Color Doppler Ultrasound Supports Early Diagnosis of Mixed High and Low Risk of Recurrence Subtypes in the Same Basal Cell Carcinoma Lesion

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Position Statement on Dermatologic Ultrasound

“…The blood flow is more prominent at the inferior aspect of the lesion. Tumor margins are difficult to assess in cases of morpheaform and infiltrative BCC, although in most cases BCCs tend to have well-defined borders [28,29]. The presence of cutaneous elastosis can on occasion make the exact measurement of the lesion difficult [24].…”

“…The presence of cutaneous elastosis can on occasion make the exact measurement of the lesion difficult [24]. Furthermore, the hyperechoic 'dots' within the tumor, determined by the presence of keratin or basal cell nests, can be of use in differentiating a basal cell carcinoma from melanoma and even different histologic varieties of BCC [29,30].…”

Ultrasound Diagnosis of Infiltrative Versus Noninfiltrative Subtypes of Cutaneous Basal Cell Carcinoma

“…Besides the novel findings of the study, in the "Discussion" section, the authors mention that they did not find significant differences in the number of hyperechoic spots between infiltrative and noninfiltrative BCC subtypes in comparison with previous articles. 2,3 This deduction would be incorrect because, first, the definition of noninfiltrative and infiltrative BCCs in the authors' study considered the well or poorly defined appearance of the histologic margins of the tumors. In contrast, in previous articles, 2,3 the categorization was based on the specific histologic high-and lowrisk-of-recurrence subtypes.…”

“…5 Additionally, the presence of BCCs with mixed high-and low-risk-of-recurrence subtypes seems to be not uncommon, and the noninvasive recognition of this combined pattern may be useful for selecting the site of a biopsy or defining the type of surgery. 3,5,6 Second, in the authors' study, they registered a qualitative feature, which was the presence or absence of hyperechoic spots in the infiltrative and noninfiltrative BCC subtypes; however, there is no mention of a specific protocol for counting the tumoral hyperechoic spots. Furthermore, previous studies have found hyperechoic spots in the histologic low-risk-of-recurrence subtypes.…”

“…Furthermore, previous studies have found hyperechoic spots in the histologic low-risk-of-recurrence subtypes. 2,3 Therefore, the comparison and deduction of the authors could be inexact because their research was focused on the description of the tumoral stiffness and not on the analysis of the counting of hyperechoic spots in BCCs per histologic high-and low-risk-ofrecurrence subtypes.Last, for making such a statement, probably, besides a common setting, similar objectives, definitions, and methods are required.…”