Week 5 - Module 4 Malignant non-melanocytic lesions

Question 1

What dermoscopic features do aggressive BCCs typically display?

Answer 1

Less than 50% pink or no pink
OR
Absent central tumor vessels.

Question 2

What are the aggressive subtypes of BCC?

Answer 2

Micronodular
Infiltrating
Morphoeic
Sclerosing
BCC with squamous differentiation

Question 3

Which aggressive BCC subtype is linked with increased metastatic risk?

Answer 3

BCC with squamous differentiation

Question 4

What vessel morphology was more common with aggressive BCCs?

Answer 4

Coil, dot and loop were more common

Question 5

What proportion of superficial BCCs have > half the area being pink?

Answer 5

Approx 85%

Question 6

What is the hallmark vascular features of nodular BCCs on dermatoscopy?

Answer 6

Large diameter vessels

also arborising vessels/ulceration

Question 7

What are the typical features of superficial BCC on dermatoscopy?

Answer 7

> 50% pink

Absence of large diameter vessels

Question 8

What are the possible dermatoscopic findings in non pigmented BCC?

Answer 8

Arborising vessel
Ulceration
Superficial fine telangectasia
Multiple small erosions
Shiny white red structureless areas
Short white streaks

Question 9

What are the dermatoscopic criteria for pigmented BCC?

Answer 9

Arborising vessel
Superficial fine telangectasia
Ulceration
Multiple small erosions
Shiny white red structureless areas
Short white streaks

Blue grey ovoid nests
Multiple blue grey nodules/dots
In focus dots
Maple leaf-like areas
Spoke wheel areas
Concentric structures

Question 10

How are arborising vessels defined?

Answer 10

Stem vessels of large diameter, branching irregularly into finest terminal capillaries. Their color is bright red, being perfectly in focus due to their location on the surface of the tumor

Question 11

How are superficial fine telangiectasia defined?

Answer 11

Short, fine, focused linear vessels with very few branches

Question 12

How are blue-grey ovoid nests defined?

Answer 12

Well circumscribed, confluent or near confluent pigmented ovoid or elongated configurations, larger than globules and not intimately connected to pigmented tumor body

Question 13

How are multiple blue-gray globules defined?

Answer 13

Numerous, loosely arranged round to oval well circumscribed structures, which are smaller than the nests

Question 14

How are “in focus dots” described?

Answer 14

Loosely arranged well-defined small gray dots, which appear sharply in focus.

Question 15

How are “maple leaf like areas defined?

Answer 15

Translucent brown to gray/blue peripheral bulbous extensions that never arise from pigmented network or from adjacent confluent pigmented areas

Question 16

Describe spoke wheel areas

Answer 16

Well-circumscribed radial projections, usually tan but

sometimes blue or gray, meeting at an often darker (dark brown,black, or blue) central axis

Question 17

Outline the dermatoscopic features of concentric structures?

Answer 17

Irregularly shaped globular-like structures with different colors (blue, gray, brown, black) and a darker central area. They possibly represent variations or “precursors” of the spoke wheel areas

Question 18

How is ulceration described dermatoscopically?

Answer 18

One or more large structureless areas of red to black-red color. Loss of epidermis, usually covered by hematogenous crust.

Question 19

What do short white streaks look like? How can you see them?

Answer 19

Orthogonal short and thick crossing lines seen only with polarized dermoscopy.

Question 20

What is the Menzies criteria for BCC diagnosis?

Which are the most reliable features? (marked with asterix)

Answer 20

Absence of pigmented network + one of:

• arborising vessels *
• maple leaf like structures *
• ulceration
• large blue-grey ovoid nests *
• spoke wheel areas
• multiple blue/grey dots/globules

Question 21

What is the suggested criteria for non pigmented BCC?

Answer 21

Ulceration/small erosions + arborising vessels/short fine superficial telangectasia

Question 22

What is a red pseudonetwork?

Answer 22

Structureless red areas that, intermingled with small roundish white areas, resemble network
structure; small white areas correspond to follicular openings of skin

Question 23

What is a red starburst pattern? What does it suggest?

Answer 23

Radial arranged structureless red lines or hairpin vessels that surround yellow to white
structureless scaly center and that resemble overall starburst appearance.

Suggests Bowen’s OR SCC

Question 24

Outline dotted, glomerular, hairpin and linear irregular vessels.

Answer 24

Dotted vessels Tiny red dots densely aligned next to each other
Glomerular vessels Variation on theme of dotted vessels, they are larger than dotted vessels, have convoluted
morphology, and are often distributed in clusters
Hairpin vessels Vascular loops sometimes twisted and bending, usually surrounded by whitish halo when seen in keratinizing tumors
Linear-irregular vessels Linear or slightly curved; irregularly shaped, sized, and distributed red structures

Question 25

What are the dermatoscopic features of actinic keratoses?

Answer 25

Red pseudonetwork

Superficial scale

Question 26

What are the dermatoscopic features of Bowen’s disease?

Answer 26

Dotted vessels
Diffuse yellow opaque scale
Microerosions

Question 27

What are the dermatoscopic features of SCC?

Answer 27

Hairpin vessels
Linear irregular vessels (18%)
Targetoid hair follicles
White structureless area
Central keratin mass
Ulceration

Question 28

What are the dermatoscopic features of of KA

Answer 28

Hairpin vessels
Linear irregular vessels (70%)
Targetoid hair follicles
White structureless area
Central keratin mass
Ulceration

Question 29

What are the two archetypal dermatoscopic patterns of pigmented Bowen’s disease?

Answer 29

1. Structureless brown pattern

2. Combination of dots and structureless pattern

Question 30

What is the risk of progression of Bowen’s disease to SCC?

Answer 30

3-5%

Question 31

What features indicate KA over SCC

Answer 31

Branching and large diameter vessels (slightly more)
Rapid growth
Circular symmetry of lesion

Question 32

What features suggest a poorly differentiated SCC over a well differentiated SCC?

Answer 32

Increased branching and serpentine vessels