Original article
Classifying distinct basal cell carcinoma subtype by means of dermatoscopy and reflectance confocal microscopy

https://doi.org/10.1016/j.jaad.2014.04.067Get rights and content

Background

The current guidelines for the management of basal cell carcinoma (BCC) suggest a different therapeutic approach according to histopathologic subtype. Although dermatoscopic and confocal criteria of BCC have been investigated, no specific studies were performed to evaluate the distinct reflectance confocal microscopy (RCM) aspects of BCC subtypes.

Objectives

To define the specific dermatoscopic and confocal criteria for delineating different BCC subtypes.

Methods

Dermatoscopic and confocal images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Frequencies of dermatoscopic and confocal parameters are provided. Univariate and adjusted odds ratios were calculated. Discriminant analyses were performed to define the independent confocal criteria for distinct BCC subtypes.

Results

Eighty-eight BCCs were included. Dermatoscopically, superficial BCCs (n = 44) were primarily typified by the presence of fine telangiectasia, multiple erosions, leaf-like structures, and revealed cords connected to the epidermis and epidermal streaming upon RCM. Nodular BCCs (n = 22) featured the classic dermatoscopic features and well outlined large basaloid islands upon RCM. Infiltrative BCCs (n = 22) featured structureless, shiny red areas, fine telangiectasia, and arborizing vessels on dermatoscopy and dark silhouettes upon RCM.

Limitations

The retrospective design.

Conclusion

Dermatoscopy and confocal microscopy can reliably classify different BCC subtypes.

Section snippets

Methods

BCC cases were collected in 4 centers in Italy, Spain, Florida, and Australia. Ethics committee approval was waived because the study affected neither the routine diagnostic nor therapeutic management of these cases.

Inclusion criteria were a definite histopathologic diagnosis of BCC, including subtype classification, the availability of clinical, dermatoscopic, and confocal images of the tumor, and the availability of histopathologic slides. All lesions were classified histologically as pure

Results

Eighty-eight patients (mean age, 60.6 ± 14.5 years) with 88 histopathologically proven BCCs were included in the study. Our sample included 44 sBCCs, 22 nBCCs, and 22 iBCCs.

Clinically, sBCCs were flat in 37 of 44 cases (84.1%) and elevated in 7 (15.9%); nBCCs were elevated or nodular in the majority of cases (86.4%) and flat in 3 cases (13.6%); and iBCCs were flat in 20 (90.9%) of the cases and elevated in 2 (9.1%).

Concerning pigmentation, 30 of 44 sBCCs were hypopigmented; 8 cases (18.1%) were

Discussion

Our study revealed significant differences in the dermatoscopic and RCM characteristics among BCC subtypes, suggesting that a combination of the 2 diagnostic modalities might significantly enhance the preoperative subtype classification of the tumor. This is particularly relevant in clinical practice, because the treatment approach of BCC is mainly determined by the tumor subtype.

Several investigators have previously noted the dermatoscopic variability of different subtypes of BCCs.7, 8, 9, 13,

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  • Cited by (0)

    Supported in part by the Italian Ministry of Health (RF-2010-2316524).

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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