Usefulness of Dermoscopy to Provide Accurate Assessment of Skin Cancers

Figures & data

Figure 1 Case presentation 1. (A) clinical presentation, (B) clinical presentation, detailed view of the suspected lesion, (C) dermoscopic picture of seborrheic keratosis, (D) dermoscopic picture of the pigmented BCC.

Figure 2 Case presentation 2. (A) clinical presentation, (B) dermoscopic picture of solar lentigo, (C) dermoscopic picture of seborrheic keratosis, (D) dermoscopic picture of the lentigo malignant melanoma.

Table 1 Dermoscopic Features of Seborrheic Keratosis

Disease	Characteristic Dermoscopic Structures	References
Seborrheic keratosis (SK)	Moth-eaten borders Hairpin vessels Brain-like structures Fingerprinting-like structures Comedo-like openings Milia-like cysts	[^Citation7,Citation12^–^Citation14]
Irritated SK	Lack of the typical SK-related features Symmetric distribution of structures (vessels surrounded by halos) Vessels of various morphologies (hairpin, glomerular, tortuous)	[^Citation11,Citation14,Citation15]
Melanoacanthoma	Heavily pigmented “Starburst” pattern Ridges and fissures Comedo-like openings Milia-like cysts Blue-white veil	[^Citation14,Citation16]
Clonal SK	Sharp demarcation Milia-like cysts Irregularly distributed brown and blue-grey globules	[^Citation7,Citation11,Citation14,Citation17,Citation18]
LPLK/solar lentigo	Light-brown pseudonetwork	[^Citation14,Citation19]
LPLK/ regression	Annular granular structures Grey pseudonetwork Blue-grey fine dots Irregular streaks Rhomboid structures	[^Citation14,Citation19]

Abbreviations: SK, Seborrheic Keratosis; LPLK, Lichen Planus Like Keratosis.

Table 2 Differential Diagnosis of Basal Cell Carcinoma²⁶

Differential Diagnosis of Basal Cell Carcinoma
Actinic keratosis
Bowen’s disease
Seborrhoeic keratosis
Dermatomycosis
Nummular eczema
Psoriasis
Discoid lupus erythematosus (DLE)
Scar
Lupus vulgaris
Cutaneous adnexal neoplasms originating in:
- Hair follicles
- Sebaceous glands
- Sudoriparous glands
Amelanotic melanoma

Table 3 Dermoscopic Features of Basal Cell Carcinoma and Basal Squamous Cell Carcinoma

Disease	Characteristic Dermoscopic Structures	References
Superficial BCC	Shiny white-red structureless areas Short fine telangiectasia Maple leaf-like areas Multiple small erosions	[^Citation26,Citation29]
Superficial BCC (pigmented)	Maple leaf-like areas Spoke-wheel areas Brown concentric structures	[^Citation26,Citation29]
Nodular BCC (non-pigmented)	Large arborizing vessels Large central ulceration Glittering white lamellae and glittering streaks	[^Citation26,Citation29]
Nodular BCC (pigmented)	Large arborizing vessels Grey and blue ovoid nests Grey and blue granules and bodies Spoke-wheel areas Maple leaf-like areas	[^Citation26,Citation29]
Infiltrative BCC	White-red or yellow-red structureless background Arborizing vessels (scattered and thin, with less pronounced ramifications) Multiple blue-grey dots and blue-grey ovoid nests “Stellate pattern” - vessels, white lines or skin folds radiating from the peripheral margin of the tumour into the surrounding skin	[^Citation26,Citation29]
Morpheaform BCC	Porcelain white glittering background Numerous fine arborizing vessels of a small caliber and less tendency to branch into finer capillaries Shiny white-red structureless areas	[^Citation26,Citation29]
Basosquamous cell carcinoma (BSC)	Unfocused arborizing vessels or serpentine BCC dermoscopic traits: ulceration or blood crusts, grey and blue ovoid nests (less visible than in classic BCC) SCC dermoscopic traits: hyperkeratosis, layered keratin masses, surface scale, white structures (lines, four dots in a square, circles, clods, white homogenous areas), blood spots in keratin mass	[^Citation12,Citation26,Citation30,Citation31]

Abbreviations: BCC, Basal Cell Carcinoma; BSC, Basosquamous Cell Carcinoma.

Table 4 Clinical Grades and Dermoscopic Patterns of Actinic Keratosis³⁵

Grade	Clinical	Dermoscopy
1°	Slightly palpable AK (better felt than seen)	Red pseudonetwork pattern, discrete white scales
2°	Moderately thick AK (easily felt and seen)	Erythematous background
		White to yellow, keratotic and enlarged follicular openings (“strawberry pattern”)
3°	Very thick, hyperkeratotic AK	Scaly and white-yellow-appearing background
		Enlarged follicular openings filled with keratotic plugs
		Structureless white-yellow areas

Table 5 Differential Diagnosis of Squamous Cell Carcinoma³²

Differential Diagnosis of Squamous Cell Carcinoma
Common warts
Genital warts
Seborrheic keratosis
Keratoacanthoma
Basal cell carcinoma
Actinic keratosis
Amelanotic melanoma
Adnexal tumours of:
- Hair follicles
- Sweat glands
Atypical fibroxanthoma
Skin metastases

Table 6 Dermoscopic Features of Squamous Cell Carcinoma (SCC) and Keratoacanthoma

Disease	Characteristic Dermoscopic Structures	References
SCC in situ/ intraepidermal carcinoma (IEC) /Bowen’s disease	Erythematous background Dotted and glomerular vessels, in clusters White, structureless areas White scales Yellowish homogenous keratin masses Microerosions	[^Citation32,Citation36,Citation42]
SCC in situ/ intraepidermal carcinoma (IEC)/Bowen’s disease - pigmented	Glomerular vessels Brown or grey granules demonstrating the linear distribution Small brown globules, regularly packed in a patchy distribution Grey to brown homogeneous pigmentation	[^Citation32,Citation36,Citation42]
Well differentiated SCC	Pink areas distributed relatively even around the periphery of the lesion Numerous irregular linear, large-diameter vessels, reduced incidence of branching and serpentine vessel forms and fewer vessel types White perivascular halos White perifollicular circles White structureless areas Yellowish exfoliation in the centre	[^Citation11,Citation32,Citation36,Citation41,Citation42]
Moderately differentiated SCC	Yellow-reddish background Pink areas central and in irregular spatial arrangement Numerous polymorphic large-diameter vessels Yellowish structureless masses with numerous hemorrhages Large ulceration in the centre, filled with a keratinous mass White ring-type structures	[^Citation11,Citation32,Citation36,Citation41,Citation42]
Poorly differentiated SCC	The predominance of red areas Pink areas central and in irregular spatial arrangement Numerous polymorphic vessels in more than 50% of the lesion surface Diffuse distribution of vessels Vessels without white perivascular halos Erosion and ulceration Absence of scaling and keratin or other white-colored criteria	[^Citation11,Citation32,Citation36,Citation41,Citation42]
Keratoacanthoma	Concentric circles of the central crater, surrounded by an ivory white area and adjacent peripheral vessels Central keratin masses White circles and white structureless areas Keratin crust/scale Blood spots	[^Citation36^–^Citation38]

Table 7 Dermoscopic Features of Melanoma Varieties

Disease	Characteristic Dermoscopic Structures	References
Melanoma in situ	Atypical network Regression >50% of the lesion surface Irregular hyperpigmented areas Prominent skin markings Angulated lines	[^Citation58,Citation63]
Spitzoid melanoma	Asymmetrically distributed structures (streaks, pseudopods) Inverse network Atypical vessels	[^Citation11,Citation59,Citation64]
Nevoid melanoma	Multicomponent pattern Polymorphic vessels	[^Citation11]
Verrucous melanoma	Blue-white veil Pseudopods Irregular streaks Atypical network Blue-black sign About 20% of melanomas have features typical of seborrheic keratosis	[^Citation65]
Regressive melanoma	White scar-like depigmentation Blue/grey granules/peppering	[^Citation11]
Amelanotic melanoma	Usually featureless	[^Citation11,Citation66]

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