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.

Plantar lesion

1 - clinical image

A 28-year-old woman consulted for a plantar  bluish ulcerated lesion on his left foot which was present for 6 months.

Clinically, a melanoma was suspected.

2 - Dermoscopic image

Dermoscopy revealed:

• blue hue
• ulceration
• blue ovoid nest

in favor of a basal cell carcinoma.

but this lesion was excised and pathology revealed an eccrine poroma (or eccrine acrospiroma).

Dermoscopic features of eccrine poroma have been described similar to basal cell carcinoma except the spoke-wheel areas and leaf-like structures (1)

1- A.Gatti, N. di Meo, G. Trevisan. Dermoscopy of eccrine acrospiroma masquerading as nodular malignant melanoma. ActaDermatoven APA Vol 19, 2010, No4, 23-25

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

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.

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

Superficial spreading melanoma

A 66-year-old man consulted for a pigmented lesion on his left scapular area.

Dermoscopy revealed a multi-component pattern, asymmetry, and multiple colours (tan, dark brown, black, blue gray, white).
Other signs were an atypical reticular pattern (irregular holes and thick lines) with a sharp demarcation, a blue-white veil and atypical vessels (irregular linear vessels), a central ulceration (crust). Dots were irregularly distributed.

All these dermoscopic signs were in favor of a superficial spreading melanoma.

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

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

Arborizing vessels

A 65-year-old man consulted for a red tumor on his forehead.

Dermoscopy revealed arborizing vessels and an ulceration which confirmed easily the diagnosis of basal cell carcinoma.

Pictures taken with 3Gen Dermlite Foto System Pro

 On the 2nd picture above, the dermoscope caused a higher pressure on the tumor and vessels appeared less apparent than on the first one.

Basal cell carcinoma

A 70-year-old woman consulted for a black ulcerated lesion on her left groin.


Dermoscopy displayed:
- absence of pigment network
- ulceration (white arrow)
- large blue gray ovoid nest (double arrow)
- delicate leaf-like areas (white circle)
in favor of a basal cell carcinoma

Invasive melanoma

A 62-year-old man consulted for this multicolored tumor on his scapular area. This lesion was clinically in favor of an advanced invasive melanoma (nodular melanoma).



Asymmetrical pigmentation pattern, multiple colours , atypical vessels, atypical reticular pattern, blue-white veil, and ulceration were found in this case of invasive melanoma, Breslow thickness 9mm





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

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.

Superficial basal cell carcinoma

A 71-year-old man presented an erythematous lesion on his back. Dermoscopy revealed arborizing blood vessels and many ulcerations in favor of a basal cell carcinoma. A biopsy was performed and confirmed the diagnosis of superficial basal cell carcinoma.
Ulcerations are frequent in BCC and are significantly specific in the absence of other signs for a melanoma.

Pigmented basal cell carcinoma

A 67-year-old man consulted for a pigmented tumor on his right forearm. Dermoscopy revealed a central ulceration, arborizing blood vessels and blue ovoid nests. The lesion was excised and pathology confirmed the diagnosis of basal cell carcinoma.