Clinical and Dermoscopic Patterns of Basal Cell Carcinoma and Its Mimickers in Skin of Color: A Practical Summary
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Type of Study | Nationality | Location of the Lesion | Subtype | Differential Diagnosis (BCC Mimickers) Based on the Authors or Text of the Respective Study | |
---|---|---|---|---|---|
Case report | [9] | Indian | Scalp | Nodular non-pigmented | Trauma, nevus sebaceous, radiation dermatitis |
Case series | [37] | Iran | Scalp (more frequent), forehead, nose and periorbital area | Mostly nodulocystic or micronodular pigmented | SCC |
Case report | [36] | NM | Vulvar | Adenoid | Extramammary Paget disease, lichen sclerosus, atrophicus and lichen simplex chronicus |
Case series | [15] | NM | 1o: Lower back 2o: Lumbosacral region | Adenoid | Pre-existing skin condition, indigenous drug intake (containing arsenic), exposure to irradiation or trauma |
Case report | [14] | NM | Nose | Adenoid | Adenoid cystic carcinoma, metastasis |
Case series | [38] | Indian | Upper lip (more frequent location) and cheek | Mostly nodular | SCC |
Case report | [18] | NM | Nose | Nodular and adenoid | SCC, adenoid cystic carcinoma, scrofuloderma and deep mycosis |
Case report | [19] | Indian | Scalp | Infiltrative | SCC |
Case report | [20] | NM | Face | Superficial | Eczema, psoriasis, lichen planus, or Bowen’s disease. |
Case series | [40] | Indian | Eyelid (mostly upper) | NM | SCC, sebaceous gland carcinoma, malignant melanoma, and miscellaneous tumors |
Case series | [39] | Indian | Eyelid (mostly upper) | NM | sebaceous gland carcinoma, SCC and miscellaneous tumors |
Case series | [42] | Indian | Forehead (most frequent) followed by cheeks | Mostly nodular followed by ulcerative and pigmented | SCC, melanoma, cutaneous lymphomas, and sarcomas. |
Case reports | [34] | Indian | Temporal region of scalp and inner canthus of left eye | Pigmented | Melanoma, squamous cell carcinoma, discoid lupus erythematosus and nevus comedonicus |
Case report | [25] | NS (Black) | Groin region | Micronodular and infiltrative | SCC, metastasis, sarcoma |
Case reports | [28] | NS (Black) and Asian | Head and neck region (most frequent) | NM | SCC, dermatofibroma protuberans, nevus, melanoma |
Case report | [29] | NS (Black) | Upper lip | Nodular | SCC, burn, chronic infection |
Case report | [16] | African American | Nose | Morpheaform | Melanoma, seborrheic keratoses or nevus sebaceous |
Case report | [31] | African American | Forehead | Infiltrative | SCC, Marjolin ulcer, metastasis |
Case series | [43] | African Americans | Mostly in head and neck regions | Mostly pigmented followed by infiltrative | Seborrheic keratosis, benign nevus |
Case report | [32] | African American | Eyelid | Nodular | Benign tumors, such as nevi, blue nevi, seborrheic keratosis, apocrine hidrocystomas, vascular malformations and inflammatory processes (such as a chalazion) Malignant tumors such as melanoma, metastasis, pigmented SCC |
Case reports | [35] | Hispanics | 1o: Nasal tip 2o: Nasal bridge 3o: Breast | Nodular | Melanoma |
Case series | [49] | Chinese | Vulvar | Nodular (mostly) | Melanocytic nevus, seborrheic keratosis, malignant melanoma, SCC, adenoid cystic carcinoma |
BCC Clinical Image in SoC | Main Findings |
---|---|
Superficial | Solitary well-defined hyperpigmented plaque or patch or erythematous, indurated, irregular plaque |
Nodular | Pigmented nodule (usually with pearly appearance) with or without ulcerated area or red giant nodule with or without ulcerated area |
Adenoid | Mainly ulcerated lesion |
Morpheaform | Scar-like lesion |
Infiltrative | Mainly ulcerated lesion |
BCC dermoscopy image in SoC | Main findings |
Superficial | Pigmented structures such as maple leaf-like area and spoke wheel-like areas, red-white homogenous area, multiple small erosions, short fine telangiectasia, spoke wheel-like areas [2,3,52,53]. |
Nodular | Ulceration, blue-white veil, brown to blue-gray ovoid nests, arborising vessels [2,3,49,50,51] |
Adenoid | - |
Morpheaform | - |
Infiltrative | - |
Macroscopy Image of BCC in Skin of Color Patients | Differential Diagnosis |
---|---|
Pigmented nodular lesion | Cutaneous neoplasms: nevi [54], blue nevi [55], melanoma [56,57,58,59], benign appendageal tumors (such as melanotrophoblastoma and hidroadenoma, etc.) [60,61,62,63], dermatofibroma and/or pigmented dermatofibrosarcoma protuberans [64,65], vascular lesions [66] Infectious diseases: deep cutaneous mycosis (such as chromoblastomycosis in endemic regions) [67,68] |
Ulcerated lesion | Cutaneous neoplasms: squamous cell carcinoma (such as Marjolin’s ulcer) [69], malignant appendageal tumors (such as hidraneosarcoma and sebaceous carcinoma) [70], dermatofibrosarcoma protuberans [71], vascular lesions [72], metastasis [73,74] |
Solid pigmented plaque patch with or without ulceration | Cutaneous neoplasms: lentigious melanoma [75], pigmented Bowen [76,77], B-lymphoma [78], extramammary Paget [79], seborrheic keratosis and nevus sebaceous [80,81]. |
Erythematous plaque or patch | Skin cancer entities: squamous cell carcinoma and Bowen disease [82,83], lymphoma and extramammary Paget [84], Kaposi sarcoma [85] Cutaneous infections such as tuberculosis [86], chromoblastomycosis [87], cutaneous mucormycosis [88] Chronic inflammations such as lupus erythematosus [89], dermatitis [90], psoriasis and erythrokeratodermia [91,92] |
Red nodule with or without ulceration | Cutaneous neoplasms: benign appendageal tumors (pilomatricoma) [93], vascular lesions and angiomas [94], melanoma [95] |
Scar-like appearance | Scar, dermatofibroma [65], lichen sclerosus [96] |
Cutaneous Neoplasms | Predominant Dermoscopy Finding |
---|---|
SCC | White areas, scales, erosions and ulcerations, polymorphic vascular pattern such as dotted or linear or irregular or serpentine vessels, white and shiny clods [52,97] |
Bowen’s disease | Blue-gray dots/globules, arranged either peripherally in clusters or linearly, scales, light to dark brown keratotic structureless areas [98,99] |
Dermatofibroma protuberans | Pigment network, pink background, white structureless area [100] |
Dermatofibroma | Peripheral pigmented network, white patches (“central scar-like” or “eccentric multiple”), central homogeneous pigmentation [101,102] |
(Acral) Melanoma | Structureless regions displaying various tones of brown, blue, black and pink colors, erosions or ulceration, parallel and fibrilla ridge pattern of surrounding skin [52] |
Cutaneous lymphoma | - |
Extramammary Paget | - |
Sebaceous keratosis | “Moth eaten” borders, comedo-like openings, milia-like cysts, “fat fingers”, cerebriform pattern, “finger print” pattern, surface white scaling [97] |
Nevus comedonicus | Not enough data to conclude to predominant dermoscopy findings. Only case reports found |
Nevi (reticular) | Brown or black color, reticular lines, structureless areas [103,104,105] |
Blue nevus | Homogenous structureless blue [106] |
Hemangioma—vascular lesions | Red-purple clods-lagoons, white lines [97] |
Skin adnexal lesions | Examples: Trichoepithelioma: white homogenous area with milia-like cyst, linear, arborizing and crown vessels Nodular hidradenoma: a white to gray structureless area, erosion and a polymorphous vascular pattern [107] |
Nevus sebaceous | Papillary to knob-like arrangement on a background ranging from yellow to gray, yellow-white homogeneous region, ovoid nests [107] |
Metastasis | - |
Inflammation diseases | |
Dermatitis (in the context of radiation) | Irregularly distributed, predominantly yellow but also including brown and white scales, purple dots and fabric fibers, brown-black dots against a background, erosions [108] |
Psoriasis | Dotted vessels, diffuse or patchy distributed white scales, pigmented structures, such as brown, gray, and blue structureless areas, dots, or globules [109] |
Lichen planus | Blue globules and Wickham striae [109] |
Facial lichen planus pigmentosus | Brown dots/globules, pseudonetwork, loss of vellus hair [108] |
Chronic lichen sclerosis | Not enough data to conclude to predominant dermoscopy findings. Only case reports found |
Infectious diseases | |
Deep fungal infections Examples: chromoblastomycosis | Not enough data to conclude to predominant dermoscopy findings. Only case reports found |
Lupus vulgaris | Yellow-orange structureless areas, linear/dotted vessels, white scales, white structureless areas [110] |
Dermoscopic Features of the Lesion in SoC | Differential Diagnosis |
---|---|
Ulceration | BCC, SCC, melanoma, deep fungal infection (chromoblastomycosis) |
Blue-white veil or blue color | BCC, melanoma, blue nevi |
Ovoid nests | BCC, nevus sebaceous |
Arborising vessels | BCC, adnexal tumors (melanotrichoepithelioma) |
White homogenous/structureless areas | BCC, SCC, dermatofibroma protuberans, nevus sebaceous, skin adnexal tumors (nodular hidradenoma), dermatofibroma, lupus vulgaris |
Scales | Psoriasis, dermatitis, SCC, Bowen’s disease, lupus vulgaris, deep fungal infection (chromoblastomycosis, etc.) |
Dotted vessels | Lupus vulgaris, SCC, psoriasis |
Pigment network | Nevi, melanoma, dermatofibroma protuberans |
Erosions | SCC, dermatitis |
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Karampinis, E.; Georgopoulou, K.-E.; Kampra, E.; Zafiriou, E.; Lallas, A.; Lazaridou, E.; Apalla, Z.; Biswanath, B.; Errichetti, E. Clinical and Dermoscopic Patterns of Basal Cell Carcinoma and Its Mimickers in Skin of Color: A Practical Summary. Medicina 2024, 60, 1386. https://doi.org/10.3390/medicina60091386
Karampinis E, Georgopoulou K-E, Kampra E, Zafiriou E, Lallas A, Lazaridou E, Apalla Z, Biswanath B, Errichetti E. Clinical and Dermoscopic Patterns of Basal Cell Carcinoma and Its Mimickers in Skin of Color: A Practical Summary. Medicina. 2024; 60(9):1386. https://doi.org/10.3390/medicina60091386
Chicago/Turabian StyleKarampinis, Emmanouil, Konstantina-Eirini Georgopoulou, Elli Kampra, Efterpi Zafiriou, Aimilios Lallas, Elizabeth Lazaridou, Zoe Apalla, Behera Biswanath, and Enzo Errichetti. 2024. "Clinical and Dermoscopic Patterns of Basal Cell Carcinoma and Its Mimickers in Skin of Color: A Practical Summary" Medicina 60, no. 9: 1386. https://doi.org/10.3390/medicina60091386