Forum for Nordic Dermato-Venereology Nr 2, 2018 | Page 32

Pascale Huet – A Growing Tender Non-pigmented Nodule of the Scalp: A Quiz
A Growing Tender Non-pigmented Nodule of the
Scalp: A Commentary
Diagnosis: A non-pigmented nodular basal cell carcinoma
Basal cell carcinoma (BCC) is considered the most common
primary malignancy in the fair-skinned population. Even if
diagnosis is most of the time suspected by clinical examina-
tion, dermatoscopy improves the diagnostic accuracy of BCC,
allowing early diagnosis, especially for incipient lesions [1].
References
1. Lallas A, Apalla Z, Argenziano G, Longo C, Moscarella E, Specchio F,
et al. The dermatoscopic universe of basal cell carcinoma. Dermatol
Pract Concept 2013; 4; 11–24.
2. Menzies SW. Dermoscopy of pigmented basal cell carcinoma. Clin
Dermatol 2002; 20: 268–269.
3. Wozniak-Rito A, Zalaudek I, Rudnicka L. Dermoscopy of basal cell
carcinoma. Clin Exp Dermatol 2018; 43: 241-247.
4. Del Busto-Wilhem I, Malvehy J, Puig S. Dermoscopic criteria and
basal cell carcinoma. G Ital Dermatol Venereol 2016; 151: 642-647.
5. Puig S, Cecilia N, Malvehy J. Dermoscopic criteria and basal cell
carcinoma. G Ital Dermatol Venereol 2012; 147: 135–140.
Dermatoscopy of BCC has been widely described and is cur-
rently very well-known [2-5]. Numerous criteria have been
published and are the following for pigmented variant of BCC:
• Ulceration not associated with a recent history of trauma;
• Arborizing vessels: vessels with distinct treelike ramifi-
cations, in-focus, running on the surface of the BCC ;
• Maple leaf-like areas: peripheral radial linear or bulbous
structures coalescing at a common off-center base;
• Spoke-wheel areas: radial lines converging at a central
dot/clod ; Concentric structures are a variant of spoke-
wheel area consisting of a darkly pigmented dot in the
center of a less heavily pigmented clod;
• Multiple blue/gray globules and multiple in-focus blue/
gray dots;
• Large blue/gray ovoid nests: accumulation of blue/gray
clods;
• White shiny structures as lines and areas, visible only
under polarized dermatoscopy, probably owing to the
associated fibroplasia (Fig. 4).
Fig. 4. Annotated dermatoscopy with clues for basal cell carcinoma.
Answers to CME on page 63–64
Case 13: 3 (spokewheel pigment pattern)
Case 14: 1 (individual components of neavus with uniform pigment network that fades)
Case 15: 3 (horn pseudocysts, follicular plugging, moth-eaten border)
Case 16: 2 (multiple black dots and globules, red globules, irregular blue-white negative network)
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Q uiz
Forum for Nord Derm Ven 2018, Vol. 23, No. 2