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Home » Topics A–Z » Basal cell carcinoma dermoscopy
Author: Naomi Ashman, Dermoscopist, Torbay Skin, Auckland, New Zealand; DermNet New Zealand Editor in Chief Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. Created 2019.
Basal cell carcinoma (BCC) is a common, locally invasive, keratinocytic, or nonmelanoma skin cancer. It is also known as rodent ulcer and basalioma. Patients with BCC often develop multiple primary tumours over time.
Basal cell carcinoma can be pigmented or nonpigmented. Its subtypes include:
The clinical features of basal cell carcinoma are:
Nodular basal cell carcinoma is the most common type of facial BCC. The clinical features of nodular basal cell carcinoma are:
Clinical features of nodular basal cell carcinoma
Superficial basal cell carcinoma is the most common type of BCC in younger adults and is the most common type on upper trunk and shoulders. The clinical features of superficial basal cell carcinoma are:
Clinical features of superficial basal cell carcinoma
Morphoeic basal cell carcinoma, also known as morpheic, morphoeiform, or sclerosing basal cell carcinoma, is usually found in midfacial sites. It can have wide and deep subclinical extensions and may infiltrate cutaneous nerves (perineural spread). It presents as an indistinct, waxy, scar-like plaque with ill-defined borders.
Clinical features of morphoeic basal cell carcinoma
The dermoscopic features of basal cell carcinoma vary according to subtype.
The dermoscopic features of pigmented basal cell carcinoma include:
Branching serpentine vessels and blue-grey ovoid nests in pigmented basal cell carcinoma dermoscopy Branching serpentine vessels, leaf-like structures, blue-grey and brown dots in pigmented basal cell carcinoma dermoscopy Leaf like areas in pigmented basal cell carcinoma dermoscopy Leaf-like structures in pigmented basal cell carcinoma dermoscopy Adherent fibre, leaf-like structures and serpentine vessels in pigmented basal cell carcinoma dermoscopy Blue-grey ovoid nests in pigmented basal cell carcinoma dermoscopy Spoke wheels in pigmented basal cell carcinoma dermoscopy Perpendicular white lines, blue globule, leaf-like structures in pigmented basal cell carcinoma dermoscopyDermoscopy of pigmented basal cell carcinoma
The dermoscopic features of nonpigmented basal cell carcinoma include:
On close inspection, some apparently non-pigmented basal cell carcinomas have a lightly pigmented stroma.
Nodular basal cell carcinomas lose the blue hue and instead may have a white rim around central ulceration. White clods (milia-like cysts may be present.
Dermoscopy of nonpigmented basal cell carcinoma
The dermoscopic features of nodular basal cell carcinoma include:
Skin coloured to pinkish stroma, blue structures, branched red lines, and polarised white structures. Pinkish stroma, light brown peripheral converging pigment, grey and blue dots, irregular branched red lines, and few polarised white lines Ill-defined borders, skin coloured stroma, branched red lines, prominent polarised white lines Pink to purple stroma, prominent irregular vessels, greyish clods, prominent polarised white structures Central ulceration, ill-defined pinkish stroma, few short vessels, solitary bluish structure, and polarised white lines Ill-defined margins, light brown stroma, concentric brown structures, branched red lines Light brown stroma, prominent irregular branched vessels, and polarised white lines Peripheral converging deeply pigmented oval or 'leaf-like- structures, ulceration, and white polarised lines Well-defined lesion with brown stroma, darker peripheral 'leaf-like' areas (pigment converging inwards), and ulcerationDermoscopy of nodular basal cell carcinoma
The dermoscopic features of superficial basal cell carcinoma include:
Irregular lesion with pink background, superficial erosions, peripheral pigmented structures, peppering, polarised white lines Red irregular patch with short linear vessels, some red dots, and polarised white perpendicular lines Irregular red background with multiple erosions and polarised white structures Irregular lesion with peripheral pigmented radial lines converging on nonpigmented central area, concentric pigmented clods, polymorphous vessels. Large irregular pink plaque with scattered light brown concentric and short linear structures with prominent polarised white structures Irregular pinkish lesion with erosions, short red vessels, erosions, polarised white structures Dermoscopy of superficial basal cell carcinoma
The dermoscopic features of morphoeic basal cell carcinoma include:
Dermoscopy of morphoeic basal cell carcinoma
Differential diagnoses for basal cell carcinoma are:
Dermoscopic differential diagnosis of BCC
Below are histological explanations for the features of basal cell carcinoma.
Thickening of the epidermis causes dilated papillary dermal blood vessels (which usually appear as red dots) to be drawn out to form sharply defined fine linear and branching serpentine vessels. They sit close to the surface of the skin.
Leaf-like areas are brown to grey-blue discrete bulbous blobs that form a pattern shaped like a leaf and are caused by nodules of pigmented basal cell carcinoma cells in the upper dermis.
Large blue ovoid nests are also known as large blue clods and are created by nests of basal cell tumour in the dermis.
Blue clods are formed by nests of basal cell tumour in the dermis.
Specks of brown and grey pigment are formed as follows:
Spoke wheel areas are also known as radial projections joined at a central hub and are formed by nests and proliferation of pigmented basal cell carcinoma cells.
Perpendicular white lines are thought to be caused by fibrous tissue.
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