Dermoscopy of Basal Cell Carcinomas

Question 1

Dermoscopy is useful to distinguish pigmented BCC from other pigmented lesions. Lesions are rarely completely pigmented in white-skinned individuals.

What coloured pigments can be present in pigmented BCCs?

What colour pigments can be present in non-pigmented BCCs?

Which (non-pigmented vs pigmented) is more common?

Answer 1

Pigment may be grey, brown, blue or black.

Non-pigmented contain flecks of grey.

Non-pigmented BCCs are much more common than pigmented BCCs.

Question 2

What are the deramtoscopic features of a pigmented BCC?

Answer 2

Linear and arborising (branch-like) telangiectasia

Structureless or leaf-like areas on the periphery of the lesion

Large blue-grey ovoid nests or blotches

Multiple blue-grey globules

Specks of brown and grey pigment

Spoke wheel areas (radial projections from a well circumscribed dark central hub)

Focal ulceration

Absence of pigment network

Question 3

What are some dermatological features of a non-pigmented BCC?

Answer 3

Typical bluish-pink colour

Symmetrical arborising vessels and focal ulceration. Slight scaling and white areas of regression

Chrystalline structures, i.e. white shiny lines, strands and larger irregular-shaped white areas. Often only visible on polarised dermoscopy.

Question 4

Describe nodular BCC

Answer 4

Lose the blue hue and instead have a white rim around central ulceration. Milia may be present. Disordered and streaky crystalline structures may be seen.

Question 5

Pigmented BCCs have what 7 main characteristics:

Answer 5

1-Absence of pigment network

2-Arborising vessels

3-Leaf-like structures

4-Large blue-grey ovoid nests

5-Multiple blue-grey globules

6-Spoke-wheel areas

7-Ulceration
(May also occur in melanoma)