Dermoscopy of Basal Cell Carcinoma Part 2: Dermoscopic Findings by Lesion Subtype, Location, Age of Onset, Size and Patient Phototype

Abstract

Introduction: Basal cell carcinoma (BCC) is the most prevalent type of skin cancer worldwide. Despite its low metastatic potential, certain subtypes present an aggressive clinical course. Part II focuses on the different dermoscopic patterns observed in BCC, depending on the lesion subtype, its location on the body, the patient's age, the size of the tumor, and skin phototype. Methods: A search of the PubMed database was conducted for studies reporting dermoscopic findings in BCC across all body locations, histopathologic subtypes, tumor sizes, ages of onset and skin phototypes. Results: There are no dermoscopic features indicative of a particular BCC subtype. However, arborizing, truncated or glomerular vessels, shiny white lines, ulceration, white areas, absence of pink zones and large blue-gray ovoid nests suggest high-risk BCCs (morpheaform, micronodular, infiltrative, basosquamous). Pigmented features can occur in all BCC types, though increased pigmentation indicates less aggressive subtypes (nodular, superficial, fibroepithelioma of Pinkus, adenoid). BCCs most commonly develop on the head, typically presenting as nodular and non-pigmented tumors. Those on the nose, eyes and ears may be more aggressive and prone to recurrence. On the trunk, BCCs are usually superficial and pigmented. Lower limb lesions often show polymorphous vessels rather than arborizing ones, which makes the dermoscopic diagnosis challenging. Dermoscopy aids early detection, with larger tumors exhibiting more established features but no size-specific patterns. Aggressive subtypes display similar dermoscopic findings regardless of size. Conclusions: Dermoscopy is a valuable tool for the early detection of BCC, though no specific dermoscopic features can definitively identify subtypes. High-risk BCCs can be suspected when distinct vascular and structural patterns are present, particularly in lesions located on the face, especially around the nose, eyes and ears, while pigmented features may indicate less aggressive subtypes.

Keywords: BCC subtypes; basal cell carcinoma; dermatoscopy; dermoscopy; high-risk BCC; nodular BCC; superficial BCC.

Figure 1

PRISMA flow chart illustrating the screening procedure.

Figure 2

Dermoscopy image of micronodular BCC showing arborizing vessels (red arrows), erosions (green arrowheads), milia-like cyst (yellow arrowheads).

Figure 3

Dermoscopy images of nodular BCCs (nBCCs). The nBCC on the left shows arborizing vessels (red arrowhead), blue clod/ovoid nest (green arrowhead), milky way areas (blue asterisks). The nBCC on the right presents arborizing vessels (red arrowhead), multiple gray-blue globules (blue arrowheads), erosions (yellow asterisks), milia-like cyst (yellow circle).

Figure 4

Dermoscopy images of superficial basal cell carcinomas (sBCCs). The sBCC on the left shows arborizing vessels (red arrowheads), shiny white areas/blotches (orange asterisks), concentric structures (blue arrows), short fine teleangiectasias (green circle), shiny white lines (yellow arrowheads), multiple in-focus blue/gray dots (yellow circles). The sBCC on the right presents short fine teleangiectasias (yellow circles), erosions (red arrowheads), milky way areas (black asterisks).

Figure 5

Dermoscopy images of pigmented BCCs (pBCCs). The pBCC on the left shows multiple gray-blue globules (green arrowheads), arborizing vessel (red arrowhead), blue clods/ovoid nests (blue arrows), multiple in-focus blue/gray dots (yellow circles), milia-like cyst (yellow arrowhead). The pBCC on the right presents erosion (blue arrow), maple-leaf-like areas (red circle), multiple gray-blue globules (red arrowheads), multiple in-focus blue/gray dots (yellow circles), milia-like cyst (green arrowhead), spoke-wheel areas (yellow arrowheads).

Figure 6

Dermoscopy images of non-pigmented BCCs. The BCC on the left shows MAY globules (yellow circle), milia-like cysts (blue arrows), arborizing vessel (red arrowhead). The BCC on the right presents arborizing vessels (red arrowheads).

Figure 7

Dermoscopy image of BCC located on the shank showing erosion (yellow asterisk), dotted vessels (yellow circle), looped vessels (red circle), glomerular vessels (green circles), milky way areas (black asterisks), brown homogenous blotch (blue arrowhead).

Figure 8

Dermoscopy images of BCCs in different sizes. The small BCC on the left shows blue clod/ovoid nest (blue arrow), multiple gray-blue globules (yellow arrowheads), concentric structures (green circle), shiny white line (red arrowheads). The large BCC on the right presents multiple gray-blue globules (green arrowheads), maple-leaf-like areas (red circle), white areas (yellow circle), multiple erosions (blue arrows).