Acta Dermato-Venereologica Issue No. 97-5 97-5CompleteContent | Page 15

612 CLINICAL REPORT Vascular Patterns in Cutaneous Ulcerated Basal Cell Carcinoma: A Retrospective Blinded Study Including Dermoscopy Nicola ARPAIA 1 , Angela FILONI 1 , Domenico BONAMONTE 1 , Giuseppe GIUDICE 2 , Margherita FANELLI 3 and Michelangelo VESTITA 2 Section of Dermatology, Department of Biomedical Science and Human Oncology, 2 Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, and 3 Department of Interdisciplinary Medicine, University of Bari, Bari, Italy 1 The aim of this retrospective study was to determine the type and prevalence of vascular patterns in the ulcerated and non-ulcerated portions of histologi- cally proven basal cell carcinomas (BCCs) and corre- late them with other dermoscopic and clinical featu- res, including the clinically supposed diagnosis. Three authors retrospectively collected 156 clinical and 156 dermoscopic digital images of ulcerated BCCs (histo- logically confirmed); each image was blindly evalua- ted by 2 other authors, who did not know the histo- logical diagnosis. Seventeen lesions were completely ulcerated, while 139 lesions presented ulcerated and non-ulcerated portions. Correct clinical diagnosis was associated with the type of lesion, in particular 90.6% of partially ulcerated lesions were correctly diagno- sed with clinical-dermoscopic examination, compared with 11.8% of totally ulcerated lesions (χ 2  = 64.00, p  = 0.000). Presence of arborizing pattern in the ulce- rated portion was associated with a correct diagno- sis (Fisher’s exact test, p  = 0.015). Correct diagnosis was also associated with absence of dotted pattern in the non-ulcerated area (χ 2  = 16.18, p  = 0.000); the ab- sence of hairpin (χ 2  = 6.08, p  = 0.000) and glomerular patterns were associated with correct diagnosis in the ulcerated areas (χ 2  = 18.64, p  = 0.000). In case of com- pletely ulcerated BCC the clinician lacks the means to correctly identify the correct nature of the lesion, and is driven towards an incorrect diagnostic conclusion. Key words: dermoscopy; basal cell carcinoma; melanoma; vas- cular pattern; ulcerated basal cell carcinoma. Accepted Jan 12, 2017; Epub ahead of print Jan 17, 2017 Acta Derm Venereol 2017; 97: 612–616. Corr: Angela Filoni, Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare, IT-70124 Bari, Italy. E-mail: [email protected] B asal cell carcinoma (BCC) is defined as a slow- growing skin malignancy, predominantly affecting middle-aged and fair-skinned individuals. Clinically BCC can manifest differently, with nodular, superficial, morpheic, and pigmented variants (1). Dermoscopy is an in vivo technique that has proven useful to differentiate BCC from other cutaneous ma- lignancies, such as squamous cell carcinoma (SCC) and melanoma (2–5). Characteristic dermoscopic features of BCC include large blue-grey ovoid nests, leaf-like areas, multiple doi: 10.2340/00015555-2609 Acta Derm Venereol 2017; 97: 612–616 blue-grey globules and spoke-wheel areas (6, 7). In addi- tion, specific vascular patterns may aid the dermoscopic diagnosis of BCC, especially when the above-mentioned traditional criteria are lacking (8–11). Arborizing vessels, in particular, are known to be a characteristic and com- mon feature of BCC, with a positive predictive value of 94.1% (9–12). Moreover, short fine telangiectasias are commonly observed in superficial BCCs (13, 14). How­ ever, several additional morphological types of vessels have been reported (11–15). The aim of our study was to determine the type and prevalence of vascular patterns in the ulcerated and non-ulcerated portions of histologically proven BCCs and correlate them with other dermoscopic and clinical features, including the clinically supposed diagnosis. MATERIALS AND METHODS Three of the authors (DB, NA, GG) retrospectively collected 156 clinical and 156 dermoscopic images of histologically confirmed ulcerated BCCs, developed by 153 patients treated at the Derma- tology Unit of University of Bari Policlinico hospital between January 2011 and December 2013. Anagraphical data (such as age and sex) and lesion-related data (such as presence of pigmentation, lesion anatomical site and diameter) were recorded. Dermoscopic images had been taken via digital dermoscopy (VideoCAP™, DS Medica, Milano, Italy) and polarized handheld dermoscopy devices (DermoGenius ® II, DermoScan GmbH, Regensburg, Germany and DermLite DL3N, 3 Gen LLC, San Juan Capistrano, CA, USA) mounted on a digital camera (10× magnification). Clinical images had been taken via videoCAPTM or digital camera. Skin preparation prior to dermoscopy included hyperkeratotic skin removal by wet gauze and application of pet- rolatum oil in case of immersion dermoscopy. Each digital image was blindly evaluated by 2 of the authors (AF, MV), who did not know the histological diagnosis, for the presence of the following types of vessels, diversified for the ulcerated and non-ulcerated portions of the lesions: arborizing, dotted, linear-irregular, comma, hairpin, crown, glomerular. In the presence of 3 or more types of vessels, the vascular pattern was defined as polymorph. Diffuse reddish coloration (milky-red globules/areas and erythema) was also considered. Moreover, the prevalent vascular pattern for each lesion was noted. Other dermoscopic features were assessed: large blue-grey ovoid nests, leaf-like areas, multiple blue-grey globules and spoke-wheel areas (classic BCC patterns); brown-to-black dots/globules, pseudopods, blue/white veil, pigment network and peppering (classic melanoma patterns). Pigmented BCCs were defined by the presence of dermoscopic pigmentation on more than 25% of the lesion’s surface. On the basis of the above characteristics a clinical-dermoscopic diagnosis was advanced by the 2 blinded authors. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica.