Macular lesion on a leg.

A 42-year-old woman consulted for this lesion localized on her left leg.

Dermoscopic evaluation revealed sharply focused elongated and serpentine telangiectasias on an whitish-yellowish structureless area in favor of a necrobiosis lipoidica.

A biopsy confirmed diagnosis.

Reference: Dermoscopy of necrobiosis lipodoidica and granuloma annulare. R. Pellican and al. Dermatology 2013; 226: 319-23

ground

Periocular blue nodule

A 28-year-old woman consulted for this slowly enlarging periocular tumor.

Dermoscopy revealed a bluish lesion with clear arborizing vessels.

This lesion was excised and pathology revealed a basal cell carcinoma.

Chrysalis structures

A 51-year-old patient consulted for this lesion located on his back.

Dermoscopy revealed :

• arborizing vessels
• ulcerations
• chrysalis structures

This lesion was a basal cell carcinoma.

Crystalline or chrysalis structures are white shiny streaks that can only be seen with polarized dermatoscopes.

Crystaline or chrysalis structures are most commonly observed in basal cell carcinoma and invasive melanomas and rarely seen in nevi. In melanoma,they reflect increased tumor thickness and progression. 
The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. Y. Balagula, R.P. Braun, H. S. Rabinovitz et al.  J Am Acad Dermatol 2012;67:194.e1-8.

A red tumor on a leg

A 42-year-old patient consulted for this red tumor present on his right leg for 1 year.

Dermoscopy revealed :

• no pigment network
• arborizing vessels

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.

A facial telangiectatic tumor

A 67-year-old woman consulted for this small lesion on her left cheek.


Dermoscopy was typical of a basal cell carcinoma: ulceration, arborizing vessels and a (subtle) leaf -like area.

Dorsal red plaque

A 51-year-old man presented a slowly enlarging red plaque on his back.

Dermoscopy revealed:

• absence of pigment network
• thin arborizing vessels

A biopsy confirmed the diagnosis of superficial basal cell carcinoma.

In superficial BCC, vessels are often thinner than in other subtypes (nodular 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

35-year-old woman with an enlarging scaly lesion.

Arborizing vessels were typically in favor of a basal cell carcinoma.

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.

Basal cell carcinomas

A 75-year-old patient consulted for 3 lésions on her face and a lesion on her back with superficial ulcerations.

Dermoscopy 1: ulcerations, leaf-like areas

Dermoscopy 2: leaf-like areas, arborizing vessels, blue ovoid nest

Dermoscopy 3: leaf-like areas and arborizing vessels

Dermoscopy 4: leaf-like areas

All these lesions were superficial basal cell carcinomas

A scalp tumour...

A 38-year-old woman presented since birth a localised parietal hairless orange-yellow plaque (1) This plaque was smooth and became verrucous during childhood.

The patient consulted because of the occurence of nodules (2) on the anterior part of the lesion.

Dermoscopy revealed yellow globular-like structures (1) on the posterior area.

On the nodules, arborizing tree vessels and blue ovoid nests were in favour of a basal cell carcinoma or a trichoblastoma

This lesion was biopsied  and pathology confirmed the diagnosis of basal cell carcinoma occuring on a Jadahsson nevus (nevus sebaceus)

Knowing that trichoblastomas are the tumors the most frequently reported as complication of nevus sebaceous  (2, 3) and that dermoscopy is not sufficently discriminative to distinguish a trichoblastoma from a basal cell carcinoma, we have to wait for the pathology result of the entire excision.

An update will be added within a month.

Litterature

1 -Nancy H. Kim et al.  The dermoscopic differential diagnosis of yellow lobularlike structures. Arch Dermatol 2008; 144 (7): 962.

2-Jaqueti et Al. Trichobastoma is the most common neoplasm debeloped in nevus sebaceus of Jadassohn: a clinicopathologic study of a series of 155 cases. Am J Dermatopathol 2000;22(2):108-18

3- Cribier et Al. Tumors arising in nevus sebaceus. A study of 596 cases. J Am Acad Dermatol 2000;42:263-8

Blue nodule

A 53-year patient consulted for this enlarging temporal  blue nodule.

Dermoscopy revealed a blue homogeneous pattern and some barely visible arborizing tree vessels in favour of a basal cell carcinoma.

This lesion was excised and pathology confirmed the diagnosis of basal cell carcinoma.

Fig 3: arborizing tree vessels (white arrows)

Blue-gray globules

A 67-year-old woman consulted for this lesion on her back. Dermoscopy revealed blue-gray globules (rectangle) and some arborizing vessels (arrows) confirming easily the diagnosis of basal cell carcinoma.

Blue-gray globules are a pathognomonic sign  in pigmented basal cell carcinoma. 

They are often associate with other basal cell carcinoma specific criteria, as leaf-like structures,

spoke-wheel areas and  large blue-gray ovoid nests.

Arborizing tree vessels

A 54-year-old woman consulted for this small pink lesion on her scalp (parietal area)

Dermoscopy revealed many arborizing vessels in favour of a basal cell carcinoma.

The lesion was excised and pathology confirmed the clinical and dermoscopic diagnoses.

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: 

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