Dermoscopic features of basal cell carcinoma and its subtypes: A systematic review

doi:10.1016/j.jaad.2019.11.008

Journal of the American Academy of Dermatology

Volume 85, Issue 3, September 2021, Pages 653-664

https://doi.org/10.1016/j.jaad.2019.11.008 Get rights and content

Background

Multiple studies have reported on dermoscopic structures in basal cell carcinoma (BCC) and its subtypes, with varying results.

Objective

To systematically review the prevalence of dermoscopic structures in BCC and its subtypes.

Methods

Databases and reference lists were searched for relevant trials according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for the relative proportion of BCC dermoscopic features. Random-effects models were used to estimate summary effect sizes.

Results

Included were 31 studies consisting of 5950 BCCs. The most common dermoscopic features seen in BCC were arborizing vessels (59%), shiny white structures (49%), and large blue-grey ovoid nests (34%). Arborizing vessels, ulceration, and blue-grey ovoid nests and globules were most common in nodular BCC; short-fine telangiectasia, multiple small erosions, and leaf-like, spoke wheel and concentric structures in superficial BCC; porcelain white areas and arborizing vessels in morpheaform BCC; and arborizing vessels and ulceration in infiltrative BCC.

Limitations

Studies had significant heterogeneity. Studies reporting BCC histopathologic subtypes did not provide clinical data on pigmentation of lesions.

Conclusion

In addition to arborizing vessels, shiny white structures are a common feature of BCC. A constellation of dermoscopic features may aid in differentiating between BCC histopathologic subtypes.

Section snippets

Methods

A systematic review of the literature was conducted and reported in concordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement.⁸

Results

Our search yielded 1412 records (Fig 1). Included in the review were 31 studies, consisting of 5950 BCCs, that fulfilled the eligibility criteria. Some lesions were reported solely as BCCs without further details, and others had additional information, including the histopathologic subtype or pigmentation status. Only one study¹¹ provided data on both the histopathologic subtype and the pigmentation status of the lesions, prohibiting analysis of both parameters combined. Individual studies

Discussion

The aims of this report were to systematically review the evidence for the prevalence of dermoscopic structures among BCC and its clinical (pigmented vs nonpigmented) and histopathologic subtypes and to investigate whether these structures can differentiate between the subtypes.

There was neither a single dermoscopic structure that appeared in all BCC lesions nor a structure exclusive for a specific BCC subtype. The most prominent features for the diagnosis of BCC seem to be blood vessels,

Conclusion

It comes as no surprise that arborizing blood vessels, which are the most well-known characteristic of BCC, are also its most common dermoscopic feature. However, shiny white structures, which are not as well known, were the second most common feature of BCC. Frequencies of dermoscopic features differ between BCC histopathologic subtypes, and the constellation of features may aid in the diagnosis: nBCC is associated with arborizing vessels, ulceration, and blue-grey ovoid nests and globules;

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Cited by (43)

European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma—update 2023
2023, European Journal of Cancer
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into ‘easy-to-treat’ (common) and ‘difficult-to-treat’ according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of ‘difficult-to-treat’ BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
Differential diagnosis and right response in a patient with pigmented lesions
2023, FMC Formacion Medica Continuada en Atencion Primaria
- •
  Ante un paciente que consulta por múltiples lesiones pigmentadas, los diagnósticos a tener en cuenta en primer lugar son nevus melanocíticos en un paciente joven y lentigos solares, angiomas seniles o queratosis seborreicas en personas mayores de 50 años. Si las lesiones son únicas o escasas probablemente se trate de un melanoma, un carcinoma basocelular, un granuloma piógeno o un dermatofibroma.
- •
  Lo difícil es diferenciar la lesión maligna del resto de lesiones, para lo que nos regimos muchas veces del signo del «patito feo» (ugly duck), aquella lesión que llama la atención, que es diferente del resto por la forma, el color, el tacto o la consistencia.
- •
  Para el análisis de las lesiones pigmentadas se suele seguir la regla del ABCDE (Asimetría, Borde irregular, poliCromía, Diámetro ≥ 0,6 cm y Evolución o crecimiento). Cualquier lesión con 3 o más criterios puede ser un nevus clínicamente atípico o un melanoma y debería ser remitida al dermatólogo para ser biopsiada.
- •
  También es muy útil valerse de un dermatoscopio. El reconocimiento de los patrones característicos facilita la diferenciación de la naturaleza de las lesiones y permite reconocer los cambios precoces de un melanoma.
- •
  Los nevus melanocíticos comunes se inician normalmente en la infancia y siguen aumentando en número y tamaño hasta el final de la edad adulta. No es muy frecuente detectar muchos nevus en el anciano, y los que se ven suelen ser intradérmicos o compuestos. La aparición de un nevus en una persona mayor de 50 años nos ha de hacer pensar en la posibilidad de un melanoma.
- •
  La mayoría de los nevos en la infancia son junturales, máculas fuertemente pigmentadas, planas, con patrón dermatoscópico globular, reticular o pigmentado homogéneo. Con el tiempo, muchos se sobreelevan y pierden parte de la coloración (nevos compuestos) adoptando patrones combinados retículo-globular o retículo-homogéneo (hiper o hipopigmentación central homogénea y retículo periférico). Algunos de estos cambios se producen con la exposición solar.
- •
  Los nevus clínicamente atípicos y los nevos displásicos son una variedad de nevus mayores de 0,5 cm, en muchas ocasiones maculopapulares, que tienen al menos 3 de las características ABCDE. Con el dermatoscopio se pueden objetivar retículo atípico, velo azul blanquecino e hiper o hipopigmentación central o parcheada, cambios muy similares a los del melanoma in situ, aunque no tan marcados.
- •
  Los dermatofibromas se manifiestan como pápulas pigmentadas de consistencia firme, estables en el tiempo, que se localizan preferentemente en las extremidades inferiores. La dermatoscopia más característica consiste en una zona central blanca, cicatricial, y una periferia con reticulado fino.
- •
  Las queratosis seborreicas suelen aparecer después de los 50 años. Hasta el 90% de la población mayor de 70 años tiene de promedio una quincena de queratosis seborreicas. Son pápulas pigmentadas y queratósicas, de tacto ligeramente rasposo, con comedones y tapones córneos y pequeños quistes de millium, hallazgos que se hacen más evidentes con el dermatoscopio.
- •
  El melanoma más común es el de extensión superficial. Suele ser una lesión que cumple 2 o más criterios del ABCDE, situada en cualquier localización, que suele cambiar en pocos meses y presenta por lo general un patrón dermatoscópico multicomponente que combina pigmentación irregular, red de pigmento atípica, seudópodos y estructuras de regresión como las estructuras blancas brillantes y las rayas blancas o el velo azul blanquecino con puntos que recuerdan la pimienta.
A case of Gorlin syndrome like phenotype with multiple infundibulocystic basal cell carcinomas in a moniliform blepharosis arrangement
2023, JAAD Case Reports
Basal cell carcinoma
2023, FMC Formacion Medica Continuada en Atencion Primaria
Puntos para una lectura rápida
- •
  El carcinoma basocelular es la neoplasia maligna más frecuente en el ser humano.
- •
  Su incidencia sigue aumentado a nivel mundial en todos los grupos de edad y para todos los fototipos cutáneos.
- •
  Entre sus factores de riesgo más relevantes encontramos la exposición UV (solar o de cabinas), los fototipos cutáneos claros, la edad avanzada y la inmunosupresión.
- •
  La historia clínica típica es la de un paciente que refiere que desde hace 1-2 años tiene una lesión en la cara que ha ido creciendo lentamente, que no se acaba de curar y que sangra con mínimos traumatismos.
- •
  Aunque puede tener múltiples presentaciones clínicas, las 5 formas más frecuentes son el subtipo nodular, ulcus rodens, superficial, esclerodermiforme y pigmentado.
- •
  Dermatoscópicamente predominan los vasos arborizantes (60%), las estructuras blancas brillantes (50%) y en más de un tercio de los casos grandes nidos ovoides gris azulados.
- •
  Entre sus diagnósticos diferenciales más habituales encontramos los nevus intradérmicos, las queratosis actínicas y los carcinomas escamosos. Las formas pigmentadas semejan a los melanomas y las queratosis seborreicas, entre otros.
- •
  La formación del CBC, tanto hereditario como esporádico, se ha asociado de forma clara a la activación constitutiva de la vía Sonic Hedgehog.
- •
  Su pronóstico en general es excelente, con una supervivencia cercana al 100% tras la cirugía, aunque sin tratamiento el carcinoma basocelular puede causar desfiguración cosmética y una morbilidad significativa.
- •
  Su tratamiento de elección es la cirugía radical, cuando es posible. Como alternativas, en los casos avanzados, disponemos de la radioterapia y los inhibidores de la vía Hedgehog.
- •
  Es muy importante para su prevención primaria y secundaria la fotoevitación y la fotoprotección.
Advanced basal cell carcinoma: What dermatologists need to know about diagnosis
2022, Journal of the American Academy of Dermatology
Citation Excerpt :
Arborizing telangiectasias are present in 75% of nodular BCCs, followed by shiny white structures (43%) and ulceration (31%). Morpheaform BCCs often display a structureless hypopigmented area and tend to have arborizing telangiectasias.35 Infiltrative BCCs can show arborizing telangiectasias, ulceration, shiny red areas, multiple blue-gray globules, and fine telangiectasias.
Basal cell carcinoma (BCC) is the most common human cancer, with approximately 3.6 million cases diagnosed each year. About 2000 deaths annually in the United States are attributed to basal and squamous cell skin cancers. There is a direct link between ultraviolet exposure and the development of BCC, as UV exposure damages DNA and induces mutations in tumor suppressor genes. Aberrations in the hedgehog pathway can also result in BCC, highlighted by the fact that most cases of sporadic BCCs have been found to have mutations in different genes involved in the hedgehog pathway. There are several genetic syndromes that are associated with BCCs, including basal cell nevus syndrome, xeroderma pigmentosum, Bazex-Dupré-Christol syndrome, Rombo syndrome, and Oley syndrome. Other risk factors include age, male gender, occupational hazards, radiation, and immunosuppression. BCCs are not typically staged but are instead stratified by their risk of recurring or metastasizing. Locally advanced BCCs are those tumors that are not amenable to surgery or radiation therapy.
“DerMohscopy”: utility of dermoscopy combined with Mohs micrographic surgery for the treatment of basal cell carcinoma
2022, Anais Brasileiros de Dermatologia

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: IRB approval status: Not applicable.

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Original articleDermoscopic features of basal cell carcinoma and its subtypes: A systematic review

Background

Objective

Methods

Results

Limitations

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Clin Dermatol

J Am Acad Dermatol

J Clin Epidemiol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Variations of basal cell carcinomas according to gender, age, location and histopathological subtype

Br J Dermatol

The status of dermoscopy in Germany–results of the cross-sectional Pan-Euro-Dermoscopy Study

J Dtsch Dermatol Ges

Factors driving the use of dermoscopy in Europe: a pan-European survey

Br J Dermatol

Surface microscopy of pigmented basal cell carcinoma

Arch Dermatol

Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis

Arch Dermatol

The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews

BMC Med Res Methodol

QUADAS and STARD: evaluating the quality of diagnostic accuracy studies

Rev Saude Publica

Vascular patterns in basal cell carcinoma

J Eur Acad Dermatol Venereol

Dermoscopy uncovers clinically undetectable pigmentation in basal cell carcinoma

Br J Dermatol

Dermoscopy of superficial basal cell carcinoma

Dermatol Surg

Dermoscopic patterns of superficial basal cell carcinoma

Int J Dermatol

What is the impact of tumour size on dermoscopic diagnosis of BCC?

J Eur Acad Dermatol Venereol

Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location

J Eur Acad Dermatol Venereol

Correlation of dermoscopic findings with histopathologic variants of basal cell carcinoma

Int J Dermatol

Original article
Dermoscopic features of basal cell carcinoma and its subtypes: A systematic review