Negative maple-leaf-like areas: a new clue for basal cell carcinoma margin recognition

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

Role of Dermoscopy in the Assessment of Basal Cell Carcinoma

“…This may be formed by white lines, vessels, or skin surface folds ( 13 ). Imbernón-Moya et al described non-pigmented bulbous structures comparable to maple leaf-like areas, named negative maple leaf-like structures that interrupt structures in the surrounding skin (telangiectasias, solar lentigines) and help delineate non-pigmented BCC ( 14 ).…”

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

“…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…”

“…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.…”

Pigmented infundibulocystic basal cell carcinoma: A diagnostic challenge in dark skin

“…1b). 1 Histopathology showed a well-circumscribed neoplasm comprising of anastomosing cords and strands of basaloid cells in a scant fibro-myxoid stroma that was at many places attached to cystic spaces lined by follicular infundibular type epithelium. The basaloid cells showed little to no cytological atypia, occasional peripheral palisading and increased melanin.…”

“…The negative leaf-like area, described in the case of nonpigmented superficial BCC, is useful in delineating the tumour's border and defining the surgical margin. 1 The closest histopathological mimickers of IBCC are basaloid follicular hamartoma (BFH), trichoblastoma and trichoepithelioma. Trichoblastoma, trichoepithelioma and BFH are excluded by the presence of follicular bulbs and papillae, and the former two do not contain stromal myxoid material deposition.…”