A Comparative Study of Pigmented and Non-pigmented Basal Cell Carcinoma in Reflectance Confocal Microscopy.

Anna Pogorzelska-Antkowiak,Jacek C Szepietowski,Sławomir Grzegorczyn,Paola Corneli

doi:10.21873/invivo.12274

Abstract

Basal cell carcinoma (BCC) is a common skin cancer, especially in the elderly population. The probability of BCC development increases past the age of 55. Dermoscopy and reflectance confocal microscopy (RCM) are two modern tools useful in the diagnosis of BCC. This is a retrospective study conducted on a group of 21 patients with a confirmed diagnosis of BCC. All patients were examined by dermoscopy and RCM. Dermoscopic images were taken using a videodermoscope. RCM was performed in three layers: epidermal, dermoepidermal junction (DEJ), and superficial dermal layer. In each layer, a few RCM criteria of basal cell carcinoma diagnosis were taken into consideration. Dermoscopy of pigmented BCCs revealed blue globules of pigment (p<0.05), gray and blue ovoid nests, which were absent in the entire non-pigmented carcinomas group. In RCM, the epidermis showed no differences between pigmented and non-pigmented carcinomas, however, significant differences were observed at the DEJ. In pigmented BCCs, cordlike structures and plump atypical cells were observed (p<0.05), while in non-pigmented carcinomas, dark silhouettes were present (p<0.05). To our knowledge, that is the first study comparing features between pigmented and non-pigmented BCC by RCM. Pigmented and non-pigmented BCCs presented different features in both dermoscopy and RCM. Furthermore, RCM revealed more discriminating features at the DEJ than dermoscopy, thus can be more efficient in the differential diagnosis of difficult BCC.

Highlights

Basal cell carcinoma (BCC) is one of the most common skin cancers, especially in the elderly population and there has been an increase in its incidence in recent years
Central part ulceration was seen in 2 pigmented carcinomas, while that feature was not observed in any of the nonpigmented BCC
By dermoscopy, blue globules were significant for pigmented BCC diagnosis and this was the case for cordlike structures at the dermoepidermal junction (DEJ) by reflectance confocal microscopy (RCM), as well as absence of dark silhouettes

Summary

Introduction

RCM revealed more discriminating features at the DEJ than dermoscopy, can be more efficient in the differential diagnosis of difficult BCC. The superficial subtype is the second most common one, and clinically, it appears as a pinkish plaque mostly located on the trunk [5]. Especially nodular ones, can reveal pigment and lead us to misdiagnosis of melanoma. Dermoscopy and reflectance confocal microscopy (RCM) are two non-invasive tools useful for BCC diagnosis. The remaining four criteria (elongated monomorphic nuclei, pleomorphic epidermis, increased vasculature, and whole blood cell count) constitute the best compromise between high sensitivity and high specificity for BCC [6]. This study aimed to compare the features of pigmented and nonpigmented BCC in dermoscopy and RCM

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Conclusion