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.

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

Glomerular vessels

Glomerular vessels are typically found in Bowen disease.

In this case, glomerular vessels were the main clue for the diagnosis of Bowen disease for this 72-year-old woman who presented a reddish and well circumscrined plaque on her right forearm.


Other cases: 1 2 3

Glomerular vessels

A 72-year-old woman consulted for this pink lesion on her right leg.
Dermoscopy revealed spared glomerular vessels in favor of a Bowen disease.

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

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.

Bowen's disease

A 75-year-old woman consulted for an enlarging red tumor of her right ankle.

Dermoscopy (x20) revealed numerous glomerular vessels in favor of a Bowen's disease.

A biopsy was performed and pathology confirmed the diagnosis.