‘Eternal sunshine of the spotless islands’: how dermoscopy may influence confocal microscopy when dealing with squamous cells carcinoma simulating basal cell carcinoma

Disguised basal cell carcinomas: how to track them down with reflectance confocal microscopy

“…1 The typical dermoscopic algorithm for the diagnosis of BCC includes the following: erosion or ulceration, maple leaf-like areas, blue-grey globules, ovoid nests, spoke wheel-like areas, brown dots and arborizing vessels. [4][5][6][7] Reflectance confocal microscopy (RCM) is an emerging noninvasive technique for the in vivo imaging of the skin. 3 However, atypical clinical presentation and misleading dermoscopy can sometimes make the diagnosis of BCC particularly challenging.…”

“…1 The CHILD naevus can be distinguished from other epidermal naevi by the presence of ptychotropism, waxy yellow scaling and a conspicuous lateralization pattern showing either diffuse involvement or linear lesions or both. 4 It should be noted that the term VX does not refer to a specific clinical entity. An important distinguishing criterion, however, is the histopathological phenomenon of verruciform xanthoma (VX).…”

“…2 Most of the light microscopical features are indistinguishable from those of psoriasis, including exocytosis of neutrophils that form superficial accumulations reminiscent of Munro abscesses. 4,5 VX lesions are preponderantly found in the oral cavity, although lesions have also been reported to involve the anogenital region of men or women and, occasionally, extragenital skin. It is a verrucous lesion of papillomatous appearance, with a surface reminiscent of a strawberry or of red caviar and varying in size from 0.2 to 2 cm in diameter.…”

“…3 However, atypical clinical presentation and misleading dermoscopy can sometimes make the diagnosis of BCC particularly challenging. [4][5][6][7] Reflectance confocal microscopy (RCM) is an emerging noninvasive technique for the in vivo imaging of the skin. We present a series of five cases of BCCs where dermoscopy mimicked other types of benign and malignant lesions and the diagnosis was unveiled by RCM.…”

“…3 The enlarged papillary areas are filled with foamy histiocytes containing lipids reflecting mutational inactivation of the 3b-hydroxysteroid dehydrogenase (NSDHL) gene located at Xq28, with blockade of cholesterol production. 4 It should be noted that the term VX does not refer to a specific clinical entity. It is a histopathological feature that may occur in many different inflammatory skin diseases such as pemphigus vulgaris, dystrophic epidermolysis bullosa, chronic lymphedema, graft-versus-host disease, squamous cell carcinoma or oral lichen planus.…”