Dermoscopy of Superficial Basal Cell Carcinoma | IBOOLO

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Dermoscopy of Superficial Basal Cell Carcinoma

Basal cell carcinoma is the most common skin cancer. Basal cell carcinoma rates have jumped sharply in the last years, particularly North America, Europe and selected parts of Asia. As BCC is slow-growing, then the majority are curable and cause little harm if diagnosed early and treated. Accompanied by the advances in medical technology, dermoscopy…

Superficial Basal Cell Carcinoma | Dermoscopy Insights - IBOOLO

IBOOLO explores dermoscopy's role in detecting superficial basal cell carcinoma (BCC). Learn key features, challenges & applications for early diagnosis of this common skin cancer.

Superficial Basal Cell Carcinoma Dermoscopy: A Comprehensive Guide

Introduction to Superficial Basal Cell Carcinoma

Superficial Basal Cell Carcinoma (sBCC) is a subtype of Basal Cell Carcinoma (BCC), the most common form of skin cancer. Understanding its characteristics and how to detect it using dermoscopy is crucial for early diagnosis and treatment.

Key Points: sBCC is a slow-growing, non-melanoma skin cancer. It typically appears as red, scaly patches on the skin. Early detection is crucial for successful treatment.

Dermoscopy: A Powerful Tool for sBCC Detection

Dermoscopy is a non-invasive diagnostic technique that allows for detailed examination of skin lesions. It's particularly useful in identifying the subtle features of superficial basal cell carcinoma.

Benefits of Dermoscopy for sBCC:

1. Enhanced visualization of surface and subsurface structures

2. Improved accuracy in distinguishing sBCC from other skin conditions

3. Non-invasive nature allows for frequent monitoring

Dermoscopic Features of Superficial Basal Cell Carcinoma

Identifying specific dermoscopic features is key to diagnosing sBCC accurately. Here are the primary characteristics to look for:

1. Arborizing Telangiectasia: Fine, branching blood vessels. Typically less prominent than in nodular BCC.

2. Superficial Fine Telangiectasia: Short, fine, unfocused vessels. Often arranged in a scattered pattern.

3. Multiple Small Erosions: Small, reddish-brown to red-orange areas. Represent micro-ulcerations on the tumor surface.

4. Shiny White-Red Structureless Areas: Pearly white to red-pink background. Often occupies a large portion of the lesion.

5. Maple Leaf-Like Areas: Brown to blue-gray pigmented structures. Resemble the shape of a maple leaf.

6. Spoke Wheel Areas: Radial projections converging at a central darker hub. Less common but highly specific for sBCC.

7. Multiple Blue-Gray Globules: Small, round to oval structures. Indicate pigmentation within tumor nests.

Differential Diagnosis Using Dermoscopy

Distinguishing sBCC from other skin conditions is crucial. Here's how dermoscopy helps in differential diagnosis:

1. Actinic Keratosis: sBCC: Multiple erosions, fine telangiectasia. AK: Strawberry pattern, white scales.

2. Bowen's Disease: sBCC: Arborizing vessels, leaf-like areas. Bowen's: Glomerular vessels, scaly surface.

3. Psoriasis: sBCC: Blue-gray globules, erosions. Psoriasis: Regularly distributed dotted vessels.

4. Amelanotic Melanoma: sBCC: Specific vascular patterns, erosions. Melanoma: Polymorphous vessels, milky-red areas.

Advanced Dermoscopic Techniques for sBCC

1. Digital Dermoscopy: Allows for image storage and comparison over time. Useful for monitoring suspicious lesions.

2. Reflectance Confocal Microscopy (RCM): Provides cellular-level imaging. Can be used in conjunction with dermoscopy for increased accuracy.

3. Optical Coherence Tomography (OCT): Offers cross-sectional imaging of skin lesions. Helps in determining tumor thickness and margins.

Management of sBCC Based on Dermoscopic Findings

Dermoscopy not only aids in diagnosis but also guides treatment decisions:

1. Surgical Excision: Recommended for well-defined lesions, Dermoscopy helps in determining appropriate margins.

2. Topical Treatments: Suitable for some cases of sBCC, Dermoscopy assists in monitoring treatment response.

3. Photodynamic Therapy: Effective for superficial lesions, Dermoscopic follow-up essential to assess effectiveness.

4. Cryotherapy: Used for small, well-defined sBCCs, Dermoscopy aids in selecting suitable candidates.

Importance of Follow-Up Dermoscopy

Regular dermoscopic examinations are crucial for:

1. Monitoring treated areas for recurrence

2. Detecting new lesions early

3. Assessing treatment efficacy

Patient Education and Self-Examination

Educating patients about sBCC and the importance of self-examination is crucial:

1. Teach patients to recognize suspicious skin changes

2. Encourage regular self-checks using a simple dermatoscope

3. Emphasize the importance of sun protection in preventing sBCC

Future Directions in sBCC Dermoscopy

1. Artificial Intelligence in Dermoscopy: Machine learning algorithms for automated sBCC detection, Potential to improve diagnostic accuracy and efficiency

2. Teledermoscopy: Remote diagnosis of sBCC using dermoscopic images, Increases access to expert opinions in rural areas

3. 3D Dermoscopy: Enhanced visualization of lesion topography, Improves assessment of lesion borders and thickness.

Superficial basal cell carcinoma dermoscopy is a powerful diagnostic tool that significantly improves the accuracy of sBCC diagnosis. By understanding the specific dermoscopic features of sBCC and utilizing advanced techniques, dermatologists can detect these lesions early, leading to better patient outcomes. Continued research and technological advancements in dermoscopy promise to further enhance our ability to diagnose and manage superficial basal cell carcinoma effectively.

 

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Basal cell carcinoma is the most common skin cancer. Basal cell carcinoma rates have jumped sharply in the last years, particularly North America, Europe and selected parts of Asia. As BCC is slow-growing, then the majority are curable and cause little harm if diagnosed early and treated. Accompanied by the advances in medical technology, dermoscopy as a non-invasive optical diagnostic tool is playing an ever-growing role for detecting superficial basal cell carcinoma at early stage.


What is superficial basal cell carcinoma?
Basal cell carcinoma often referred to as basaloid is the most common type of skin cancer. It starts as a basaloid low-grade malignancy of the basal layer of epidermis or outer root sheath of hair follicles. Morphologically from clinical standpoint basal cell carcinoma can be mostly classified as: nodular-ulcerative type, superficial type, pigmented like. Basal cell carcinoma has multifactorial causes, but many cases have demonstrated a clear association with chronic sun exposure and ionizing radiation. Superficial basal cell carcinoma, a subtype of BCC that presents as red, scaly plaques on the skin, often resembling eczema or psoriasis.
Basal cell carcinoma can present in diverse clinical manifestations. The texture of these lesions tends to be firm, the surface is smooth or slightly elevated as well with a noticeable pigmentation. Basal cell carcinomas are most common on the head and neck, where they almost always affect sun-exposed areas; such as around your nose, eyelids or cheeks.

Superficial Basal Cell Carcinoma
Superficial Basal Cell Carcinoma


Dermoscopic features of basal cell carcinoma
Dermoscopy is useful in detecting the specific features of BCC. Some common dermoscopic characteristics are as follows:
Dendritic blood vessels: Most classic dermoscopic presentations of BCC include dendritic blood vessels, which are often found in the superficial and nodular types on this lesion.
Blue-gray globules: These blobs are round or oval structures, varying in size but relatively homogeneous, and blue-gray in color on dermoscopic examination. They indicate the presence of melanin within the tumor and are commonly seen in hyperpigmented basal cell carcinoma.
Ulcers: Ulcers represent breaks or flat depres- sions in the skin, and they are observed on dermoscopy as areas of structurelessness that can appear red to orange.
Crusting: A crust is a hard cover that forms on the surface of ulcers. A crust, a yellowish or brown spot at the center of the lesion.


Superficial basal cell carcinoma features
Clinicopathological study to differentiate if a basal cell carcinoma is superficial, the morphology and growth pattern of each lesion should be evaluated. Superficial basal cell carcinomas often present as a single or multiple mildly infiltrating, erythematous scaly plaque that grows slowly and largely limits itself to the epidermis.
The often seen superficial basal cell carcinoma on the trunk, especially the back. The superficial form appears as a flat, thin red or pink patch while the sclerosing shape is characterized by thick patches that are flesh-colored or light rose and resemble scars to some extent.

Dermoscopy of Superficial Basal Cell Carcinoma
Dermoscopy of Superficial Basal Cell Carcinoma


Differential diagnosis of basal cell carcinoma
By dermoscopy basal cell carcinoma commonly demonstrates a pink-to-red structureless area with or without central ulceration/armor. They are more common in older individuals and usually appear on parts of the body that get lots of sun. Clinically, basal cell carcinoma is a multifaceted and multiform disease that can make subtyping challenging.
Dermoscopically melanomas have an irregular structure and shape in a multitude of colors particularly reds, blues and blacks. Although most melanomas are larger than 6 mm in diameter, early lesions can mimic benign pigmented nevi but not be noticed by the naked eye.
Dermoscopically squamous cell carcinoma has a squamous surface with visible keratin. Squamous cell infiltrative growth can be misleading to benign skin lesions such as keratosis pilaris.


Dermoscopic features and diagnostic difficulties in atypical basal cell carcinoma
Sclerosing basal cell carcinoma:
Features: white, without structure, with small twining serpentine blood vessels and many brown spots.
Challenge: Scar-like frequently and hard to differentiate from a benign scar or other sclerotic disorders.
Superficial basal cell carcinoma:
Features: fine translucent rolled margin, scattering of microerosions and mild scaling.
Challenge: Similar to inflammatory skin conditions such as eczema or psoriasis.
Cystic Basal Cell Carcinoma:
Features: soft jelly-like contents with a translucent appearance.
Challenge: confused with benign cystic lesions.

Basal Cell Carcinoma
Basal Cell Carcinoma


Clinical applications of dermoscopic images
Dermatoscopic images can aid in accurate sampling of biopsies when they need to be done and also decrease the unnecessary number. Characteristics of skin lesions in dermoscopy images enable experienced doctors to provide diagnoses of the type of skin cancer, and plan appropriate treatments for patients with a high speed. Furthermore, dermoscopy as a hand-held and non-invasive instrument can be easily used by the doctors to exam patients during their subsequent visits without serious of invasions that offers no discomforts for the patient; thus it may help improving compliance from patients.

The important role of dermoscopy in the treatment of basal cell carcinoma
Treatment options depend on the site and stage of the cancer, and surgery with or without adjuvant radiotherapy plays a major role in resectable basal cell carcinoma. The mainstay of treatment for limited basal cell carcinoma is surgery, and radiotherapy may be used in adjacent and complex areas, but metastatic patients will not have any hope other than benefit from systemic drug therapy.


The significance of dermoscopy in the early detection of superficial basal cell carcinoma
Many moles are invisible and some changes can only be visualized by dermoscopy, so patients should undergo routine comprehensive skin evaluation, especially of sun-exposed skin surfaces. Dermoscopy has new implications in the prevention and early diagnosis of superficial basal cell carcinoma. Dermoscopy allows visualization of the surface of skin lesions and subepidermal structures that are not visible to the naked eye through optical magnification, immersion or polarized lenses. Skin lesions revealed by dermoscopy results can be detected and managed as potentially cancerous skin lesions prior to higher cancer risk or under/over-treatment.

Superficial Basal Cell Carcinoma
Superficial Basal Cell Carcinoma


Patient education and self-examination
If you have a wound on your skin that has not healed after a few weeks, or if you experience redness, swelling, please seek medical attention promptly. This can be an early sign of skin cancer. In your daily life, pay attention to whether there are any new moles growing on your skin. You can use a dermatoscope to observe any changes in their size, shape, color, or texture, and promptly visit a hospital for examination if there are any abnormalities.

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How can dermoscopy images be captured?

Dermoscopy images can be captured and stored in different ways, such as: • Using a smartphone or tablet with dermoscopic adapter, which consisted in the package.• Using a digital camera

Dermoscopy images can be captured and stored in different ways, such as:

• Using a smartphone or tablet with dermoscopic adapter, which consisted in the package.
• Using a digital camera with dermoscopic adapter, there’s 49mm screw size camera adapter available to order now.

Compatible phone/tablet models:
All iPhone models, 95% Android phones, 90% tablet. For phone/tablet size in 5.25-14mm

Compatible camera models:
All camera with built 49mm filter screw, such as Canon EOS 70D, 80D, 90D; Canon EOS R7, R10, R50, R100; Canon M100, M200, M50, Mark II; Canon G7X Mark III, Sony ZV-1

How can I connect my phone to my dermatoscope?

There’s universal phone adapter for all our dermoscopes. Please check the installation procedure bellow or watch operation guide. Smartphone Connector (1) Place phone adapter screw in the center of smartphone’s

There’s universal phone adapter for all our dermoscopes. Please check the installation procedure bellow or watch operation guide.

Smartphone Connector

(1) Place phone adapter screw in the center of smartphone’s main camera.
(2) Screw magnet attachment on phone adapter.
(3) Put dermoscope’s back ring and magnet attachment together

Take The Best Images

You need to adjust the focus ring after the dermoscpe connected on smartphone to get the best images.

How can I clean my dermoscopy after usage?

Cleaning your dermoscopy after usage is important to prevent cross-contamination and infection. The cleaning method may vary depending on the type and model of your dermoscopy, so you should always

Cleaning your dermoscopy after usage is important to prevent cross-contamination and infection. The cleaning method may vary depending on the type and model of your dermoscopy, so you should always follow the manufacturer’s instructions. However, some general steps are:

• Turn off and disconnect your dermoscopy from any power source or device.

• Wipe off any visible dirt or debris from the dermoscopy with a soft cloth or tissue.

• Disinfect the dermoscopy with an alcohol-based wipe or spray, or a disinfectant solution recommended by the manufacturer. Make sure to cover all surfaces, especially the lens and contact plate.

• Let the dermoscopy air dry completely before storing it in a clean and dry place.

• Do not use abrasive or corrosive cleaners, solvents, or detergents that may damage the dermoscopy.

• Do not immerse the dermoscopy in water or any liquid, unless it is waterproof and designed for immersion.

You should clean your dermoscopy after each use, or at least once a day if you use it frequently. You should also check your dermoscopy regularly for any signs of damage or malfunction, and contact the manufacturer or service provider if needed.

Polarized VS Non-polarized Dermoscopy

A dermoscopy is a device that allows the examination of skin lesions with magnificationand illumination. By revealing subsurface structures and patterns that are not visible tothe naked eye. It can

A dermoscopy is a device that allows the examination of skin lesions with magnificationand illumination. By revealing subsurface structures and patterns that are not visible tothe naked eye. It can improve the diagnose accuracy of skin lesions, such as melanoma,basal cell carcinoma, seborrheic keratosis, etc.

There are two main types of dermoscopy: Non polarized and polarized dermoscopy.We’ve fitted most of our dermoscopys with polarized and non-polarized light. They canbe used in multiple skin structures.

Non-polarized contact Mode

In non-polarized mode, the instrument can provide information about the superficialskin structures, such as milia-like cysts, comedo-like openings, and pigment in theepidemis.

The dermoscopy requires applying a liquid such as mineral oil or alcohol to the skin andplacing the lens in contact with the skin. This reduces surface reflection and enhancesthe view of subsurface structures.

Image with non-polarized light (DE-3100)

Polarized contact Mode

In polarized mode, the instrument allows for visualization for deeper skin structures,such as blood vessels, collagen, and pigment in the dermis.

The dermoscopy does not need to be in contact with the skin or use any liquid. Theirpolarized light can help to eliminate surface reflection and allow visualization ofvascular structures.

Image with polarized light (DE-3100)

Polarized non-contact Mode

The dermoscopy can also use polarized light to examine the skin without direct contact.

In polarized non-contact mode, the instrument allows for examination infected areasand lesions that are painful for the patient, or the difficult to contact pigmented lesions,such as nails and narrow areas.

The contact plate should be removed in this mode, and it does not require applying aliquid to the skin. As it doesn’t require pressure or fluid application on the skin, it canalso avoid cross-contamination and infection risk.

Image in polarized non-contact mode (DE-3100)

How effectiveness is dermoscopy

Compared with visual inspection, the dermoscopy can be used to capture and store skin lesion photos, which play an important role in early skin cancer examination. The dermoscopy allows the

Compared with visual inspection, the dermoscopy can be used to capture and store skin lesion photos, which play an important role in early skin cancer examination.

The dermoscopy allows the examination of skin lesions with magnification and illumination. This can be greatly avoiding the factors that cause interference to visual detection. Such as lighting, skin color, hair and cosmetics.

Several studies have demonstrated that dermoscopy is useful in the identification of melanoma, when used by a trained professional.

It may improve the accuracy of clinical diagnosis by up to 35%
It may reduce the number of harmless lesions that are removed
In primary care, it may increase the referral of more worrisome lesions and reduce the referral of more trivial ones

A 2018 Cochrane meta-analysis published the accuracy of dermoscopy in the detection.

Table 1. Accuracy of dermoscopy in the detection of melanoma in adults
Detection Method Sensitivity, % Specificity, % Positive Likelihood Ratio NegativeLikelihood Ratio
Visual inspection alone (in person) 76 75 3.04 0.32
Dermoscopy with visual inspection (in person) 92 95 18 0.08
Image-based visual inspection alone (not in person) 47 42 0.81 1.3
Dermoscopy with image-based visual inspection (not in person) 81 82 4.5 0.23
ROC—receiver operating characteristic. *Estimated sensitivity calculated on the summary ROC curve at a fixed specificity of 80%.

As we can see, the dermoscope can improve the accuracy of diagnosis of skin lesions, especially melanoma.

Table 1. Accuracy of dermoscopy in the detection of melanoma in adults
Detection Method Sensitivity, % Specificity, % Positive Likelihood Ratio NegativeLikelihood Ratio
Visual inspection alone (in person) 79 77 3.4 0.27
Dermoscopy with visual inspection (in person) 93 99 93 0.07
Image-based visual inspection alone (not in person) 85 87 6.5 0.17
Dermoscopy with image-based visual inspection (not in person) 93 96 23 0.07
ROC—receiver operating characteristic. *Estimated sensitivity calculated on the summary ROC curve at a fixed specificity of 80%.

Characteristics of the dermatoscopic structure of the skin lesions include:

• Symmetry or asymmetry
• Homogeny/uniformity (sameness) or heterogeny (structural differences across the lesion)
• Distribution of pigment: brown lines, dots, clods and structureless areas
• Skin surface keratin: small white cysts, crypts, fissures
• Vascular morphology and pattern: regular or irregular
• Border of the lesion: fading, sharply cut off or radial streaks
• Presence of ulceration

There are specific dermoscopic patterns that aid in the diagnosis of the following pigmented skin lesions:

• Melanoma
• Moles (benign melanocytic naevus)
• Freckles (lentigos)
• Atypical naevi
• Blue naevi
• Seborrhoeic keratosis
• Pigmented basal cell carcinoma
• Haemangioma

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