (nuclear pleomorphism, degree of keratinization) [22].…”