Ann Dermatol.  2015 Dec;27(6):682-687. 10.5021/ad.2015.27.6.682.

Usefulness of Dermatoscopy for the Preoperative Assessment of the Histopathologic Aggressiveness of Basal Cell Carcinoma

• Kim HS
• Park JM
• Mun JH
• Song M
• Ko HC
• Kim BS
• Kim MB

• KMID: 2157443
• DOI: http://doi.org/10.5021/ad.2015.27.6.682

Abstract

BACKGROUND
Limited information is available regarding dermatoscopic differences between non-aggressive and aggressive types of basal cell carcinoma (BCC).
OBJECTIVE
To investigate dermatoscopic differences between non-aggressive and aggressive types.
METHODS
We evaluated 145 histopathologically confirmed BCCs from 141 patients. Histopathologic types and aggressiveness from 4 mm punch biopsy and their dermatoscopic findings were evaluated. We assessed the statistical significance of dermatoscopic differences between non-aggressive and aggressive types. To objectively predict aggressiveness, we created a "dermatoscopic index of BCC aggressiveness" in which 1 point was added and subtracted for each dermatoscopic finding significantly higher in aggressive and non-aggressive types, respectively.
RESULTS
Large blue-gray ovoid nests were found more frequently in non-aggressive type than aggressive one (85/105 [80.9%] vs. 21/40 [52.5%], p=0.001). Compared to non-aggressive type, aggressive type had more multiple blue-gray globules (29/40 [72.5%] vs. 57/105 [54.3%], p=0.046), arborizing telangiectasia (29/40 [72.5%] vs. 48/105 [45.7%], p=0.004), and concentric structure (11/40 [27.5%] vs. 12/105 [11.4%], p=0.018). Regarding dermatoscopic index, cases of aggressive type with a score of 1 were most common (n=18, 45.0%), followed by a score of 2 (n=14, 35.0%). Limited number of aggressive type of BCCs and the effect of width on the determination of histopathologic aggressiveness.
CONCLUSION
Aggressive type BCCs more often exhibited multiple blue-gray globules, arborizing telangiectasia, and concentric structure, while the non-aggressive type exhibited large blue-gray ovoid nests more frequently. Score exceeding 2 on the dermoscopic index can be screening criteria for aggressiveness. These dermatoscopic features and dermoscopic index could be useful for assessing aggressiveness of BCCs before surgery.

Keyword

Basal cell carcinoma; Dermatoscopy; Histopathologic aggressiveness

MeSH Terms

Biopsy
Carcinoma, Basal Cell*
Dermoscopy*
Humans
Mass Screening
Telangiectasis

Figure

• 

  Fig. 1 Non-aggressive types of basal cell carcinoma. (A) Nodular type, (B) superficial type. Left column: dermatoscopic findings (inset, clinical photo). Right column: histologic findings (H&E, ×40). ᚇ: large blue-gray ovoid nests, ■: multiple blue-gray globules, ●: maple leaf-like areas, ᚆ: spoke-wheel areas, ▲: ulceration, †: concentric structure, >: brown-black dots.

• 

  Fig. 2 Aggressive types of basal cell carcinoma. (A) Micronodular type, (B) infiltrative type. Left column: dermatoscopic findings (inset, clinical photo). Right column: histologic findings (H&E, ×40). ᚇ: large blue-gray ovoid nests, ■: multiple blue-gray globules, ➔: arborizing telangiectasia, ▲: ulceration, △: multiple blue-gray dots.

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