Basal cell carcinoma in skin of color
Basal cell carcinoma (BCC)
Basal cell carcinoma (BCC) is the most common malignancy. [1] It is most prevalent in those of light and intermediate skin types, and only rarely affects those of darker skin tones. Unfortunately, the lower incidence and lack of surveillance frequently results in delayed diagnosis, increased morbidity, and poorer outcomes for this population. [2] Health inequities, poverty and lack of healthcare access also contribute to delayed diagnosis and worse outcomes.
The dermoscopic features and structures of BCC have been very well described and delineated in the literature. A summary of these features and structures can be found here: https://dermoscopedia.org/Basal_cell_carcinoma
The following schematic is a great overview of BCC features.
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| File created by Natalia Jaimes. |
Despite this extensive knowledge about the dermoscopy of BCCs, very little has been reported about the dermoscopy of BCCs in patients of color. The most comprehensive dermatology article on skin cancer in skin of color does not even mention dermoscopy once. [3] Therefore, we will summarize dermoscopy features of BCC in patients of color here.
We will divide the section up by the most common BCC types:
- Nodular
- Superficial
- Morpheaform/Sclerosing/Infiltrative
NODULAR BASAL CELL CARCINOMA
A nodular BCC on the cheek of a Hispanic man.
Note the arborizing vessels, shiny white lines (blotches and strands), blue-gray ovoid nests, blue-gray non-aggregated globules.
A nodular BCC on the nasolabial fold of a 50-year-old Hispanic woman.
Note the arborizing vessels, shiny white lines (blotches and strands), blue-gray ovoid nests.
A nodular BCC on the forehead of an 80-year-old Hispanic woman.
Note the arborizing vessels, shiny white lines (blotches and strands), blue-gray ovoid nest
A small pigmented nodular BCC on the nose of a 55-year-old Hispanic man.
This nodular BCC was detected early and the most prominent dermoscopy feature is a blue white veil pointing toward melanoma except that there is no network. The clinical pearly appearance and the absence of network led the clinician to believe that this is most likely a pigmented BCC.
A pigmented, nodular BCC on the cheek of a Hispanic man.
This very dark pigmented nodular BCC is a mimicker of melanoma clinically and dermoscopically with a blue white veil. The absence of network points to a pigmented BCC.
A pigmented nodular BCC on the nose of a Hispanic man.
The central ulceration is visible dermoscopically and clinically but is not specific for one type of skin cancer. The dark pigment on the border resembles leaf-like structures, dark globules or pseudopods of melanoma. This is another example of how a darkly pigmented nodular BCC in skin of color can mimic a melanoma.
A pigmented nodular BCC on the nose of an African American woman.
This also has a blue white veil but the clinical pearly appearance without network helps to make the suspected diagnosis of a pigmented BCC
In summary, many nodular BCCs in patients of color are darkly pigmented, and have one or more of the following dermoscopic features:
- Arborizing vessels
- Shiny white blotches and strands
- Blue-gray ovoid nests
- Blue-gray non-aggregated globules
It is also important to note that some BCCs in patients of color have features that mimic melanoma (i.e. blue white veil).
SUPERFICIAL BASAL CELL CARCINOMA
A superficial BCC on the lateral forehead of a Hispanic woman with Basal Cell Nevus Syndrome.
Note the extensive leaf like structures.
A superficial BCC on the back of an African American man.
Note the leaf-like structures on the periphery.
In summary, the following are some dermoscopy features seen in superficial BCCs in patients of color:
- Leaf-like structures
- Erosions
- Spoke-wheel structures
MORPHEAFORM/SCLEROSING/INFILTRATIVE BASAL CELL CARCINOMA
Infiltrative BCC on the nose of an 83yo Hispanic man.
Note fine arborizing vessels with white blotches and strands.
Links to additional chapters on Skin of Color
References
- ↑ Marzuka & Book: Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. Yale J Biol Med 2015;88:167-79. PMID: 26029015.
- ↑ Ahluwalia et al.: Basal cell carcinoma in skin of color. J Drugs Dermatol 2012;11:484-6. PMID: 22453586.
- ↑ Gloster & Neal: Skin cancer in skin of color. J Am Acad Dermatol 2006;55:741-60; quiz 761-4. PMID: 17052479. DOI.
