Week 5 - Module 4 Malignant non-melanocytic lesions Flashcards
What dermoscopic features do aggressive BCCs typically display?
Less than 50% pink or no pink
OR
Absent central tumor vessels.
What are the aggressive subtypes of BCC?
Micronodular Infiltrating Morphoeic Sclerosing BCC with squamous differentiation
Which aggressive BCC subtype is linked with increased metastatic risk?
BCC with squamous differentiation
What vessel morphology was more common with aggressive BCCs?
Coil, dot and loop were more common
What proportion of superficial BCCs have > half the area being pink?
Approx 85%
What is the hallmark vascular features of nodular BCCs on dermatoscopy?
Large diameter vessels
also arborising vessels/ulceration
What are the typical features of superficial BCC on dermatoscopy?
> 50% pink
Absence of large diameter vessels
What are the possible dermatoscopic findings in non pigmented BCC?
Arborising vessel Ulceration Superficial fine telangectasia Multiple small erosions Shiny white red structureless areas Short white streaks
What are the dermatoscopic criteria for pigmented BCC?
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
How are arborising vessels defined?
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
How are superficial fine telangiectasia defined?
Short, fine, focused linear vessels with very few branches
How are blue-grey ovoid nests defined?
Well circumscribed, confluent or near confluent pigmented ovoid or elongated configurations, larger than globules and not intimately connected to pigmented tumor body
How are multiple blue-gray globules defined?
Numerous, loosely arranged round to oval well circumscribed structures, which are smaller than the nests
How are “in focus dots” described?
Loosely arranged well-defined small gray dots, which appear sharply in focus.
How are “maple leaf like areas defined?
Translucent brown to gray/blue peripheral bulbous extensions that never arise from pigmented network or from adjacent confluent pigmented areas
Describe spoke wheel areas
Well-circumscribed radial projections, usually tan but
sometimes blue or gray, meeting at an often darker (dark brown,black, or blue) central axis
Outline the dermatoscopic features of concentric structures?
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
How is ulceration described dermatoscopically?
One or more large structureless areas of red to black-red color. Loss of epidermis, usually covered by hematogenous crust.
What do short white streaks look like? How can you see them?
Orthogonal short and thick crossing lines seen only with polarized dermoscopy.
What is the Menzies criteria for BCC diagnosis?
Which are the most reliable features? (marked with asterix)
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
What is the suggested criteria for non pigmented BCC?
Ulceration/small erosions + arborising vessels/short fine superficial telangectasia
What is a red pseudonetwork?
Structureless red areas that, intermingled with small roundish white areas, resemble network
structure; small white areas correspond to follicular openings of skin
What is a red starburst pattern? What does it suggest?
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
Outline dotted, glomerular, hairpin and linear irregular vessels.
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
What are the dermatoscopic features of actinic keratoses?
Red pseudonetwork
Superficial scale
What are the dermatoscopic features of Bowen’s disease?
Dotted vessels
Diffuse yellow opaque scale
Microerosions
What are the dermatoscopic features of SCC?
Hairpin vessels Linear irregular vessels (18%) Targetoid hair follicles White structureless area Central keratin mass Ulceration
What are the dermatoscopic features of of KA
Hairpin vessels Linear irregular vessels (70%) Targetoid hair follicles White structureless area Central keratin mass Ulceration
What are the two archetypal dermatoscopic patterns of pigmented Bowen’s disease?
- Structureless brown pattern
2. Combination of dots and structureless pattern
What is the risk of progression of Bowen’s disease to SCC?
3-5%
What features indicate KA over SCC
Branching and large diameter vessels (slightly more)
Rapid growth
Circular symmetry of lesion
What features suggest a poorly differentiated SCC over a well differentiated SCC?
Increased branching and serpentine vessels
