A temporal lesion

A 60-year-old woman consulted for this temporal  pigmented lesion

 Dermoscopy revealed:

• blue-gray dots / globules
• leaf-like areas

Pathology was in favor of a basal cell carcinoma

Red lesion

The same 65-year-old man presented a red lesion on his back.
Dermoscopy revealed:

• no signs for a melanocytic lesion
• thin arborizing vessels (green arrow)
• ulcerations (black arrow)
• blue gray globules (white arrow)

in favour of a basal cell carcinoma

Red nodule

A 62-year-old man consulted for a red tumor on his back.

Three dermoscopic pictures are exposed with different levels of pressure on the tumor. Vessels are well seen with a slight pressure.

Dermoscopy revealed arborizing vessels and a blue globule in favour of a basal cell carcinoma.

What is this lesion on a leg (first case) ?

A 72-year-old woman consulted for this ulcerated lesion on her right leg.

Dermoscopy revealed:

• ulceration (crusts)
• central glomerular vessels regularly disposed
• blue-gray globules
• spokewheel areas

Discussion: blue-gray globules were the main sign in favor of a basal cell carcinoma (BCC), in association with ulceration and some spokewheel areas.

Nevertheless, glomerular vessels have not been reported in BCC. We think that, in our case, these glomerular vessels were due to a stasis dermatitis.

An excision was performed and pathology confirmed the diagnosis of BCC.

Nasal lesion.

A 72-year-old man consulted for a lesion on his nose.

Dermoscopy revealed:

• absence of pigment network
• arborizing blood vessels
• blue-gray globules
• spokewheel areas

in favor of a basal cell carcinoma and confirming the clinical hypothesis.

Basal cell carcinoma

A 72-year-old woman consulted for this pigmented lesion on the left side of her nose.

Dermoscopy revealed a non melanocytic tumor with:

• large blue ovoïd nest
• arborizing vessels (in the blue ovoïd nest)
• blue gray globules
• leaf-like areas

in favor of a basal cell carcinoma.

leaf-like structures

Other cases of basal cell carcinomas: 

1 2 3 4 5 6 7 8 9  10 11 12 13 14 15 16 17 18 19 20 21

Basal cell carcinoma

A 59-year-old man consulted for this tumor on his nose.

Dermoscopy was typically in favor of a basal cell carcinoma:

• arborizing blood vessels
• blue ovoid nest
• blue gray globules
• ulceration with congealed blood
  

Other cases of basal cell carcinomas: 

1 2 3 4 5 6 7 8 9  10 11 12 13 14 15 16 17 18 19 20 21

Basal cell carcinoma

A 89-year-old woman consulted for a pigmented lesion on her forehead. A basal cell carcinoma was the main clinical diagnosis.

On this picture, with a slight pressure of the dermoscope (polarized light dermoscopy), arborizing blood vessels are well seen.
Blue gray dots and globules are the other dermoscopic signs in favor of this basal cell carcinoma.

If the pressure of the dermoscope is too important, the blood vessels are not visible.

Vessels and red areas are better visualized with polarized light dermoscopy than with immersion contact dermoscopy (1)

References:
1 - Marghoob et al. Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions. Arch Dermatol 2007 Mar;143(3):329-38

Basal cell carcinoma

Clinical picture
A 44-year-old woman consulted for this lesion on her back with a circinar papulous border clinically suspicious of being a basal cell carcinoma.


Dermoscopy 1
In dermoscopy the lesion lacked pigment network.
There were blue- gray globules and polymorphous vessels (glomerular vessels, linear irregular vessels, hairpin vessels)

Dermoscopy 2


Dermoscopy 3
Glomerular vessel and hairpin vessels (right part)


Dermoscopy 4
irregular linear vessels

In this case, vascular pattern was atypical for a basal cell carcinoma which features typically arborizing tree vessels. Irregular linear vessels are more often observed in melanomas.
The lesion was excised and pathology confirmed the diagnosis of basal cell carcinoma.

Other cases of basal cell carcinomas: 

1 2 3 4 5 6 7 8 9  10 11 12 13 14 15 16 17 18 19 20 21

Blue ovoïd nests

A 73-year old woman consulted for this ulcerated tumor of her forehead. The main clinical diagnosis was a basal cell carcinoma.



Dermoscopy confirmed easily the diagnosis, showing ulceration and many blue ovoïd nests.



Blue ovoïd nests (or blue-gray ovoïd nests) are well circumscribed areas, larger than blue-gray globules and often associate. Their presence is a good dermoscopic sign for a basal cell carcinoma.

Melanoma in situ

A 28-year-old man consulted for a pruritic pigmented lesion of his right shoulder.
Dermoscopy revealed an asymetric pattern with blue-gray globules and focal structureless areas. The lesion was excised and pathology revealed a melanoma in situ.






Other cases of melanoma
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Basal cell carcinoma

Nodular lesion located on the neck.
Dermoscopy revealed multiple blue gray globules and arborizing telangiectasia in favor of basal cell carcinoma. The lesion was excised and pathology confirmed the diagnosis.

Basal cell carcinoma

A 72-year-old woman consulted for this nodular lesion on her nose.
The lesion was clinically suggestive of a basal cell carcinoma.













Dermoscopy confirmed easily the clinical diagnosis showing arborizing vesels and multiple blue-gray globules

Basal cell carcinoma

A 56-year-old man consulted for a slowly enlarging lesion of his right temple.






Dermoscopy revealed multiple blue gray globules in favor of a basal cell carcinoma.In this case , blue gray globules are the only suggestive dermoscopic signs of basal cell carcinoma.

A biopsy was performed and confirmed the diagnosis.

basal cell carcinoma (pigmented)

A 30-year-old man consulted for this pigmented lesion on his back.




















On dermoscopy: multi-component pattern with blue gray globules, blue-gray ovoïd nests, leaf-like areas (upper left quadrant) and arborizing vessels