Clinical, Dermoscopic and Histopathological Evaluation of Basal Cell Carcinoma Subtypes: A Retrospective Analysis

Abstract

Introduction: Dermoscopy aids in identifying histopathological subtypes and the presence of clinically undetectable pigmentation in basal cell carcinoma (BCC). Objectives: To investigate the dermoscopic features of BCC subtypes and better understand non-classical dermoscopic patterns. Methods: Clinical and histopathological findings were recorded by a dermatologist who was blinded to the dermoscopic images. Dermoscopic images were interpreted by two independent dermatologists blinded to the patients’ clinical and histopathologic diagnosis. Agreement between the two evaluators and with histopathological findings was evaluated using Cohen’s kappa coefficient analysis. Results: The study included a total of 96 BBC patients with 6 histopathologic variants: nodular (n=48, 50%), infiltrative (n=14, 14.6%), mixed (n=11, 11.5%), superficial (n=10, 10.4%), basosquamous (n=10, 10.4%), and micronodular (n=3, 3.1%). Clinical and dermoscopic diagnosis of pigmented BCC showed high agreement with histopathological diagnosis. The most common dermoscopic findings according to subtype were as follows: nodular BCC: shiny white-red structureless background (85.4%), white structureless areas (75%), and arborizing vessels (70.7%); infiltrative BCC: shiny white-red structureless background (92.9%), white structureless areas (78.6%), arborizing vessels (71.4%); mixed BCC: shiny white-red structureless background (72.7%), white structureless areas (54.4%), and short fine telangiectasias (54.4%); superficial BCC: shiny white-red structureless background (100%), short fine telangiectasias (70%); basosquamous BCC: shiny white-red structureless background (100%), white structureless areas (80%), keratin masses (80%); micronodular BCC: short fine telangiectasias (100%). Conclusions: In this study, arborizing vessels were the most common classical dermoscopic feature of BCC, while shiny white-red structureless background and white structureless areas were the most frequent non-classical dermoscopic features.

Assessment of Standard Surgical Excision Efficacy and Analysis of Recurrence-Associated Factors in 343 Cases of Nasal Basal Cell Carcinoma: a single-center retrospective study

“…In a retrospective study by Ürün et al (2022), they found that the rate of non-radical (R1) excisions was 18.9 %, and the recurrence rate was 9.6 % in BCC treated with SSE. Their findings also demonstrated a statistically significant higher recurrence rate for incompletely removed tumors compared to those removed with radical excision (p < 0.05) [5]. In our research, a similar trend of statistical dependence was observed, with BCC recurrence after R1 operations being 14.5 % higher, while the overall recurrence was 3.2 % lower.…”

“…Its occurrence in the nasal region presents intricate challenges for surgeons due to anatomical, functional, and aesthetic issues [1][2][3][4]. The prevalence of this heterogeneous group of tumors, encompassing a spectrum of histopathological and clinical traits spanning from superficial lesions to extensive, destructive manifestations, has demonstrated a consistent upward trend on a global scale in recent decades, notably among the elderly population [1,[5][6][7]. In European countries, including Lithuania, the average life expectancy of the population is on the rise.…”

Dermoscopic characteristics of Merkel cell carcinoma

“…When only lesions in the differential diagnosis for BCC are considered, the PPV of arborizing vessels may be higher compared to when all lesions, regardless of differential diagnosis, are included. It is worth noting that adnexal tumours can sometimes exhibit similar features, including arborizing vessels, as BCCs [ 34 , 35 ].…”

“…One study demonstrated a link between the irregular linear vessels observed through dermoscopy and the presence of clustered dilated vessels at the tumor’s periphery upon histopathological examination [ 35 ]. These linear irregular vessels are indicative of small, structurally abnormal, and variably dense blood vessels, commonly seen in tumor angiogenesis.…”

Micronodular Basal Cell Carcinoma Presenting as an Achromic Macule

“…The interesting aspect of this case is that the tumor clinically appeared more consistent with a vitiliginous macule or a morpheaform BCC, despite not being sclerous upon palpation, as opposed to a micronodular BCC. Micronodular BCCs often present as an erythematous macule, thin papule/plaque [ 2 , 4 ], or an elevated or flat yellow-whitish infiltrated tumor that rarely ulcerates. Moreover, they are commonly located on the skin of the back [ 5 ].…”