Original article
Accuracy of dermoscopic criteria for discriminating superficial from other subtypes of basal cell carcinoma

https://doi.org/10.1016/j.jaad.2013.10.003Get rights and content

Background

The management of basal cell carcinoma (BCC) depends, among other factors, on its histopathologic subtype. Although dermoscopic criteria of BCC have been investigated, the possible role of dermoscopy in predicting the tumor subtype remains unclear.

Objectives

We sought to assess the diagnostic accuracy of dermoscopic criteria for differentiating superficial BCC (sBCC) from other BCC subtypes.

Methods

Dermoscopic images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver operating characteristic curves.

Results

In all, 77 sBCCs and 258 non-sBCCs were included. Maple leaf–like areas, short fine superficial telangiectasia, multiple small erosions, and shiny white-red structureless areas were potent predictors of sBCC, each making its diagnosis over 5-fold more likely. Conversely, the presence of arborizing vessels, blue-gray ovoid nests, and ulceration gave 11-fold, 15-fold, and 3-fold increased possibility for the diagnosis of non-sBCCs, respectively. Based on the results of the multivariate analysis, we propose a diagnostic algorithm that can predict the diagnosis of sBCC with a sensitivity of 81.9% and a specificity of 81.8%.

Limitations

The retrospective design and the inclusion of only Caucasian patients are limitations.

Conclusion

Dermoscopy is reliable in differentiating sBCC from other BCC subtypes.

Section snippets

Methods

This was a retrospective study conducted at the Skin Cancer Unit of the Arcispedale Santa Maria Nuova IRCCS in Reggio Emilia, Italy. The ethics committee approval was waived, as the study affected neither the routine diagnostic, nor therapeutic management. Patients recorded in our database were screened for eligibility for inclusion in the study. Inclusion criteria were a definite histopathologic diagnosis of BCC, the availability of clinical and dermoscopic images of the tumor before

General data

In all, 313 patients (mean age 67.1 ± 15.3 years) with a definite histopathologic diagnosis of BCC were included in the study. Our sample included 172 men (mean age 69.7 ± 13.6 years) and 141 women (mean age 63.9 ± 16.6 years). The histopathologic categorization of the included BCCs after the re-evaluation of histopathologic slides was superficial in 77, nodular in 154, micronodular in 19, morpheaform in 8, mixed in 15, infiltrating in 32, and fibroepithelioma of Pinkus in 8 patients.

Discussion

In this study we assessed the accuracy of dermoscopic criteria for differentiating sBCC from other subtypes. Our results suggest that dermoscopy, in addition to its documented value for differentiating BCC from other diseases, is also valid for predicting its superficial nature. In particular, maple leaf–like areas and short fine superficial telangiectasias in the absence of arborizing vessels, blue-gray ovoid nests, and ulceration are predictive of sBCC with a sensitivity of 81.9% and a

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      In concordance with previous studies evaluating biopsied/treated lesions, dermoscopy was not very helpful in evaluating the presence or absence of residual BCC.19 The only dermoscopic feature with potential relevance was the presence of arborizing vessels, typically seen in nodular BCC5,30; however, only 6 of our patients had disease of the nodular subtype. In addition, other BCC-specific dermoscopic features, such as short, fine telangiectasias and shiny white blotches and strands, lose validity in biopsied lesions because they can also be seen in scars.19

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

    Conflicts of interest: None declared.

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