Dermatoscopic Criteria of Non-pigmented Basal Cell Carcinoma

Abstract

Introduction. Basal cell carcinoma is one of the most common malignant tumors, which accounts for about 75.0 % of all skin cancers. Despite the fact that the characteristic manifestations of BCC are fairly typical, different clinical sub-varieties can vary greatly and require extended differential diagnosis. The aim of the present study – definition and detalization of dermatoscopic criteria for non-pigmented basal cell carcinoma of the skin. Materials and methods. During the three years study were revealed 75 cases of non-pigmented basal cell carcinoma in 58 men and 17 women aged from 47 to 80 years (mean age – 62 years). All patients were with I–II type of skin photosensitivity in accordance to Fitzpatrick. The diagnosis was exhibited on the basis of clinical, dermatoscopic picture and further cytological or histological studies. Dermatoscopic images were received due to DermLite 3 GEN DL3 connected to Samsung Galaxy (Android) smartphone. The evaluation of dermatoscopic picture of different types of BCC was done in accordance with H. Kittler pattern analysis algorithm. Results. In patients with light skin types the non- pigmented forms of basal cell carcinoma are dominant; such forms are often described as pink pearl nodes or sites of erythema with desquamation and ulceration located mainly on the open photo exposed areas. In such cases the clinical diagnosis is often uncertain or implicates a variety of differential diagnoses. In this context, dermoscopic features may be of primary importance. The main dermatoscopic criteria for the diagnosis of non-pigmented BCC is the pattern of blood vessels according to the existing literature. A further important hint in the diagnosis might be found in the presence of small ulcerations, which appear on dermoscopy as red to yellow or skin colored structureless area. The most consistent global pattern of vessels in all categories of non-pigmented BCCs was mono- or polymorphic pattern of vessels, which in the majority of cases was represented by serpentine and coiled vessels with branchy arrangement. Such a picture was observed in 92.0 % of our cases. Other additional features were structureless area often with adherent fibers and randomly spaced white lines. Our findings, regarding vessels are in accordance with the currently available literature; some minor differences concerning the rates of vessels morphology are due to the lack of metaphoric terminology which is the main methodological disadvantage of dermatoscopy. It proves once again that in this situation an affordable and logical method based on the analysis of the pattern is urgently needed. Сonclusions. Presented by H. Kittler algorithmic method based on pattern analysis gives the possibility to establish the specific dermatoscopic criteria which are essential for early and accurate diagnosis of different BCC subtypes. Further studies are needed to evaluate the specificity and sensitivity of these dermatoscopic features.

Keywords

• basal cell carcinoma
• dermatoscopic criteria
• dermatoscopy