Dermoscopy of Basal Cell Carcinoma Part 1: Dermoscopic Findings and Diagnostic Accuracy-A Systematic Literature Review

Abstract

Introduction: Basal cell carcinoma (BCC) is the most common malignant skin tumor. While rarely fatal, it can cause local tissue damage. Part I of the review summarizes the dermoscopic features of BCC and the diagnostic accuracy of dermoscopy in the diagnosis of BCC.

Methods: A search of the PubMed database was performed for studies reporting on the diagnostic accuracy of dermoscopy or dermoscopic findings in BCC, either pigmented or non-pigmented, located anywhere on the body, of any histopathologic subtype, size and at any age of onset.

Results: BCC was found to present with a wide range of dermoscopic features, including white structures (shiny white lines, shiny white areas, rosettes), yellow structures (milia-like cysts, yellow lobular-like structures), multiple aggregated yellow-white globules (MAY globules), blue structures (blue ovoid nests), vascular structures (arborizing vessels, short fine telangiectasias), multiple small erosions/ulcerations, features of regression (pepper-like structures, white scar-like areas) and pigmented structures (spoke-wheel areas, maple leaf-like areas (MLLAs), blue/gray dots). Dermoscopy showed a sensitivity of 67.6-98.6% and a positive predictive value (PPV) of 85.9-97% in identifying BCC. The physician's experience and training improve the accuracy, however, BCCs on the trunk and extremities, particularly of superficial subtypes, may still constitute a challenge.

Conclusions: Dermoscopy, especially when performed by a trained physician, increases the accuracy of early BCC detection.

Keywords: basal cell carcinoma; dermatoscopy; dermoscopy; non-polarized; polarized.

Figure 1

PRISMA flow chart showing the screening process (available also: Wojtowicz I et al. [10]).

Figure 2

Dermoscopy images of basal cell carcinomas (BCCs) with shiny white lines (blue arrows).

Figure 3

Dermoscopy images of BCCs with shiny white blotches (yellow arrows).

Figure 4

Dermoscopy images of BCCs with milia-like cysts (MLCs) (green arrows).

Figure 5

Dermoscopy images of BCCs with yellow lobular-like structures (red arrows and red circle).

Figure 6

Dermoscopy images of BCCs with multiple aggregated yellow-white globules (MAY globules) (yellow circles).

Figure 7

Dermoscopy images of BCCs with arborizing vessels (yellow arrows).

Figure 8

Dermoscopy images of BCCs with short fine telangiectasias (green arrows and circles).

Figure 9

Dermoscopy images of BCCs with multiple small erosions/ulcerations (red arrowheads).

Figure 10

Dermoscopy images of BCCs with bluish features of regression called “blue areas” or “blue hue” (yellow circles) and “pepper-like structures” (green circles).

Figure 11

Dermoscopy images of BCCs with white/reddish features of regression called “white scar-like areas”, “white areas” or “milky way areas” (red circles).

Figure 12

Dermoscopy images of BCCs with spoke-wheel areas (yellow arrows).

Figure 13

Dermoscopy images of BCCs with maple leaf-like areas—MLLAs (blue arrowheads).

Figure 14

Dermoscopy images of BCCs with blue-gray ovoid nests (blue arrows).

Figure 15

Dermoscopy images of BCCs with concentric structures (yellow circles).

Figure 16

Dermoscopy images of BCCs with multiple blue/gray globules (red circles).

Figure 17

Dermoscopy images of BCCs with multiple in-focus blue/gray dots (green circles).

Figure 18

Dermoscopy image of BCC with brown homogeneous blotches (BHB) (yellow circles).

Figure 19

Dermoscopy image of BCC with large blue-gray structureless areas (yellow arrowhead).

Figure 20

Dermoscopy image of BCC with semitranslucent areas (red circle).