The use of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma: A retrospective, morphological study

Background: The role of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma (BCC) is not fully elucidated. Aims: To determine the accuracy of dermoscopy in diagnosing different BCC subtypes. Methods: The dermoscopic features of 102 histopathologically verified BCCs were studied retrospectively. The tumours were classified as superficial (n=33,32.3%), nodular (n=46,45.1%) and aggressive (n=23,22.6%) BCCs by histopathology. Statistical analysis included Cohen’s kappa test, proportion of correlation, measures of diagnostic accuracy, diagnostic odds ratio and the credibility ratio of positive (LR+) and negative (LR?) tests. Results: The highest value in all performed tests was seen in superficial BCCs (kappa 0.85; proportion of correlation 93%; diagnostic accuracy 93.1%), good correlation was noted in nodular BCCs (kappa 0.62, proportion of correlation 80%; diagnostic accuracy 80.4%) but dermoscopic correlation with histopathology was low for aggressive BCCs (kappa 0.13; proportion of correlation 79%; diagnostic accuracy 78.4%). Short, fine telangiectasias (83.3%) showed the greatest importance for the diagnosis of superficial BCCs, blue-grey ovoid nests (61.8%) had the highest diagnostic accuracy in nodular BCCs, while arborising vessels (79.4%) was the most significant dermoscopic feature for the diagnosis of aggressive BCCs. Limitations: This was a retrospective analysis and included only Caucasian patients from a single centre. Conclusion: The highest agreement of dermoscopic features with the histologic type was found in superficial BCCs. We did not find any specific dermoscopic structure that could indicate a diagnosis of aggressive BCC. The presence of relevant dermoscopic features in the evaluated cases was determined by the depth of tumour invasion and not by its histology

Photodynamic Therapy with Methyl Aminolevulinate for Nodular Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Photodynamic therapy (PDT) is useful for treating basal cell carcinoma (BCC), and the incidence of nodular type BCC is high among Koreans. However, only one case on the treatment of nodular BCC using methyl aminolevulinate (MAL)-PDT has been reported in Korea. OBJECTIVE: We investigated the efficacy and tolerability of PDT for treating nodular BCC in Korean patients. METHODS: Fifteen patients with nodular BCC were treated. We conducted three MAL-PDT sessions separated by a 1 week interval and assessed the clinical therapeutic effects after 3 months. Then, we performed a histopathological assessment of the lesions in patients who showed complete clinical responses (CR) and surgical procedures for lesions in patients who showed no clinical response (NR). We prescribed three more MAL-PDT sessions to the patients who showed partial clinical responses (PR), and decided whether to carry out a histopathological evaluation or to treat with surgery according to the clinical therapeutic assessment after 3 months. RESULTS: After the first three MAL-PDT sessions, three patients showed CR, eight patients showed PR, and four patients showed NR. One of the eight patients, who had been treated repeatedly, showed CR. CONCLUSION: BCC occurs mainly as the nodular type in Korea, so MAL-PDT may be the main treatment for BCC in Korean patients. However, it could be used as an alternative treatment for selected nodular BCCs when it is difficult to use conventional therapy or when a serious cosmetic defect is expected.

A Case of Nodular and Fibroepithelial Type Fibroepithelioma / 대한피부과학회지

Fibroepithelioma is a rare subtype of basal cell carcinoma (BCC) with a distinct growth pattern. We report a case of a 68 year-old man who presented with a 1.7x1.0x0.5 cm sized pedunculated mass on his left axilla. Histopathologic examination revealed two distinct patterns at the same time; a large nodular mass with a peripheral palisading pattern and a small locus of strands in a fenestrated fashion. In higher magnification, there were long, thin, branching, and anastomosing epithelial strands embedded in a fibrous stroma. Small buds were seen projecting from the epithelial strands, with many of the strands showing connections to the surface epidermis. The tumor was totally excised, and the patient has shown no evidence of recurrence for 4 months. This case shows an example of atypical fibroepithelioma with two distinct histopathologic types.