Dermoscopic criteria explained by LC‐OCT: Negative maple leaf‐like areas

Abstract

Dear Editor, Basal cell carcinoma (BCC) is the most common malignant tumour and accounts for 75% of all skin cancers. 1 Nowadays, BCC diagnosis mainly relies on dermoscopy. 2 The dermoscopic features of BCC are diverse and depend on tumour's subtype, location, and depth, and on patient's phototype, gender, and age. 3-5 A new dermoscopic criterion for BCC, the 'negative maple-leaf-like areas' (NMLLAs), was recently proposed by Imbernón-Moya et al. 6 NMLLAs are round, nonpigmented bulbous structures with a homogeneous whitish background and well-defined borders. They represent a non-pigmented (i.e. negative) version of the 'maple-leaf-like areas' described by Menzies et al. 3 It was reported that NMLLAs are associated with superficial BCC (sBCC) and that, indeed, they usually correspond to non-pigmented tumour nests at the dermal-epidermal junction level. The authors also provided a description of NMLLAs with reflectance confocal microscopy (RCM), currently the most established non-invasive skin imaging technique, as 'nonpigmented tumour islands with low-tomoderate refractive cells, peripheral palisading and cleftlike dark spaces'. 6

Understanding the Dermoscopic Patterns of Basal Cell Carcinoma Using Line-Field Confocal Tomography

“…From our results, maple-leaf-like areas corresponding to medium-reflective lobules with maple-leaf shapes were appreciable in 12% of cases considering both dermoscopy and LC-OCT, thus showing a high level of concordance ( p < 0.001). Although they were not evaluated in our study, Palmisano et al [ 27 ] revealed a correlation between negative maple-leaf shape areas and deep hypopigmented tumor lobules.…”

“…Based on previous works [ 27 ] and our experience, we attempted to assess the association between dermoscopy and LC-OCT using ten-point criteria. Overall, we found that most dermoscopic aspects evaluated were also appreciable under LC-OCT, and no statistically significant differences were found between them ( p > 0.005).…”