No abstract

DEAR EDITOR, Dermoscopy and reflectance confocal microscopy (RCM) improve accuracy in the diagnosis of both pigmented and nonpigmented basal cell carcinoma (BCC) in the early stages. [1][2][3][4] The classical dermoscopy algorithm includes lack of pigment network and the presence of at least one of the following criteria: ulceration, maple-leaf-like areas, blue-grey globules, blue ovoid nests, arborizing vessels and spoke-wheel structures. 5 Our goal is to describe a new dermoscopic finding, negative maple-leaf-like areas (NMLLAs), which can be useful in the delimitation of BCC margins.Dermoscopic images of 100 BCCs of different histopathological subtypes and anatomical locations, which had been surgically removed previously, were included. The dermoscopic images were evaluated by three independent dermoscopists with different levels of experience ranging from < 5 years (one) to > 20 years (two). The interobserver agreement was evaluated using the kappa coefficient. For further analyses, the presence of NMLLAs was considered when at least two observers identified this criterion. The v 2 -test was used to describe the association of this criterion with a specific histological subtype and anatomical location. Multivariate analyses were also performed.The results are summarized in Table 1. NMLLAs were present in 12% of analysed lesions, with good or excellent interobserver agreement (kappa coefficient between 0Á75 and 0Á92). Seventy five per cent of superficial BCCs showing NMLLAs were located on the trunk, and 83% of NMLLAs appeared in superficial BCCs. Both associations were statistically significant: odds ratio 4Á77 (95% confidence interval 1Á20-18Á85; P = 0Á026) for lesions on the trunk and odds ratio 8Á33 (95% confidence interval 1Á72-40Á39; P = 0Á008) for superficial sBCC (Fig. 1). Both associations remained significant in a multivariate analysis.Dermoscopy has a diagnostic accuracy for BCC ranging from 95% to 99%. The dermoscopic features of BCC depend on the histopathological subtype, pigmentation, ulceration, phototype, tumour depth, location, sex and age. BCCs may display a wide variety of global and local dermoscopic features. 1-5 RCM has a high sensitivity and specificity for detecting healing, local persistence or local recurrence after nonsurgical treatments. 4 Superficial BCCs usually appear in younger women and more frequently involve the trunk and lower legs. The most

No abstract