Practical Dermoscopy
What Wrinkles Actually Hide
Lo que la arruga esconde
G. Baeza-Hernández
, S.P. Herrero-Ruiz, A.A. Garrido-Ríos
Corresponding author
Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain
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"apellidos" => "Baeza-Hernández" "email" => array:1 [ 0 => "gloria.baezahdez@outlook.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S.P." "apellidos" => "Herrero-Ruiz" ] 2 => array:2 [ "nombre" => "A.A." "apellidos" => "Garrido-Ríos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lo que la arruga esconde" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1188 "Ancho" => 900 "Tamanyo" => 113057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic images with polarized light (a and b). Absence of pigmented network. Presence of maple leaf-like structures, dots, blue-gray globules, ulceration, and several erosions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 70-year-old woman, with no relevant past medical history, presented with a 1-year history asymptomatic lesion on her neck. Upon examination, she showed a 30<span class="elsevierStyleHsp" style=""></span>mm x 2<span class="elsevierStyleHsp" style=""></span>mm linear erythematous-brownish plaque, somewhat crusted, located in the depth of a fold on the left side of her neck (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopic findings shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> are consistent with a non-superficial basal cell carcinoma. Complete excision of the lesion was performed, which confirmed the diagnosis of nodular and micronodular basal cell carcinoma with clear margins.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In our case, clinical differential diagnosis also included the following entities: scar, exogenous pigmentation, inverse pigmented lichen planus, and terra firma-forme dermatosis. Dermoscopy allowed us to establish an early diagnosis of basal cell carcinoma.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Linear basal cell carcinoma was first described in 1985<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> and is most commonly located in the periocular area and the neck<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–6</span></a>; the pathogenic mechanism by which the tumor tends to grow along skin tension lines is unknown to this date.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> No specific dermoscopic findings have ever been described for the linear variant of basal cell carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,5</span></a> A recently published retrospective, descriptive study with 18 tumors of this type has analyzed their dermoscopic features<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>: more than 80% were pigmented, as in our case, a higher proportion than expected perhaps due to the ethnic characteristics of the study patients (mostly Hispanic/Latino) and a difficulty in diagnosing non-pigmented linear basal cell carcinoma that may lead to underdiagnosis.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> Dermoscopic structures specific to basal cell carcinoma most frequently observed were blue-gray globules, well-focused dots, and maple leaf-like structures<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> (all present in our case).</p><p id="par0030" class="elsevierStylePara elsevierViewall">We wish to mention the utility of dermoscopy to diagnose linear basal cell carcinoma, exclude other diseases that may also present a linear morphology,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> and more accurately delineate the tumor's extension, as reportedly, tumors have a greater-than-expected subclinical extension.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,6</span></a> Furthermore, dermoscopy can help guide the histological subtype before anatomopathological results become available and classify it as low or high risk, thus allowing for the selection of the most appropriate surgical technique and margins.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,6</span></a> The most common histological subtype of linear basal cell carcinoma is nodular,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3–6</span></a> although it can sometimes be associated with more aggressive subtypes, such as the infiltrative or morpheaform subtypes.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a> In retrospective studies and case series, Mohs surgery is the most widely used treatment for linear basal cell carcinoma,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4,6</span></a> although other authors have also achieved good results with conventional surgery, as in our case, and recommend reserving Mohs surgery for aggressive histological subtypes, or those located in high or medium risk areas (H or M areas).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 897 "Ancho" => 600 "Tamanyo" => 87964 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical case presentation: left cervical area.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1188 "Ancho" => 900 "Tamanyo" => 113057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic images with polarized light (a and b). Absence of pigmented network. Presence of maple leaf-like structures, dots, blue-gray globules, ulceration, and several erosions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Linear basal cell epithelioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.E. Lewis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4362.1985.tb05396.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." 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