The “Signature” Pattern of Multiple Basal Cell Carcinomas

Abstract

T HE CONCEPT OF THE “SIGNATURE” PATtern, which is widely recognized in the treatment of patients with multiple nevi, refers to the observation that most nevi in a given individual are morphologically similar. We also recently noticed that multiple basal cell carcinomas (BCCs) on the same patient and in the same anatomical region often reveal similar clinical and dermoscopic appearances. We describe 4 cases, including 1 clinical image (Figure, A [the arrow indicates the BCC that is shown in Figure, B]), an associated dermoscopic image (Figure, B), and 2 additional dermoscopic images (Figure, C and D), of multiple superficial BCCs located on the head, neck, and trunk of a 57-year-old man (Figure) and on the trunk of an 89-year-old man (eFigure 1; http: //www.archdermatol.com), a 94-year-old man (eFigure 2), and a 56-year-old man (eFigure 3). On dermoscopy, the BCCs revealed spoke wheel areas (Figure), leaflike areas and blue-gray dots and globules (eFigure 1), structureless pink areas and multiple erosions (eFigure 2), and structureless white areas with subtle linear vessels (eFigure 3). Although the dermoscopic features of multiple BCCs may vary between different patients and anatomical subsites, the morphological features of BCCs on the same patient and body area are strikingly similar. Our observation suggests that the concept of the signature pattern, which was originally introduced for the treatment of patients with multiple nevi, also applies to patients with multiple BCCs. This finding may increase diagnostic confidence and aid in the treatment plan, especially in times of increasing availability and use of nonsurgical treatments for skin cancer.