Correlation of dermoscopic structures of basal cell carcinoma

From dermoscopedia

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 Editor: Oriol Yélamos

 Author(s): Oriol Yélamos     ·  Ralph P. Braun
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Description This chapter describes the correlation of dermoscopic structuresThis glossary term has not yet been described. of basal cell carcinomais the most common skin cancer, and one of the most common cancers in the United States.[1] While BCC has a very low metastatic risk, this tumor can cause significant disfigurement by invading surrounding tissues
Author(s) Oriol Yélamos · Ralph P. Braun
Responsible author Oriol Yélamos→ send e-mail
Status released
Status update January 1, 2019
Status by Ralph P. Braun


This chapter describes the correlation of dermoscopic structures of basal cell carcinoma

It has the following subchapters:

Correlation of leaf like areas and spoke wheel areas Oriol Yélamos, Ralph P. Braun
Correlation of large blue gray ovoid nests Oriol Yélamos, Ralph P. Braun
Correlation of multiple blue-gray non-aggregated dots and globules Oriol Yélamos, Ralph P. Braun
Correlation of ulcerations and erosions Oriol Yélamos, Ralph P. Braun
Shiny white blotches and strands Ralph P. Braun, Oriol Yélamos
Correlation of arborizing vessels and serpentine vessels Oriol Yélamos, Ralph P. Braun


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Leaflike areas and spoke wheel areas

Leaflike areas are brown to blue-gray projections connected radially to a common base, which remind the shape of leaves (Kittler et al., 2016a). Spoke wheel areas are a variant of leaflike areas where radial projections emerge from a dark brown central hub. Sometimes the projections are ill-defined and may resemble concentric structuresThis glossary term has not yet been described. (clod within a clodvariant of spoke wheel area BCC). In the absence of pigment networkThis glossary term has not yet been described. they are highly suggestive of pigmented BCCAbbreviation for Basal Cell Carcinoma. (Aimilios Lallas et al., 2015) Histologically, they represent dermal aggregates of pigmented BCC nests at the DEJ and in the papillary dermis (table 6) (Aimilios Lallas et al., 2015).

Blue-gray ovoid nestsclods blue large clustered, multiple blue-gray globules and dotsDots are small, round structures of less than 0.1 mm in diameter that have a red color when corresponding to blood vessels; however, when due to melanin, their color ranges from black, brown, to blue-gray depending on the depth and concentration of the melanin in the skin (Tyndall effect).

Ovoid nestsThis glossary term has not yet been described. are well-circumscribed blue-gray oval clodsThis glossary term has not yet been described., larger than globulesThis glossary term has not yet been described.. Histologically, they reveal large BCC nodules in the dermis. Blue-gray globules and dots (in-focus dots) are multiple non-aggregated oval structures smaller than nests. Histologically, they correspond to small pigmented BCC nests in the dermis (Aimilios Lallas et al., 2015).

Ulcerations and erosions

Ulcerations are larger red to orange structureless areas. Histologically, they correspond with loss of the entire epidermis (reaching the papillary dermis). A single ulcerationThis glossary term has not yet been described. is highly suggestive of nodular BCC, but can also be observed in melanomaThis glossary term has not yet been described., SCCSquamous cell carcinoma or traumatized lesions (table 7) (Aimilios Lallas et al., 2015). Erosions are small brown-red to orange-yellow crusts. Histopathologically, they correspond to partial epidermal loss (Aimilios Lallas et al., 2015). Multiple small erosions are associated with superficialThis glossary term has not yet been described. BCC, but can also occur in traumatized lesions (Ahnlide et al., 2016).

Shiny white blotches and strandsWhite structures in the form of circles, oval structures, or large structureless areas that are bright-white longer and less well defined lines oriented parallel or distributed haphazardly, or forming blotches (shiny white clods). Seen only under polarized dermoscopy.

Shiny white blotches are small to large white homogenous areas. Strands are parallel and linear white areas that usually do not intersect (Liebman et al., 2012). The exact histopathological correlate is unknown, but they seem to correspond to dermal fibrosis. The combined presence of shiny white blotches and strandsWhite structures in the form of circles, oval structures, or large structureless areas that are bright-white longer and less well defined lines oriented parallel or distributed haphazardly, or forming blotches (shiny white clods). Seen only under polarized dermoscopy. is associated with a high diagnostic specificityThis glossary term has not yet been described. for nonpigmented BCC (Navarrete-Dechent et al., 2016).

Arborizing vesselsanalytic term is branched vessels; Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels; BCC and serpentine vesselslinear irregular vessels with multiple bends. Seen with flat BCC and melanoma

Arborizing vessels are bright red large-diameter vesselsThis glossary term has not yet been described., with distinct treelike branching into finer capillaries, sharply focused on dermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections.. They are highly suggestive of BCC, especially nodular BCC, but can also be seen in other tumoral and non-tumoral dermatosis such as hypertrophic scars/keloids, epidermal cysts, actinic keratoses intradermal neviThis glossary term has not yet been described., among othersThis glossary term has not yet been described.This glossary term has not yet been described. (Jin et al., 2017). Histologically, they may correlate with a major need for vascularization in nodular BCC compared with superficial BCC (Micantonio et al., 2011). Unfocused arborizing vesselsanalytic term is branched vessels; Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels; BCC can also be observed in BCC, but in a lower proportion (Jin et al., 2017). Other vessels found in BCC, especially superficial BCCs, include serpentine vessels which are short thin vessels that do not branch significantly (Micantonio et al., 2011).