Thin arborizing vessels

A 67-year-old man consulted for this lesion on his back.

Dermoscopy revealed a vascular pattern with (thin) arborizing vessels, some small ulcérations and some scales.

A biopsy confirmed the diagnosis of superficial basal cell carcinoma (BCC)

In superficial BCC, arborizing vessels are often thinner than in other subtypes (nodular), and there are no other signs than arborizing vessels.

Strawberry appearance

Facial non pigmented actinic keratoses (AKs) display 4 main dermoscopic features:

1. erythema, with a pink-to-red pseudonetwork surrounding the hair follicles
2. white-to-yellow surface scale
   
3. fine, linear-wavy vessels surrounding the hair follicles
   
4. hair follicle openings filled with yellowish keratotic plugs and/or surrounded by a white halo
   

These features combined to produce a strawberry’ appearance.

Strawberry appearance in a non pigmented AK

Strawberry appearance in a slightly pigmented AK

Other cases of AKs:
1

Literature:
I. Zalaudek, J. Giacomel, G. Argenziano, R. Hofmann-Wellenhof, T. Micantonio, A. Di Stefani, M. Oliviero, H. Rabinovitz, H.P. Soyer, K. Peris (2006) Dermoscopy of facial nonpigmented actinic keratosis. British Journal of Dermatology 2006: 155 (5) , 951–956

Pigmented actinic keratosis

Facial pigmented actinic keratosis (AK) is a differential diagnosis of lentigo maligna because it can have the same clinical and dermoscopic aspects: asymmetric pigmented follicles, annular-granular structures, and rhomboidal structures. Possible clues for pigmented actinic keratosis are scales and a superficial broken-up network usually not present in lentigo maligna.
In our case dermoscopy revealed annular-granular pattern. A biopsy was performed and pathology revealed a pigmented actinic keratosis.

Other cases of AKs:
1

Bowen's disease

A 84-year-old woman presented a keratotic erythematous lesion of her right leg.



Dermoscopy revealed scales many glomerular vessels in favor of a Bowen's disease.
See the glomerular vessels. The pressure of the dermoscope has to be slight not to empty the vessels. Polarized dermoscopy is more performing than contact immersion dermoscopy to see accurately vessels.