LETTER TO EDITOR

Year: 2019 I Volume: 2 I Issue: 3 I Page: 84-85

The dermoscopic constellation of basal cell carcinoma.

Aseem Sharma¹, Sandip Agrawal¹, Deep Jarsania¹ , Kiran Chahal¹ , Rachita Dhurat¹

¹Dermatology Department, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai – 22

Corresponding Author:
Dr Aseem Sharma
Assistant Professor (Dermatology),
OPD 16, Department of Dermatology, LTM General Hospital, Sion, Mumbai – 400022
E-mail – aseemsharma082@gmail.com

How to cite this article:
Sharma A, Agarwal S, Jasrania D, Chahal K, Dhurat R. The dermoscopic constellation of basal cell carcinoma. JDA Indian Journal of Clinical Dermatology. 2019;2:84-85.

Abstract:

When it comes to basal cell carcinoma (BCC), dermoscopy is primarily a diagnostic aid, helping in its discrimination from other cutaneous tumours and morphologically similar dermatoses. It also has a role in subtyping, since it provides clincopathological correlation, especially in pigmented BCC. And lastly, its role as a prognosticator, by assessing the extension of the tumour beyond clinically visible margins, and by gauging the response to various non-ablative treatments in follow-up visits. The dermoscopic compendium and diagnostic criteria for basal cell carcinoma (BCC) have been described in global literature, over the last two decades. We report a case, wherein, all eleven diagnostic criteria were found in a single dermoscopic frame. This can be helpful for teaching purposes and educational demonstrations.

Key words: basal cell carcinoma, dermoscopy, dermatoscopy, diagnosis

Sir,

A 59-year-old woman presented to the dermatology department with the chief complaint of a black facial patch, of 7 months’ duration, which had increased in size, and begun bleeding, spontaneously, over the course of the past 5 weeks. Cutaneous examination revealed a solitary, well-circumscribed hyperpigmented (black to brown) plaque measuring 4 cm over

Figure 1: A solitary, hyperpigmented plaque, 4 x 2.5 cm, over left zygomatic region. Ulceration, erosions, serosanguinous crusting can be appreciated.  Click here to view

the widest axis and 2.5 cm on the short axis, over the left zygomatic region. (Figure-1) Ulceration, erosions and serosanguinous crusting were noted at 4 o’ clock position of the lesion. No regional lymphadenopathy was noted on general

Figure 2: Polarized dermoscopy: A – spoke-wheel structures, B – maple-leaf structures, C – pinkish-white background, D – blue-gray-ovoid clods, globules and blotches, E–amorphous crystalline areas, short white lines, white blotches, F – arborizing telangiectasia and atypical vessels, G – ulceration, frank hemorrhage and red dots  Click here to view

examination. Contact polarized dermoscopy, with an immersion fluid, was performed, which revealed findings of: blue-gray-ovoid clods and globules, pigmented maple-leaf and spoke-wheel structures, a pinkish-white backdrop, short white chrysaloid lines, white amorphous areas, ulceration, erosions and atypical vasculature in the form of arborizing telangiectasia, red dots and areas of hemorrhage. (Figure-2) The dermoscopic

Table-1. The dermoscopic features described and seen in our figure have been tabulated  Click here to view

features described [1], and seen in our figure, have been tabulated as Table-1. A clinical and dermoscopic diagnosis of pigmented basal cell carcinoma was made. A 4-mm punch biopsy from the edge of the lesion showed basaloid cell nests with peripheral palisading, and a few stromal retraction artefacts, all consistent with the clinical diagnosis. A multi-disciplinary approach was initiated, and still on follow-up and close monitoring. This case shows all the dermoscopic signs that have been reported in BCC, in one single picture, and re-emphasizes the role of the elementary, handy dermatoscope in a dermatological setup.

References:

1.Lallas A, Apalla Z, Argenziano G, et al. The dermatoscopic universe of basal cell carcinoma. Dermatol Pract Concept. 2014;4(3):11-24. doi:10.5826/dpc.0403a02