Assessment of Basal Cell Carcinoma Using Dermoscopy and High Frequency Ultrasound Examination

Abstract

Basal cell carcinoma (BCC) is the most common form of cutaneous neoplasia in humans, and dermoscopy may provide valuable information for histopathological classification of BCC, which allows for the choice of non-invasive topical or surgical therapy. Similarly, dermoscopy may allow for the identification of incipient forms of BCC that cannot be detected in clinical examination. The importance of early diagnosis using the dermoscopy of superficial BCC forms is proven by the fact that despite their indolent clinical appearance, they can be included in high-risk BCC forms due to the rate of postoperative recurrence. Nodular pigmentary forms of BCCs present ovoid gray-blue nests or multiple gray-blue dots/globules associated with arborized vessels, sometimes undetectable on clinical examination. The management of BCC depends on this, as pigmentary forms have been shown to have a poor response to photodynamic therapy. High frequency ultrasound examination (HFUS) aids in the diagnosis of BCC with hypoechoic tumour masses, as well as in estimating tumour size (thickness and diameter), presurgical margin delineation, and surgical planning. The examination is also useful for determining the invasion of adjacent structures and for studying local recurrences. The use of dermoscopy in combination with HFUS allows for optimisation of the management of the oncological patient.

Keywords: basal cell carcinoma; dermoscopy; high frequency ultrasound examination.

Figure 1

Nodular pigmented BCC: clinical aspect (a) and dermoscopic (Dermlite^®) appearance showing small bluish-gray dot-like structures (indicated my black arrows) and bluish-brown globules (indicated by black circles) accompanied by arborized vessels (indicated by white arrows) (b) (own collection).

Figure 2

Pigmentary BCC: clinical aspect (indicated by black circle) (a) and videodermatoscopic appearance using Visiomed microDERM AG^® (×30) targeting “maple leaf-like” elements (indicated by black arrows) which are brown homogeneous structures that are not associated with the pigment network, and their morphology is reminiscent of leaves, with brown extensions in the periphery, always without connection to the pigmentary network or adjacent pigmentary areas; similarly, “spoke−wheel-like” pigmentary structures (indicated by white circles) as radially distributed brown structures, with a central axis and with brown radial projections, are identified (b) (own collection).

Figure 3

Example of superficial BCC examination: the clinical appearance of an oval, pink-translucent, ulcerated tumour located on the photoexposed cervical area (indicated by black circle) (a), videodermoscopic aspect (using Visiomed microDERM AG^®—×15) showing a small ulceration (indicated by a black arrow) (b), HFUS examination (using Dermascan C^® 20 MHz) with evidence of a subepidermal, well-demarcated, linear hypoechoic mass (indicated by orange circle) representing the superficial basal cell carcinoma (c) (own collection).

Figure 3

Example of superficial BCC examination: the clinical appearance of an oval, pink-translucent, ulcerated tumour located on the photoexposed cervical area (indicated by black circle) (a), videodermoscopic aspect (using Visiomed microDERM AG^®—×15) showing a small ulceration (indicated by a black arrow) (b), HFUS examination (using Dermascan C^® 20 MHz) with evidence of a subepidermal, well-demarcated, linear hypoechoic mass (indicated by orange circle) representing the superficial basal cell carcinoma (c) (own collection).

Figure 4

Pigmentary nodular BCC at videodermoscopic examination (using Visiomed microDERM AG^® × 15 magnification) showing bright red, sharp in focus and large arborizing vessels (indicated by black arrows), and blue gray globules (indicated by black circles), with no presence of the pigmentary network (a). Extensive superficial malignant melanoma (Clark III Breslow 1.1 mm, pT1b Nx, Pn0) with videodermoscopic appearance (using Visiomed microDERM AG^® ×30 magnification), which indicates an asymmetric tumour lesion, with a longitudinal diameter greater than 6 mm (D1/D2 = 13.4/6.7 mm), with the presence of an atypical pigmented network with irregular blotches (indicated by black circles), with radial streaming (parallel linear extension at the periphery indicated by black arrows) and regression, with the white area lighter than the surrounding skin (indicated by white circles) (b) (own collection).