Basal cell carcinoma

A 72-year-old woman consulted for this red left cervical tumor.


Dermoscopy revealed an unspecific pattern and many arborizing blood vessels in favor of a basal cell carcinoma.

Arborizing vessels are the most typical local criteria in basal cell carcinoma.


They are rarely observed in other tumors:

• melanocytic nevus
• melanoma
• seborrheic keratosis
  

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

Glomerular vessels

A 65-year-old woman consulted for this red lesion on her right leg for 8 months. (clinical picture above)

Fig 1: polarized-light contact dermoscopy with a slight pressure
of the dermoscope.

Dermoscopy with a polarized-light contact dermoscope revealed an unspecific pattern and typical glomerular vessels in a symmetric distribution, in favor of a Bowen disease.

Fig 2: polarized-light contact dermoscopy with
a heavier pressure of the dermoscope which emptied
the blood vessels.

Polarized-light dermoscopy offers a better visualization than contact-light dermoscopy for blood vessels whatever the type of vessels, at the condition not to heavily press on the lesion.

Glomerular vessels are the specific local criteria for diagnosing Bowen disease.

Other non specific criteria for Bowen disease are:

• unspecific global pattern
• scales *
  
• ulceration*
  

* not present in our case

Difference between polarized dermoscopy and immersion contact dermoscopy for diagnosis of seborrheic keratosis

Fig 1: clinical view of a seborrheic keratosis

Fig 2: Dermoscopic image taken with polarized dermoscopy

Fig 3: Dermoscopic image of the same seborrheic keratosis taken
with non polarized dermoscopy (immersion contact dermoscopy)

In our case milia-like cysts were better observed with immersion contact dermoscopy.

In an article published in the Archives of Dermatology in 2007 (1) , the authors showed that milia-like cysts and comedo-like openings were better visualized with non polarized dermoscopy (NPD), suggesting that NPD was more helpful for identification of seborrheic keratosis.

1: Benvenuto-Andrade C, Dusza SW, Agero AL, Scope A, Rajadhyaksha M, Halpern AC, Marghoob AA. Arch Dermatol. 2007 Mar; 143(3):329-38. Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions.

Keratoacanthoma

This rapidly engrowing lesion for 2 months was clinically in favor of a keratoacanthoma.


In our case dermoscopy revealed:

• an unspecific pattern
• a central ulceration with blood crusts
• a corona of elongated hairpin blood vessels on a white background corresponding to a white keratotic halo
  

Other dermoscopic features of keratoacanthomas are:

• multicomponent pattern
• polymorphous vessels
• central keratotic plug
  

Elongated hairpin blood vessels on a white keratotic halo are non specific of keratoacanthomas and can be observed in invasive squamous cell carcinomas.

Keratoacanthomas is considered as "benign" variant of squamous cell carcinoma. The first line therapy consists in an excision although other alternatives are possible (imiquimod, PDT, etc...)

Other cases: 1

Comma vessels

This is a case of dermal nevus located on the back of a woman.

Comma vessels are well observed on this picture taken with a polarized light dermoscope. Milia-like cysts are present but they are less marked than on pictures taken with dermoscope using immersion principle.

Comma vessels are frequently observed in dermal nevi but can be observed too in atypical nevi.

Solar lentigos

Case 1: clinical image

The clinical aspect of a solar lentigo* is a light brown macule.
(* other denominations: lentigo actinica, senile lentigo)

Case 1: dermoscopic image

2 types of patterns can be observed:

• reticular pattern with regular meshes and thin lines
• homogeneous pattern

In all cases, the pattern has a sharp demarcation and a light brown to tan colour.

Case 2: dermoscopic image

In the 2nd case, the moth eaten borders are one of the typical aspects of solar lentigos.

Another dermoscopic feature sometimes observed is fingerprint-like structures.

Other cases: 1

Halo nevus

A 16-year-old boy underwent a yearly mole check-up. One year later, one of his nevi presented a peripheral depigmentation in favor of halo nevus.



The difference between the two dermoscopic images at a one year interval was very marked:

• depigmentation of the surrounding skin
• enlightening of the global pattern and rarefaction of the globules
  

In this case occuring in a teen, there were no atypical dermoscopic features in favor of a melanoma and another appointment was scheduled one year later.


Halo nevus is a benign lesion and no treatment is required. It is a frequent phenomena during childhood. Despite benign features, the presence of a new halo lesion in an adult has to be examined with a high index of suspcion of melanoma. If a halo nevus is showing atypical dermoscopic features, an excision has to be scheduled.

Melanoma

Asymmetric lesion with pink homogeneous area

A 68-year old man consulted for an atypical pigmented lesion on his left lumbar area.

Dermoscopy revealed a melanocytic lesion characterized by:

• asymmetry
• an atypical pigment network
• a pink homogeneous area
• a white area of regression
• linear-irregular vessels
• polymorphous vessels

Polymorphous and linear-irregular vessels

Atypical pigment network (circle)

White area of regression (circle)

This lesion was highly suspicious of melanoma and excised.

Pathology revealed a superficial spreading melanoma (SSM) in situ developed on a melanocytic nevus developed on a melanocytic nevus