Arborizing blood vessels

From dermoscopedia

Main PageVascular structuresArborizing blood vessels
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 Authored by: Ralph P. Braun

 Keywords:   arborizing blood vessels · bcc · basal cell carcinoma
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Description This chapter describes arborizing blood vesselsThis glossary term has not yet been described.
Author(s) Ralph P. Braun
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Status update June 29, 2017
Status by Ralph P. Braun
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Arborizing Blood VesselsThis glossary term has not yet been described.[1]

Arborizing vesselsanalytic term is branched vessels; Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels; BCC appear under dermoscopyDermoscopy is a non invasive diagnostic method. as bright red, thick diameter vesselsThis glossary term has not yet been described. (0.2 mm or more) from which emanate branching vessels with progressively thinner diameters. The arborizing vesselsanalytic term is branched vessels; Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels; BCC are sharply in focus due to their superficialThis glossary term has not yet been described. location, situated slightly below the epidermis, and exhibit irregular branching into fine terminal capillaries of small diameter (10 μm). These “tree-like vessels” are present in more than 80% of BCCs, yielding a positive predictive value (PPV) of 94%, and sensitivity and specificity of 96.1% and 90.9%, respectively. Adnexal tumors can sometimes appear similar to BCCs and may display arborizing vessels. Although uncommon, arborizing vessels may be seen in benignThis glossary term has not yet been described. lesions, such as fibrous papules, intradermal neviThis glossary term has not yet been described., and epidermoid cysts; however, in these lesions the vessels are usually not in sharp focus. In addition, arborizing vessels can, on rare occasions, be seen in invasive cancers, including melanomaThis glossary term has not yet been described. and Merkel cell carcinoma. There are several histologic variants of BCC, including nodularThis glossary term has not yet been described., superficial, and infiltrative. Each of these BCC subtypes can present as amela- notic lesions or they can present with pigment. BCCs that are amelanotic can be identified based on the presence of arborizing vessels, shiny white areas, crystalline structures, and/or ulceration. Pigmented BCCs (pBCC), which may clinically mimic melanoma, contain specific dermoscopic structures that aid in their proper diagnosisThis glossary term has not yet been described.. Menzies model for dermoscopic diagnosis of pBCCs (sensitivity of 93% and specificity of 89–92%) includes arborizing vessels as an important diagnostic feature. Arborizing vessels were observed in 52% of pBCCs, compared with 23% of melanomas and only 8% of benign skin lesions. While arborizing vessels are often quite prominent in nodular BCC, they tend to be less conspicuous in superficial BCCs (sBCC) and in fibroepithelioma of Pinkus, a rare BCC subtype.

In sBCC it is common to see short fine telangiectasias, which are sharply in focus and arranged irregularly throughout the lesion. Additional presence of shiny white-to-red areas and multiple small ulcer- ations or erosions can provide reassurance that the lesion under investigation is a superficial BCC. These fine arborizing vessels, which are described as smaller in diameter than typical arborizing vessels and with less branching, have also been noted in fibroepithelioma of Pinkus. In addition, Pinkus tumors are often accompanied by dotted vesselstiny pinpoint vessels flat melanocytic lesions inflammatory diseases Bowen disease at the lesion’s periphery.
Arborizing vessels schematics.jpg
References:
  1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.